public record · 2020-04-24 · letter which was posted to dr donadio’s ‘xxx’ address was not...
TRANSCRIPT
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 1
PUBLIC RECORD Dates 19022020 - 26022020
Medical Practitionerrsquos name Dr Anthony DONADIO
GMC reference number 4653770
Primary medical qualification State Exam 1992 Universita di Napoli
Type of case Outcome on impairment New - Misconduct Impaired
Summary of outcome
Suspension 12 months Review hearing directed Immediate order imposed
Tribunal
Legally Qualified Chair Mrs Nessa Sharkett
Medical Tribunal Member Dr Alan Shepherd
Medical Tribunal Member Mrs Anjali Ahluwalia
Tribunal Clerk Ms Angela Carney
Attendance and Representation
Medical Practitioner Not present and not represented
Medical Practitionerrsquos Representative NA
GMC Representative Ms Jenni Ferrario Counsel
Attendance of Press Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 2
Overarching Objective Throughout the decision making process the tribunal has borne in mind the statutory overarching objective as set out in s1 Medical Act 1983 (the 1983 Act) to protect promote and maintain the health safety and well-being of the public to promote and maintain public confidence in the medical profession and to promote and maintain proper professional standards and conduct for members of that profession Determination on Facts - 24022020 Background 1 Dr Donadio qualified as a doctor in Naples in 1992 Immediately prior to the events which are the subject of the hearing Dr Donadio had been working as a Locum Consultant Radiologist at Kettering General Hospital (Kettering) since January 2018 2 The allegation that has led to Dr Donadiorsquos hearing can be summarised that on a number of occasions in July and August 2018 he undertook work at Kettering and in breach of the conditions imposed on his practice by an interim order Tribunal on 9 July 2018 he failed to inform the General Medical Council (GMC) of this work It is further alleged that Dr Donadio failed to inform relevant persons at Kettering that he was subject to interim conditions It is the GMCrsquos case that Dr Donadiorsquos failure to comply with the interim conditions were dishonest The Allegation and the Doctorrsquos Response 3 The Allegation made against Dr Donadio is as follows
1 You worked at Kettering General Hospital between
a 9 July 2018 to 10 July 2018 To be determined b 18 July 2018 to 20 July 2018 To be determined c 6 August 2018 to 10 August 2018 To be determined
2 When working as described at paragraph 1 you were
a unsupervised To be determined
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 3
b working as a consultant To be determined
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) To be determined ii the contact details of your employer andor contracting body including your direct line manager To be determined
b notify the GMC of new posts accepted To be determined c inform the following persons of the interim conditions 1-5
i your employer To be determined ii your line manager To be determined
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1 To be determined 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 To be determined 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 To be determined
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 4
The Facts to be Determined 4 Dr Donadio has not admitted any of the paragraphs of the Allegation In light of Dr Donadiorsquos response to the Allegation made against him the Tribunal is required to determine all of the facts Factual Witness Evidence 5 The Tribunal received evidence on behalf of the GMC in the form of witness statements from the following witnesses who were not called to give oral evidence because the Tribunal was satisfied that the witnesses would not be able to provide further relevant evidence in relation to the issues being determined by the Tribunal
bull Mr A GMC Investigation Officer bull Ms B Executive Assistant Kettering General Hospital Trust Headquarters bull Ms C Head of Group Quality and Compliance DRC Locums
6 Although Dr Donadio did not provide his own witness statement the Tribunal has been provided with a number of emails from him dated as follows
bull 5 October 2018 bull 4 June 2019 (in response to GMC Rule 7 letter)
bull 20 January 2020 bull 22 January 2020 bull 26 January 2020 bull 29 January 2020 bull 4 February 2020
bull 7 February 2020 timed 1130 and 1231 Documentary Evidence 7 The Tribunal had regard to the documentary evidence provided by the parties This evidence included but was not limited to
bull Dr Donadiorsquos emails as above bull Dr Donadiorsquos DRC Locum timesheets for his shifts at Kettering bull IOT conditions imposed on 9 July 2018
bull Letter dated 27 June 2018 from Mr A to Dr Donadio bull Email correspondence between Ms D IOT Co-ordinator and Dr Donadio
dated 4 to 6 July 2018 bull Email from Dr Donadio dated 29 June 2018 confirming receipt of Mr Arsquos letter
of 27 June 2018 bull Email from Ms E IOT Clerk to Dr Donadio dated 9 July 2018 containing the
IOT outcome letter
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 5
bull Letter to Dr F Responsible Officer dated 11 July 2018 informing him of Dr Donadiorsquos interim conditions
bull Dr Donadiorsquos email dated 12 July 2018 to Ms G DRC Locums
The Tribunalrsquos Approach 8 In reaching its decision on facts the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation Dr Donadio does not need to prove anything The standard of proof is that applicable to civil proceedings namely the balance of probabilities ie whether it is more likely than not that the events occurred 9 The Tribunal had regard to the documents put before it and noted that Dr Donadio had asked that the witness statement of Ms C of DRC Locum be included The Tribunal noted that as a result of Ms Crsquo statement the GMC initially thought that Dr Donadio had been working at Kettering after 10 July 2018 without the knowledge of DRC Locums and that it was Dr Donadio and not DRC Locums who had arranged for him to work there It has subsequently come to light that this information was incorrect and that at no time to the knowledge of the Tribunal had Dr Donadio undertaken work following 10 July 2018 without the knowledge of the locum agency 10 The Tribunal was satisfied that Ms Crsquos witness statement was incorrect as was the letter dated 13 March 2019 from Mr H Chief Executive Officer DRC Locums to Kettering Consequently the Tribunal found neither statement to be reliable The Tribunalrsquos Analysis of the Evidence and Findings 11 Before considering the paragraphs of the Allegation the Tribunal decided that it must first determine the date if any on which Dr Donadio knew of the interim conditions imposed on his registration 12 The Tribunal noted that in July 2016 the GMC opened an investigation into Dr Donadiorsquos practice The detail of this investigation is not known to the Tribunal as it is irrelevant for the purposes of these proceedings 13 The Tribunal noted that Dr Donadio has corresponded with the GMC and MPTS using two email addresses which it will refer to as lsquoXXXrsquo and lsquoXXXrsquo The Tribunal also noted that Dr Donadiorsquos registered address which is referred to in this determination as lsquoXXXrsquo and an alternative postal address referred to in this determination as lsquorsquoXXXrsquo which were outside of the UK 14 On 27 June 2018 a GMC investigation officer Mr A sent a letter to Dr Donadiorsquos registered address ndash XXXrsquo informing him that a GMC Case Examiner had referred him to an Interim Orders Tribunal (IOT) which was scheduled for 9 July 2018 This letter was also emailed to Dr Donadio at his lsquoXXXrsquo email address
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 6
15 On 28 June 2018 Ms D of the MPTS sent a Notice of Interim Order Tribunal (IOT) hearing by special delivery to Dr Donadiorsquos lsquoXXXrsquo address and also by email to his lsquoXXXrsquo email address The Tribunal noted that the hard copy Notice of IOT hearing letter which was posted to Dr Donadiorsquos lsquoXXXrsquo address was not delivered and was sometime later returned to the MPTS 16 Dr Donadio confirmed receipt of Mr Arsquos email of 27 June 2018 on 29 June 2018 informing him of the IOT referral from his lsquoXXXrsquo email address 17 On 4 July 2018 Dr Donadio emailed Ms D acknowledging receipt of her email of 28 June 2018 from his lsquoXXXrsquo email address Dr Donadio copied Mr A into this email In his email Dr Donadio stated
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
18 On 6 July 2018 at 0952 Dr Donadio emailed Ms D from his lsquoXXXrsquo email address stating
lsquoI am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 7
19 The Tribunal found that as Dr Donadio acknowledged receipt of the email containing the Notice of the IOT hearing it is clear that he knew about the IOT hearing scheduled for 9 July 2018 20 On 9 July 2018 the IOT imposed interim conditions on Dr Donadiorsquos registration Dr Donadio was not present or represented at the IOT hearing 21 The Tribunal noted that on 9 July 2018 the IOT Tribunal Clerk Ms E sent the IOT outcome letter to Dr Donadiorsquos lsquoXXXrsquo postal address by special delivery This letter was subsequently returned undelivered Ms E also emailed the outcome letter at 1358 hrs to Dr Donadiorsquos lsquoXXXrsquo email address The subject line in the email stated lsquoConfidential ndash FAO Dr Donadio ndash IOT Hearing 9 July 2018 ndash Outcome Letterrsquo On 29 June 2018 Dr Donadio did not acknowledge receipt of the outcome letter sent to his lsquoXXXrsquo email address 22 The Tribunal was told that Ms E did not receive an automatic lsquoundeliverable email alertrsquo informing her that the email sent to Dr Donadio on 9 July 2018 was lsquoundeliverablersquo The Tribunal was told that had such a receipt been received Dr Donadio would have been contacted by other means 23 The Tribunal noted that there was no acknowledgment from Dr Donadio that he received the IOT Outcome letter either by post or by email at his lsquoXXXrsquo email address 24 The Tribunal noted that the last contact from Dr Donadio with either the GMC or the MPTS was his email on 6 July 2018 timed 0952 No further communication was received from him until the 5 October 2018 25 On 5 October 2018 Dr Donadio emailed Mr A in response to two emails dated 13 and 20 September 2018 referring to an offer of undertakings These emails were sent to Dr Donadiorsquos lsquoXXXrsquo email address In response from his lsquoXXXrsquo email address Dr Donadio states
lsquoAs I was not able to go often on my email I realised that for more than 2 months this e mail address has NOT been active (due to overfilled e mail box ‐ went over the limits of the provided space occupancy for the e mail box) and this has been only recently reactivated but unfortunately ALL the post you and the GMC sent me from the beginning of the investigation has been deleted I would like also to inform you that NO letterscorrespondence has been received through post to my Ukrainian address (I do not know the reason for this I assume that my Kiev residence post box being not secured could represent a possible cause)rsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 2
Overarching Objective Throughout the decision making process the tribunal has borne in mind the statutory overarching objective as set out in s1 Medical Act 1983 (the 1983 Act) to protect promote and maintain the health safety and well-being of the public to promote and maintain public confidence in the medical profession and to promote and maintain proper professional standards and conduct for members of that profession Determination on Facts - 24022020 Background 1 Dr Donadio qualified as a doctor in Naples in 1992 Immediately prior to the events which are the subject of the hearing Dr Donadio had been working as a Locum Consultant Radiologist at Kettering General Hospital (Kettering) since January 2018 2 The allegation that has led to Dr Donadiorsquos hearing can be summarised that on a number of occasions in July and August 2018 he undertook work at Kettering and in breach of the conditions imposed on his practice by an interim order Tribunal on 9 July 2018 he failed to inform the General Medical Council (GMC) of this work It is further alleged that Dr Donadio failed to inform relevant persons at Kettering that he was subject to interim conditions It is the GMCrsquos case that Dr Donadiorsquos failure to comply with the interim conditions were dishonest The Allegation and the Doctorrsquos Response 3 The Allegation made against Dr Donadio is as follows
1 You worked at Kettering General Hospital between
a 9 July 2018 to 10 July 2018 To be determined b 18 July 2018 to 20 July 2018 To be determined c 6 August 2018 to 10 August 2018 To be determined
2 When working as described at paragraph 1 you were
a unsupervised To be determined
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 3
b working as a consultant To be determined
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) To be determined ii the contact details of your employer andor contracting body including your direct line manager To be determined
b notify the GMC of new posts accepted To be determined c inform the following persons of the interim conditions 1-5
i your employer To be determined ii your line manager To be determined
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1 To be determined 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 To be determined 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 To be determined
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 4
The Facts to be Determined 4 Dr Donadio has not admitted any of the paragraphs of the Allegation In light of Dr Donadiorsquos response to the Allegation made against him the Tribunal is required to determine all of the facts Factual Witness Evidence 5 The Tribunal received evidence on behalf of the GMC in the form of witness statements from the following witnesses who were not called to give oral evidence because the Tribunal was satisfied that the witnesses would not be able to provide further relevant evidence in relation to the issues being determined by the Tribunal
bull Mr A GMC Investigation Officer bull Ms B Executive Assistant Kettering General Hospital Trust Headquarters bull Ms C Head of Group Quality and Compliance DRC Locums
6 Although Dr Donadio did not provide his own witness statement the Tribunal has been provided with a number of emails from him dated as follows
bull 5 October 2018 bull 4 June 2019 (in response to GMC Rule 7 letter)
bull 20 January 2020 bull 22 January 2020 bull 26 January 2020 bull 29 January 2020 bull 4 February 2020
bull 7 February 2020 timed 1130 and 1231 Documentary Evidence 7 The Tribunal had regard to the documentary evidence provided by the parties This evidence included but was not limited to
bull Dr Donadiorsquos emails as above bull Dr Donadiorsquos DRC Locum timesheets for his shifts at Kettering bull IOT conditions imposed on 9 July 2018
bull Letter dated 27 June 2018 from Mr A to Dr Donadio bull Email correspondence between Ms D IOT Co-ordinator and Dr Donadio
dated 4 to 6 July 2018 bull Email from Dr Donadio dated 29 June 2018 confirming receipt of Mr Arsquos letter
of 27 June 2018 bull Email from Ms E IOT Clerk to Dr Donadio dated 9 July 2018 containing the
IOT outcome letter
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 5
bull Letter to Dr F Responsible Officer dated 11 July 2018 informing him of Dr Donadiorsquos interim conditions
bull Dr Donadiorsquos email dated 12 July 2018 to Ms G DRC Locums
The Tribunalrsquos Approach 8 In reaching its decision on facts the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation Dr Donadio does not need to prove anything The standard of proof is that applicable to civil proceedings namely the balance of probabilities ie whether it is more likely than not that the events occurred 9 The Tribunal had regard to the documents put before it and noted that Dr Donadio had asked that the witness statement of Ms C of DRC Locum be included The Tribunal noted that as a result of Ms Crsquo statement the GMC initially thought that Dr Donadio had been working at Kettering after 10 July 2018 without the knowledge of DRC Locums and that it was Dr Donadio and not DRC Locums who had arranged for him to work there It has subsequently come to light that this information was incorrect and that at no time to the knowledge of the Tribunal had Dr Donadio undertaken work following 10 July 2018 without the knowledge of the locum agency 10 The Tribunal was satisfied that Ms Crsquos witness statement was incorrect as was the letter dated 13 March 2019 from Mr H Chief Executive Officer DRC Locums to Kettering Consequently the Tribunal found neither statement to be reliable The Tribunalrsquos Analysis of the Evidence and Findings 11 Before considering the paragraphs of the Allegation the Tribunal decided that it must first determine the date if any on which Dr Donadio knew of the interim conditions imposed on his registration 12 The Tribunal noted that in July 2016 the GMC opened an investigation into Dr Donadiorsquos practice The detail of this investigation is not known to the Tribunal as it is irrelevant for the purposes of these proceedings 13 The Tribunal noted that Dr Donadio has corresponded with the GMC and MPTS using two email addresses which it will refer to as lsquoXXXrsquo and lsquoXXXrsquo The Tribunal also noted that Dr Donadiorsquos registered address which is referred to in this determination as lsquoXXXrsquo and an alternative postal address referred to in this determination as lsquorsquoXXXrsquo which were outside of the UK 14 On 27 June 2018 a GMC investigation officer Mr A sent a letter to Dr Donadiorsquos registered address ndash XXXrsquo informing him that a GMC Case Examiner had referred him to an Interim Orders Tribunal (IOT) which was scheduled for 9 July 2018 This letter was also emailed to Dr Donadio at his lsquoXXXrsquo email address
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 6
15 On 28 June 2018 Ms D of the MPTS sent a Notice of Interim Order Tribunal (IOT) hearing by special delivery to Dr Donadiorsquos lsquoXXXrsquo address and also by email to his lsquoXXXrsquo email address The Tribunal noted that the hard copy Notice of IOT hearing letter which was posted to Dr Donadiorsquos lsquoXXXrsquo address was not delivered and was sometime later returned to the MPTS 16 Dr Donadio confirmed receipt of Mr Arsquos email of 27 June 2018 on 29 June 2018 informing him of the IOT referral from his lsquoXXXrsquo email address 17 On 4 July 2018 Dr Donadio emailed Ms D acknowledging receipt of her email of 28 June 2018 from his lsquoXXXrsquo email address Dr Donadio copied Mr A into this email In his email Dr Donadio stated
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
18 On 6 July 2018 at 0952 Dr Donadio emailed Ms D from his lsquoXXXrsquo email address stating
lsquoI am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 7
19 The Tribunal found that as Dr Donadio acknowledged receipt of the email containing the Notice of the IOT hearing it is clear that he knew about the IOT hearing scheduled for 9 July 2018 20 On 9 July 2018 the IOT imposed interim conditions on Dr Donadiorsquos registration Dr Donadio was not present or represented at the IOT hearing 21 The Tribunal noted that on 9 July 2018 the IOT Tribunal Clerk Ms E sent the IOT outcome letter to Dr Donadiorsquos lsquoXXXrsquo postal address by special delivery This letter was subsequently returned undelivered Ms E also emailed the outcome letter at 1358 hrs to Dr Donadiorsquos lsquoXXXrsquo email address The subject line in the email stated lsquoConfidential ndash FAO Dr Donadio ndash IOT Hearing 9 July 2018 ndash Outcome Letterrsquo On 29 June 2018 Dr Donadio did not acknowledge receipt of the outcome letter sent to his lsquoXXXrsquo email address 22 The Tribunal was told that Ms E did not receive an automatic lsquoundeliverable email alertrsquo informing her that the email sent to Dr Donadio on 9 July 2018 was lsquoundeliverablersquo The Tribunal was told that had such a receipt been received Dr Donadio would have been contacted by other means 23 The Tribunal noted that there was no acknowledgment from Dr Donadio that he received the IOT Outcome letter either by post or by email at his lsquoXXXrsquo email address 24 The Tribunal noted that the last contact from Dr Donadio with either the GMC or the MPTS was his email on 6 July 2018 timed 0952 No further communication was received from him until the 5 October 2018 25 On 5 October 2018 Dr Donadio emailed Mr A in response to two emails dated 13 and 20 September 2018 referring to an offer of undertakings These emails were sent to Dr Donadiorsquos lsquoXXXrsquo email address In response from his lsquoXXXrsquo email address Dr Donadio states
lsquoAs I was not able to go often on my email I realised that for more than 2 months this e mail address has NOT been active (due to overfilled e mail box ‐ went over the limits of the provided space occupancy for the e mail box) and this has been only recently reactivated but unfortunately ALL the post you and the GMC sent me from the beginning of the investigation has been deleted I would like also to inform you that NO letterscorrespondence has been received through post to my Ukrainian address (I do not know the reason for this I assume that my Kiev residence post box being not secured could represent a possible cause)rsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 3
b working as a consultant To be determined
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) To be determined ii the contact details of your employer andor contracting body including your direct line manager To be determined
b notify the GMC of new posts accepted To be determined c inform the following persons of the interim conditions 1-5
i your employer To be determined ii your line manager To be determined
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1 To be determined 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 To be determined 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 To be determined
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 4
The Facts to be Determined 4 Dr Donadio has not admitted any of the paragraphs of the Allegation In light of Dr Donadiorsquos response to the Allegation made against him the Tribunal is required to determine all of the facts Factual Witness Evidence 5 The Tribunal received evidence on behalf of the GMC in the form of witness statements from the following witnesses who were not called to give oral evidence because the Tribunal was satisfied that the witnesses would not be able to provide further relevant evidence in relation to the issues being determined by the Tribunal
bull Mr A GMC Investigation Officer bull Ms B Executive Assistant Kettering General Hospital Trust Headquarters bull Ms C Head of Group Quality and Compliance DRC Locums
6 Although Dr Donadio did not provide his own witness statement the Tribunal has been provided with a number of emails from him dated as follows
bull 5 October 2018 bull 4 June 2019 (in response to GMC Rule 7 letter)
bull 20 January 2020 bull 22 January 2020 bull 26 January 2020 bull 29 January 2020 bull 4 February 2020
bull 7 February 2020 timed 1130 and 1231 Documentary Evidence 7 The Tribunal had regard to the documentary evidence provided by the parties This evidence included but was not limited to
bull Dr Donadiorsquos emails as above bull Dr Donadiorsquos DRC Locum timesheets for his shifts at Kettering bull IOT conditions imposed on 9 July 2018
bull Letter dated 27 June 2018 from Mr A to Dr Donadio bull Email correspondence between Ms D IOT Co-ordinator and Dr Donadio
dated 4 to 6 July 2018 bull Email from Dr Donadio dated 29 June 2018 confirming receipt of Mr Arsquos letter
of 27 June 2018 bull Email from Ms E IOT Clerk to Dr Donadio dated 9 July 2018 containing the
IOT outcome letter
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 5
bull Letter to Dr F Responsible Officer dated 11 July 2018 informing him of Dr Donadiorsquos interim conditions
bull Dr Donadiorsquos email dated 12 July 2018 to Ms G DRC Locums
The Tribunalrsquos Approach 8 In reaching its decision on facts the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation Dr Donadio does not need to prove anything The standard of proof is that applicable to civil proceedings namely the balance of probabilities ie whether it is more likely than not that the events occurred 9 The Tribunal had regard to the documents put before it and noted that Dr Donadio had asked that the witness statement of Ms C of DRC Locum be included The Tribunal noted that as a result of Ms Crsquo statement the GMC initially thought that Dr Donadio had been working at Kettering after 10 July 2018 without the knowledge of DRC Locums and that it was Dr Donadio and not DRC Locums who had arranged for him to work there It has subsequently come to light that this information was incorrect and that at no time to the knowledge of the Tribunal had Dr Donadio undertaken work following 10 July 2018 without the knowledge of the locum agency 10 The Tribunal was satisfied that Ms Crsquos witness statement was incorrect as was the letter dated 13 March 2019 from Mr H Chief Executive Officer DRC Locums to Kettering Consequently the Tribunal found neither statement to be reliable The Tribunalrsquos Analysis of the Evidence and Findings 11 Before considering the paragraphs of the Allegation the Tribunal decided that it must first determine the date if any on which Dr Donadio knew of the interim conditions imposed on his registration 12 The Tribunal noted that in July 2016 the GMC opened an investigation into Dr Donadiorsquos practice The detail of this investigation is not known to the Tribunal as it is irrelevant for the purposes of these proceedings 13 The Tribunal noted that Dr Donadio has corresponded with the GMC and MPTS using two email addresses which it will refer to as lsquoXXXrsquo and lsquoXXXrsquo The Tribunal also noted that Dr Donadiorsquos registered address which is referred to in this determination as lsquoXXXrsquo and an alternative postal address referred to in this determination as lsquorsquoXXXrsquo which were outside of the UK 14 On 27 June 2018 a GMC investigation officer Mr A sent a letter to Dr Donadiorsquos registered address ndash XXXrsquo informing him that a GMC Case Examiner had referred him to an Interim Orders Tribunal (IOT) which was scheduled for 9 July 2018 This letter was also emailed to Dr Donadio at his lsquoXXXrsquo email address
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 6
15 On 28 June 2018 Ms D of the MPTS sent a Notice of Interim Order Tribunal (IOT) hearing by special delivery to Dr Donadiorsquos lsquoXXXrsquo address and also by email to his lsquoXXXrsquo email address The Tribunal noted that the hard copy Notice of IOT hearing letter which was posted to Dr Donadiorsquos lsquoXXXrsquo address was not delivered and was sometime later returned to the MPTS 16 Dr Donadio confirmed receipt of Mr Arsquos email of 27 June 2018 on 29 June 2018 informing him of the IOT referral from his lsquoXXXrsquo email address 17 On 4 July 2018 Dr Donadio emailed Ms D acknowledging receipt of her email of 28 June 2018 from his lsquoXXXrsquo email address Dr Donadio copied Mr A into this email In his email Dr Donadio stated
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
18 On 6 July 2018 at 0952 Dr Donadio emailed Ms D from his lsquoXXXrsquo email address stating
lsquoI am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 7
19 The Tribunal found that as Dr Donadio acknowledged receipt of the email containing the Notice of the IOT hearing it is clear that he knew about the IOT hearing scheduled for 9 July 2018 20 On 9 July 2018 the IOT imposed interim conditions on Dr Donadiorsquos registration Dr Donadio was not present or represented at the IOT hearing 21 The Tribunal noted that on 9 July 2018 the IOT Tribunal Clerk Ms E sent the IOT outcome letter to Dr Donadiorsquos lsquoXXXrsquo postal address by special delivery This letter was subsequently returned undelivered Ms E also emailed the outcome letter at 1358 hrs to Dr Donadiorsquos lsquoXXXrsquo email address The subject line in the email stated lsquoConfidential ndash FAO Dr Donadio ndash IOT Hearing 9 July 2018 ndash Outcome Letterrsquo On 29 June 2018 Dr Donadio did not acknowledge receipt of the outcome letter sent to his lsquoXXXrsquo email address 22 The Tribunal was told that Ms E did not receive an automatic lsquoundeliverable email alertrsquo informing her that the email sent to Dr Donadio on 9 July 2018 was lsquoundeliverablersquo The Tribunal was told that had such a receipt been received Dr Donadio would have been contacted by other means 23 The Tribunal noted that there was no acknowledgment from Dr Donadio that he received the IOT Outcome letter either by post or by email at his lsquoXXXrsquo email address 24 The Tribunal noted that the last contact from Dr Donadio with either the GMC or the MPTS was his email on 6 July 2018 timed 0952 No further communication was received from him until the 5 October 2018 25 On 5 October 2018 Dr Donadio emailed Mr A in response to two emails dated 13 and 20 September 2018 referring to an offer of undertakings These emails were sent to Dr Donadiorsquos lsquoXXXrsquo email address In response from his lsquoXXXrsquo email address Dr Donadio states
lsquoAs I was not able to go often on my email I realised that for more than 2 months this e mail address has NOT been active (due to overfilled e mail box ‐ went over the limits of the provided space occupancy for the e mail box) and this has been only recently reactivated but unfortunately ALL the post you and the GMC sent me from the beginning of the investigation has been deleted I would like also to inform you that NO letterscorrespondence has been received through post to my Ukrainian address (I do not know the reason for this I assume that my Kiev residence post box being not secured could represent a possible cause)rsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 4
The Facts to be Determined 4 Dr Donadio has not admitted any of the paragraphs of the Allegation In light of Dr Donadiorsquos response to the Allegation made against him the Tribunal is required to determine all of the facts Factual Witness Evidence 5 The Tribunal received evidence on behalf of the GMC in the form of witness statements from the following witnesses who were not called to give oral evidence because the Tribunal was satisfied that the witnesses would not be able to provide further relevant evidence in relation to the issues being determined by the Tribunal
bull Mr A GMC Investigation Officer bull Ms B Executive Assistant Kettering General Hospital Trust Headquarters bull Ms C Head of Group Quality and Compliance DRC Locums
6 Although Dr Donadio did not provide his own witness statement the Tribunal has been provided with a number of emails from him dated as follows
bull 5 October 2018 bull 4 June 2019 (in response to GMC Rule 7 letter)
bull 20 January 2020 bull 22 January 2020 bull 26 January 2020 bull 29 January 2020 bull 4 February 2020
bull 7 February 2020 timed 1130 and 1231 Documentary Evidence 7 The Tribunal had regard to the documentary evidence provided by the parties This evidence included but was not limited to
bull Dr Donadiorsquos emails as above bull Dr Donadiorsquos DRC Locum timesheets for his shifts at Kettering bull IOT conditions imposed on 9 July 2018
bull Letter dated 27 June 2018 from Mr A to Dr Donadio bull Email correspondence between Ms D IOT Co-ordinator and Dr Donadio
dated 4 to 6 July 2018 bull Email from Dr Donadio dated 29 June 2018 confirming receipt of Mr Arsquos letter
of 27 June 2018 bull Email from Ms E IOT Clerk to Dr Donadio dated 9 July 2018 containing the
IOT outcome letter
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 5
bull Letter to Dr F Responsible Officer dated 11 July 2018 informing him of Dr Donadiorsquos interim conditions
bull Dr Donadiorsquos email dated 12 July 2018 to Ms G DRC Locums
The Tribunalrsquos Approach 8 In reaching its decision on facts the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation Dr Donadio does not need to prove anything The standard of proof is that applicable to civil proceedings namely the balance of probabilities ie whether it is more likely than not that the events occurred 9 The Tribunal had regard to the documents put before it and noted that Dr Donadio had asked that the witness statement of Ms C of DRC Locum be included The Tribunal noted that as a result of Ms Crsquo statement the GMC initially thought that Dr Donadio had been working at Kettering after 10 July 2018 without the knowledge of DRC Locums and that it was Dr Donadio and not DRC Locums who had arranged for him to work there It has subsequently come to light that this information was incorrect and that at no time to the knowledge of the Tribunal had Dr Donadio undertaken work following 10 July 2018 without the knowledge of the locum agency 10 The Tribunal was satisfied that Ms Crsquos witness statement was incorrect as was the letter dated 13 March 2019 from Mr H Chief Executive Officer DRC Locums to Kettering Consequently the Tribunal found neither statement to be reliable The Tribunalrsquos Analysis of the Evidence and Findings 11 Before considering the paragraphs of the Allegation the Tribunal decided that it must first determine the date if any on which Dr Donadio knew of the interim conditions imposed on his registration 12 The Tribunal noted that in July 2016 the GMC opened an investigation into Dr Donadiorsquos practice The detail of this investigation is not known to the Tribunal as it is irrelevant for the purposes of these proceedings 13 The Tribunal noted that Dr Donadio has corresponded with the GMC and MPTS using two email addresses which it will refer to as lsquoXXXrsquo and lsquoXXXrsquo The Tribunal also noted that Dr Donadiorsquos registered address which is referred to in this determination as lsquoXXXrsquo and an alternative postal address referred to in this determination as lsquorsquoXXXrsquo which were outside of the UK 14 On 27 June 2018 a GMC investigation officer Mr A sent a letter to Dr Donadiorsquos registered address ndash XXXrsquo informing him that a GMC Case Examiner had referred him to an Interim Orders Tribunal (IOT) which was scheduled for 9 July 2018 This letter was also emailed to Dr Donadio at his lsquoXXXrsquo email address
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 6
15 On 28 June 2018 Ms D of the MPTS sent a Notice of Interim Order Tribunal (IOT) hearing by special delivery to Dr Donadiorsquos lsquoXXXrsquo address and also by email to his lsquoXXXrsquo email address The Tribunal noted that the hard copy Notice of IOT hearing letter which was posted to Dr Donadiorsquos lsquoXXXrsquo address was not delivered and was sometime later returned to the MPTS 16 Dr Donadio confirmed receipt of Mr Arsquos email of 27 June 2018 on 29 June 2018 informing him of the IOT referral from his lsquoXXXrsquo email address 17 On 4 July 2018 Dr Donadio emailed Ms D acknowledging receipt of her email of 28 June 2018 from his lsquoXXXrsquo email address Dr Donadio copied Mr A into this email In his email Dr Donadio stated
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
18 On 6 July 2018 at 0952 Dr Donadio emailed Ms D from his lsquoXXXrsquo email address stating
lsquoI am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 7
19 The Tribunal found that as Dr Donadio acknowledged receipt of the email containing the Notice of the IOT hearing it is clear that he knew about the IOT hearing scheduled for 9 July 2018 20 On 9 July 2018 the IOT imposed interim conditions on Dr Donadiorsquos registration Dr Donadio was not present or represented at the IOT hearing 21 The Tribunal noted that on 9 July 2018 the IOT Tribunal Clerk Ms E sent the IOT outcome letter to Dr Donadiorsquos lsquoXXXrsquo postal address by special delivery This letter was subsequently returned undelivered Ms E also emailed the outcome letter at 1358 hrs to Dr Donadiorsquos lsquoXXXrsquo email address The subject line in the email stated lsquoConfidential ndash FAO Dr Donadio ndash IOT Hearing 9 July 2018 ndash Outcome Letterrsquo On 29 June 2018 Dr Donadio did not acknowledge receipt of the outcome letter sent to his lsquoXXXrsquo email address 22 The Tribunal was told that Ms E did not receive an automatic lsquoundeliverable email alertrsquo informing her that the email sent to Dr Donadio on 9 July 2018 was lsquoundeliverablersquo The Tribunal was told that had such a receipt been received Dr Donadio would have been contacted by other means 23 The Tribunal noted that there was no acknowledgment from Dr Donadio that he received the IOT Outcome letter either by post or by email at his lsquoXXXrsquo email address 24 The Tribunal noted that the last contact from Dr Donadio with either the GMC or the MPTS was his email on 6 July 2018 timed 0952 No further communication was received from him until the 5 October 2018 25 On 5 October 2018 Dr Donadio emailed Mr A in response to two emails dated 13 and 20 September 2018 referring to an offer of undertakings These emails were sent to Dr Donadiorsquos lsquoXXXrsquo email address In response from his lsquoXXXrsquo email address Dr Donadio states
lsquoAs I was not able to go often on my email I realised that for more than 2 months this e mail address has NOT been active (due to overfilled e mail box ‐ went over the limits of the provided space occupancy for the e mail box) and this has been only recently reactivated but unfortunately ALL the post you and the GMC sent me from the beginning of the investigation has been deleted I would like also to inform you that NO letterscorrespondence has been received through post to my Ukrainian address (I do not know the reason for this I assume that my Kiev residence post box being not secured could represent a possible cause)rsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
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Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 5
bull Letter to Dr F Responsible Officer dated 11 July 2018 informing him of Dr Donadiorsquos interim conditions
bull Dr Donadiorsquos email dated 12 July 2018 to Ms G DRC Locums
The Tribunalrsquos Approach 8 In reaching its decision on facts the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation Dr Donadio does not need to prove anything The standard of proof is that applicable to civil proceedings namely the balance of probabilities ie whether it is more likely than not that the events occurred 9 The Tribunal had regard to the documents put before it and noted that Dr Donadio had asked that the witness statement of Ms C of DRC Locum be included The Tribunal noted that as a result of Ms Crsquo statement the GMC initially thought that Dr Donadio had been working at Kettering after 10 July 2018 without the knowledge of DRC Locums and that it was Dr Donadio and not DRC Locums who had arranged for him to work there It has subsequently come to light that this information was incorrect and that at no time to the knowledge of the Tribunal had Dr Donadio undertaken work following 10 July 2018 without the knowledge of the locum agency 10 The Tribunal was satisfied that Ms Crsquos witness statement was incorrect as was the letter dated 13 March 2019 from Mr H Chief Executive Officer DRC Locums to Kettering Consequently the Tribunal found neither statement to be reliable The Tribunalrsquos Analysis of the Evidence and Findings 11 Before considering the paragraphs of the Allegation the Tribunal decided that it must first determine the date if any on which Dr Donadio knew of the interim conditions imposed on his registration 12 The Tribunal noted that in July 2016 the GMC opened an investigation into Dr Donadiorsquos practice The detail of this investigation is not known to the Tribunal as it is irrelevant for the purposes of these proceedings 13 The Tribunal noted that Dr Donadio has corresponded with the GMC and MPTS using two email addresses which it will refer to as lsquoXXXrsquo and lsquoXXXrsquo The Tribunal also noted that Dr Donadiorsquos registered address which is referred to in this determination as lsquoXXXrsquo and an alternative postal address referred to in this determination as lsquorsquoXXXrsquo which were outside of the UK 14 On 27 June 2018 a GMC investigation officer Mr A sent a letter to Dr Donadiorsquos registered address ndash XXXrsquo informing him that a GMC Case Examiner had referred him to an Interim Orders Tribunal (IOT) which was scheduled for 9 July 2018 This letter was also emailed to Dr Donadio at his lsquoXXXrsquo email address
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 6
15 On 28 June 2018 Ms D of the MPTS sent a Notice of Interim Order Tribunal (IOT) hearing by special delivery to Dr Donadiorsquos lsquoXXXrsquo address and also by email to his lsquoXXXrsquo email address The Tribunal noted that the hard copy Notice of IOT hearing letter which was posted to Dr Donadiorsquos lsquoXXXrsquo address was not delivered and was sometime later returned to the MPTS 16 Dr Donadio confirmed receipt of Mr Arsquos email of 27 June 2018 on 29 June 2018 informing him of the IOT referral from his lsquoXXXrsquo email address 17 On 4 July 2018 Dr Donadio emailed Ms D acknowledging receipt of her email of 28 June 2018 from his lsquoXXXrsquo email address Dr Donadio copied Mr A into this email In his email Dr Donadio stated
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
18 On 6 July 2018 at 0952 Dr Donadio emailed Ms D from his lsquoXXXrsquo email address stating
lsquoI am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 7
19 The Tribunal found that as Dr Donadio acknowledged receipt of the email containing the Notice of the IOT hearing it is clear that he knew about the IOT hearing scheduled for 9 July 2018 20 On 9 July 2018 the IOT imposed interim conditions on Dr Donadiorsquos registration Dr Donadio was not present or represented at the IOT hearing 21 The Tribunal noted that on 9 July 2018 the IOT Tribunal Clerk Ms E sent the IOT outcome letter to Dr Donadiorsquos lsquoXXXrsquo postal address by special delivery This letter was subsequently returned undelivered Ms E also emailed the outcome letter at 1358 hrs to Dr Donadiorsquos lsquoXXXrsquo email address The subject line in the email stated lsquoConfidential ndash FAO Dr Donadio ndash IOT Hearing 9 July 2018 ndash Outcome Letterrsquo On 29 June 2018 Dr Donadio did not acknowledge receipt of the outcome letter sent to his lsquoXXXrsquo email address 22 The Tribunal was told that Ms E did not receive an automatic lsquoundeliverable email alertrsquo informing her that the email sent to Dr Donadio on 9 July 2018 was lsquoundeliverablersquo The Tribunal was told that had such a receipt been received Dr Donadio would have been contacted by other means 23 The Tribunal noted that there was no acknowledgment from Dr Donadio that he received the IOT Outcome letter either by post or by email at his lsquoXXXrsquo email address 24 The Tribunal noted that the last contact from Dr Donadio with either the GMC or the MPTS was his email on 6 July 2018 timed 0952 No further communication was received from him until the 5 October 2018 25 On 5 October 2018 Dr Donadio emailed Mr A in response to two emails dated 13 and 20 September 2018 referring to an offer of undertakings These emails were sent to Dr Donadiorsquos lsquoXXXrsquo email address In response from his lsquoXXXrsquo email address Dr Donadio states
lsquoAs I was not able to go often on my email I realised that for more than 2 months this e mail address has NOT been active (due to overfilled e mail box ‐ went over the limits of the provided space occupancy for the e mail box) and this has been only recently reactivated but unfortunately ALL the post you and the GMC sent me from the beginning of the investigation has been deleted I would like also to inform you that NO letterscorrespondence has been received through post to my Ukrainian address (I do not know the reason for this I assume that my Kiev residence post box being not secured could represent a possible cause)rsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 6
15 On 28 June 2018 Ms D of the MPTS sent a Notice of Interim Order Tribunal (IOT) hearing by special delivery to Dr Donadiorsquos lsquoXXXrsquo address and also by email to his lsquoXXXrsquo email address The Tribunal noted that the hard copy Notice of IOT hearing letter which was posted to Dr Donadiorsquos lsquoXXXrsquo address was not delivered and was sometime later returned to the MPTS 16 Dr Donadio confirmed receipt of Mr Arsquos email of 27 June 2018 on 29 June 2018 informing him of the IOT referral from his lsquoXXXrsquo email address 17 On 4 July 2018 Dr Donadio emailed Ms D acknowledging receipt of her email of 28 June 2018 from his lsquoXXXrsquo email address Dr Donadio copied Mr A into this email In his email Dr Donadio stated
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
18 On 6 July 2018 at 0952 Dr Donadio emailed Ms D from his lsquoXXXrsquo email address stating
lsquoI am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 7
19 The Tribunal found that as Dr Donadio acknowledged receipt of the email containing the Notice of the IOT hearing it is clear that he knew about the IOT hearing scheduled for 9 July 2018 20 On 9 July 2018 the IOT imposed interim conditions on Dr Donadiorsquos registration Dr Donadio was not present or represented at the IOT hearing 21 The Tribunal noted that on 9 July 2018 the IOT Tribunal Clerk Ms E sent the IOT outcome letter to Dr Donadiorsquos lsquoXXXrsquo postal address by special delivery This letter was subsequently returned undelivered Ms E also emailed the outcome letter at 1358 hrs to Dr Donadiorsquos lsquoXXXrsquo email address The subject line in the email stated lsquoConfidential ndash FAO Dr Donadio ndash IOT Hearing 9 July 2018 ndash Outcome Letterrsquo On 29 June 2018 Dr Donadio did not acknowledge receipt of the outcome letter sent to his lsquoXXXrsquo email address 22 The Tribunal was told that Ms E did not receive an automatic lsquoundeliverable email alertrsquo informing her that the email sent to Dr Donadio on 9 July 2018 was lsquoundeliverablersquo The Tribunal was told that had such a receipt been received Dr Donadio would have been contacted by other means 23 The Tribunal noted that there was no acknowledgment from Dr Donadio that he received the IOT Outcome letter either by post or by email at his lsquoXXXrsquo email address 24 The Tribunal noted that the last contact from Dr Donadio with either the GMC or the MPTS was his email on 6 July 2018 timed 0952 No further communication was received from him until the 5 October 2018 25 On 5 October 2018 Dr Donadio emailed Mr A in response to two emails dated 13 and 20 September 2018 referring to an offer of undertakings These emails were sent to Dr Donadiorsquos lsquoXXXrsquo email address In response from his lsquoXXXrsquo email address Dr Donadio states
lsquoAs I was not able to go often on my email I realised that for more than 2 months this e mail address has NOT been active (due to overfilled e mail box ‐ went over the limits of the provided space occupancy for the e mail box) and this has been only recently reactivated but unfortunately ALL the post you and the GMC sent me from the beginning of the investigation has been deleted I would like also to inform you that NO letterscorrespondence has been received through post to my Ukrainian address (I do not know the reason for this I assume that my Kiev residence post box being not secured could represent a possible cause)rsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 7
19 The Tribunal found that as Dr Donadio acknowledged receipt of the email containing the Notice of the IOT hearing it is clear that he knew about the IOT hearing scheduled for 9 July 2018 20 On 9 July 2018 the IOT imposed interim conditions on Dr Donadiorsquos registration Dr Donadio was not present or represented at the IOT hearing 21 The Tribunal noted that on 9 July 2018 the IOT Tribunal Clerk Ms E sent the IOT outcome letter to Dr Donadiorsquos lsquoXXXrsquo postal address by special delivery This letter was subsequently returned undelivered Ms E also emailed the outcome letter at 1358 hrs to Dr Donadiorsquos lsquoXXXrsquo email address The subject line in the email stated lsquoConfidential ndash FAO Dr Donadio ndash IOT Hearing 9 July 2018 ndash Outcome Letterrsquo On 29 June 2018 Dr Donadio did not acknowledge receipt of the outcome letter sent to his lsquoXXXrsquo email address 22 The Tribunal was told that Ms E did not receive an automatic lsquoundeliverable email alertrsquo informing her that the email sent to Dr Donadio on 9 July 2018 was lsquoundeliverablersquo The Tribunal was told that had such a receipt been received Dr Donadio would have been contacted by other means 23 The Tribunal noted that there was no acknowledgment from Dr Donadio that he received the IOT Outcome letter either by post or by email at his lsquoXXXrsquo email address 24 The Tribunal noted that the last contact from Dr Donadio with either the GMC or the MPTS was his email on 6 July 2018 timed 0952 No further communication was received from him until the 5 October 2018 25 On 5 October 2018 Dr Donadio emailed Mr A in response to two emails dated 13 and 20 September 2018 referring to an offer of undertakings These emails were sent to Dr Donadiorsquos lsquoXXXrsquo email address In response from his lsquoXXXrsquo email address Dr Donadio states
lsquoAs I was not able to go often on my email I realised that for more than 2 months this e mail address has NOT been active (due to overfilled e mail box ‐ went over the limits of the provided space occupancy for the e mail box) and this has been only recently reactivated but unfortunately ALL the post you and the GMC sent me from the beginning of the investigation has been deleted I would like also to inform you that NO letterscorrespondence has been received through post to my Ukrainian address (I do not know the reason for this I assume that my Kiev residence post box being not secured could represent a possible cause)rsquo
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
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Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
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Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 8
26 In respect of this email the Tribunal found that it is reasonable for it to conclude that that Dr Donadio is suggesting that he did not receive the email copy of the IOT outcome letter The Tribunal made this finding because in Dr Donadiorsquos email dated 5 October 2018 he made reference to his inbox being full and that all the post he had received from the beginning of the investigation with the GMC to that date had been deleted 27 In considering the email of 5 October 2018 the Tribunal had regard to the email activity around the time of the IOT It noted that at 1035 on 12 July 2018 Dr Donadio communicated from his lsquoXXXrsquo email address with Ms G DRC Locums The Tribunal noted that at that time he was able to both send and receive emails from his lsquoXXXrsquo email address On the balance of probabilities and given that Dr Donadio was notified of the outcome of the IOT and the conditions imposed on his registration on 9 July 2018 at the lsquoXXXrsquo email address it is more likely than not that on a date no later than 12 July 2018 Dr Donadio knew of the existence of the conditions imposed upon his registration 28 In making this finding the Tribunal had regard to the fact that immediately prior to the IOT Dr Donadio was actively communicating with the GMC and had expressed a wish to attend the hearing It further noted that the doctor was anxious that should he not be able to attend the Tribunal would be told of his circumstances of his non-attendance The Tribunal found that it is more likely than not that a doctor who had clearly expressed an interest in the hearing would be keen to know the outcome and that if he had not received email notification of the same he would more likely than not have contacted the GMC Dr Donadio did not contact the GMC and no further communication was received from him until 5 October 2018 when he was asked to respond to an offer of undertakings 29 The Tribunal was satisfied on the balance of probabilities that at a time no later than 12 July 2018 it was more likely than not that Dr Donadio accessed the email containing the IOT outcome letter Therefore the Tribunal was satisfied that by 12 July 2018 Dr Donadio knew of the interim conditions on his registration 30 Having established that on a date no later than 12 July 2018 Dr Donadio knew of the IOT conditions it has considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts Paragraphs 1 and 2 31 The Tribunal has had regard to the timesheets from Dr Donadiorsquos shifts at Kettering The Tribunal noted that Dr Donadio was provided with copies of these timesheets and has not disputed the content of the same
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
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Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
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Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 9
32 The Tribunal noted that Dr Donadio commenced work at Kettering in January 2018 and he has not disputed that he worked on several occasions between 9 July 2018 and 10 August 2018 Dr Donadio has also not disputed that he was working at Kettering at Consultant level and that he was unsupervised Therefore the Tribunal was satisfied that Dr Donadio worked as an unsupervised as a Consultant at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 33 Accordingly the Tribunal found paragraphs 1 and 2 proved Paragraph 3a 34 It is Dr Donadiorsquos case that he was unaware of the outcome of the IOT on 9 July 2018 and it is for that reason that he failed to notify the GMC within seven calendar days of his current post job title location and the name of his Responsible Officer 35 The Tribunal have already found proved that Dr Donadio was working at Kettering between 9 July 2018 to 10 July 2018 18 July 2018 to 20 July 2018 and 6 August 2018 to 10 August 2018 36 The Tribunal considered that that Dr Donadio had an obligationduty to notify the GMC within seven calendar days of 9 July 2018 about his current post job title location and the name of his Responsible Officer It noted that seven calendar days from 9 July 2018 would have been 16 July 2018 37 The Tribunal has already determined that it was only at a time no later than 12 July 2018 that Dr Donadio knew that the IOT had imposed interim conditions In particular it required Dr Donadio to notify the GMC with seven days of 9 July 2018 of his current post By 16 July 2018 Dr Donadio had not done this 38 The Tribunal was satisfied that once the interim conditions were imposed on 9 July 2018 Dr Donadio had a duty to notify the GMC within seven calendar days about his current post job title location and the name of his Responsible Officer of the contact details of his employer andor contracting body including his direct line manager but failed to do so 39 Accordingly the Tribunal found paragraph 3a proved Paragraph 3b 40 The Tribunal noted that DRC Locums placed Dr Donadio at Kettering in January 2018 and his last shift at Kettering was due to be on 10 August 2018 His placement was as a consultant a position which was unsupervised
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 10
41 The Tribunal noted the email dated 11 July 2018 from Mr A of the GMC to Dr F Dr Donadiorsquos Responsible Officer informing him of the interim conditions imposed on Dr Donadiorsquos registration on 9 July 2018 The email states
lsquoDear Dr F Please find attached my correspondence in respect of the above matter following the hearing which took place on 9 July 2018 You will note that conditions have been imposed for a period of 12 months with a requirement for direct supervision I understand that Dr Donadio is not currently placed by DRC Locums but please be aware of the conditions imposed that require Responsible Officer involvement in the event that work is sought I trust that you will find the attached to be self-explanatory however if you have any queries please do not hesitate to contact mersquo
42 The Tribunal were told that Dr F is employed by the West London Mental Health NHS Trust and that Kettering General Hospital is part of this Trust 43 The Tribunal noted that Dr F had been made aware of Dr Donadiorsquos interim condition of the requirement for direct supervision by email on 11 July 2018 Dr F acknowledged this email but Dr Donadio continued to work unsupervised as a consultant at Kettering 44 The Tribunal noted that whilst the email from Mr A to Dr F suggests that the GMC were under the impression that Dr Donadio was not working at Kettering Hospital it is clear from the email correspondence between Dr Donadio and Ms G that Dr Donadiorsquos placement at Kettering was only due to expire on 10 August 2018 45 Whilst the Tribunal found that Dr Donadio was in breach of the interim order conditions imposed on 9 July 2018 by continuing his placement working as a Consultant unsupervised after this date it was not satisfied that Dr Donadio failed to notify the GMC of his acceptance of a new post as no new post had been either offered or accepted The Tribunal considered that this was not a new placement as he had been working at Kettering as a consultant since January 2018 46 Accordingly the Tribunal found paragraph 3b not proved
Paragraph 3c 47 The Tribunal was told that the GMC considered Kettering to be Dr Donadiorsquos employer
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Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
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Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
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Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
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Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
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Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
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Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
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Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 11
48 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not inform anyone of them 49 The Tribunal having determined that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions Dr Donadio does not dispute that he did not inform anyone of the interim conditions The Tribunal considered that had Dr Donadio informed his employers and line manager of conditions 1-5 this may have resulted in any contract being terminated 50 Accordingly the Tribunal found paragraph 3c proved Paragraph 4 51 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 52 The Tribunal was satisfied that irrespective of whether Dr Donadio knew or did not know of the interim conditions imposed on his registration on 9 July 2018 in continuing to work at Kettering after 9 July 2018 as an unsupervised consultant he was in breach of those interim conditions by carrying out the actions described in paragraphs 1 to 3 of the Allegation 53 Accordingly the Tribunal found paragraph 4 not proved in relation 3b and proved in relation to paragraphs 1b 1c 2a 2b 3a and 3c Paragraph 5 54 It is Dr Donadiorsquos case that as he did not know of the interim conditions he could not have been in breach of them 55 The Tribunal has already determined above that at a time no later than 12 July 2018 Dr Donadio knew about the interim conditions 56 In relation to paragraph 1a Dr Donadio did not know of the interim conditions and could not have known that he was in breach of the conditions at that time Therefore the Tribunal found paragraph 5 in relation to paragraph 1a not proved 57 In relation to paragraph 3b the Tribunal determined that Dr Donadio was neither offered nor accepted a new post and therefore a breach did not occur and therefore found paragraph 5 in relation to paragraph 3b not proved 58 In relation to paragraphs 1b 1c 2a 2b 3a and 3c as Dr Donadio knew of the interim conditions the Tribunal determined that he was in breach and found paragraph 5 in relation to paragraphs 1b 1c 2a 2b 3a and 3c proved
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
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Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
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Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
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Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
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Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
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Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
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Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
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Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
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Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
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Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
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Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 12
Paragraph 6 in relation to paragraphs 1 to 3 by reason of paragraph 5 59 In submissions Ms Ferrario referred the Tribunal to the email correspondence between Dr Donadio and the GMC and MPTS between 4-6 July 2018 She relied on this correspondence as illustrating Dr Donadio to be a dishonest person 60 The Tribunal had regard to this correspondence in particular it noted the Notice of Interim Order hearing letter which Ms D Tribunal Co-ordinator MPTS sent to Dr Donadio in an email dated 28 June 2018 61 The Tribunal noted Dr Donadiorsquos response replied to Ms D in an email dated 4 July 2018 copied to Mr A Dr Donadio states(Page 24)
lsquoBecause I am fully aware of the seriousness of the Tribunal Decision I want to express my intention to attend the Hearing but I would like to ask if I will be able to express my points or if I will not be able to attend from abroad (I am left with little time available and actually in a City distant from the Capital Kiev) this would affect the Tribunal decision I am sorry but from abroad everything gets more difficult for me I am obviously ready to book a flight and come to the Tribunal Hearing but unfortunately I am not in the condition to organise from here my representation and organise eventual further documentation to support my points Thank you for all the information you provided me so far I kindly ask you if I will be able to express my points during the Tribunal hearing as if this case I will immediately book a flight to be present on 9 July although not able to organise in time my representation and collect all documentation to support my pointsrsquo
62 The Tribunal noted Ms Drsquos response to Dr Donadio in her email dated 4 July 2018 timed at 1458 which states
lsquoDear Dr Donadio Thank you for your email and I am sorry to hear of the difficulties that you are experiencing Regarding your forthcoming IOT hearing whether or not you attend is a matter for you It is not uncommon for doctors to choose not to attend their hearing and instead provide documentation and written submissions to put before the tribunal The tribunal would not make any negative inference if you were not to attend and all written submissions are considered in full by the tribunal prior to making a decision
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Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
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Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
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Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
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Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
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Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
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Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
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Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
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Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
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Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
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Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
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Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
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Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
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Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 13
With regards to your query about attending from abroad unfortunately the facility for skype video link or telephone attendance is not available for IOTrsquosrsquo
63 The Tribunal noted Dr Donadiorsquos response to Ms Drsquos email dated 4 July and timed 1553 which states
lsquoGood afternoon Mrs D Thank you for your reply Given the little time I have and being far away from my place of residence in Ukraine (I am actually in a small distant village visiting relatives) I want to communicate that I will personally attend the hearing of 9th July at the address you gave me hellip Again I confirm that despite at he moment I am in in a quite remote area of Ukraine I will be present at the hearing although not left with enough time to organise my paperwork and representation with the Tribunalrsquo
64 The Tribunal noted Dr Donadiorsquos email dated 6 July 2018 timed 952 in which he states
lsquoGood Morning Mrs D I am sorry to inform you that despite my initial decision to come to the Tribunal Hearing I am actually not able to organize my trip to Manchester from Ukraine and I will therefore not attend the Hearing and I have no possibility to organize from here a Representation for the Hearing Again my apologies I tried my best but due to personal circumstances abroad and with little days notice I am not able to attend to the Tribunal Hearingrsquo
65 The Tribunal noted all of the correspondence between Dr Donadio Mr A of the GMC and Ms D of the MPTS leading up to the IOT hearing on 9 July 2018 It found that in the course of this correspondence Dr Donadio gave the impression that at the time of writing these emails he was not in the UK and that it was his geographical location that was causing his difficulties in attending or arranging legal representation for the IOT hearing The Tribunal was mindful that it is of course a matter for Dr Donadio whether or not he attended the IOT It also noted that Dr Donadio was advised that no adverse inference would be drawn from his non- attendance 66 The Tribunal noted the timesheets provided by Ms C which show that Dr Donadio was working at Kettering between 2 July 2018 to 6 July 2018 and in the week commencing 9 July 2018
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 14
67 The Tribunal found that it was somewhat disingenuous of Dr Donadio to give the impression that he was not in the UK when he was here working at Kettering especially when he knew that the IOT considering his case would not take a negative view of his absence 68 In making this observation the Tribunal also had regard to the fact that in his email on 5 October 2019 Dr Donadio claimed that all email communications had been deleted from his inbox which was inconsistent with his later disclosure of the email correspondence of 12 July 2018 with Ms G 69 Whilst the Tribunal found that Dr Donadio has not been entirely candid in his communication with his Regulator this chain of email correspondence does not form part of the Allegation and this Tribunal is not required to make a finding of dishonesty in respect of the same Dr Donadio has not been afforded the opportunity to explain why he communicated in this way and the Tribunal found it would be unfair on him to rely on this as evidence of his dishonesty without affording him that opportunity 70 It matters not for the purposes of the interim conditions that Dr F the Responsible Officer was aware that conditions had been imposed The duty to comply with the conditions lay with Dr Donadio 71 The Tribunal found that on 18 to 20 July 2018 and the 6 to 10 August 2018 Dr Donadio knowingly and falsely represented himself both by conduct and omission as being entitled to carry out the locum shifts as a consultant arranged for him at Kettering In determining whether Dr Donadiorsquos actions were dishonest the Tribunal applied the two-stage test as laid out in the case of Ivey v Genting Casinos (UK) Limited [2017] UKSC 67 The Tribunal found that even though it is Dr Donadiorsquos case that he was unaware of the conditions and therefore could not have been dishonest having found that he was aware of the conditions the Tribunal considered that the objective standards of ordinary reasonable and honest people would find his actions to have been dishonest Dr Donadiorsquos actions in failing to comply with the obligation of the conditions as found proven above were dishonest because it resulted in him being afforded the opportunity to work in a position that the conditions prohibited Had Dr Donadio told the employer of conditions 1 to 5 his contract with may well have been terminated 72 Accordingly the Tribunal found paragraph 6 in relation to paragraph 3 by reason of paragraph 5 proved The Tribunalrsquos Overall Determination on the Facts 73 The Tribunal has determined the facts as follows 1 You worked at Kettering General Hospital between
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
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Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
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Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 15
a 9 July 2018 to 10 July 2018 Determined and found proved b 18 July 2018 to 20 July 2018 Determined and found proved c 6 August 2018 to 10 August 2018 Determined and found proved
2 When working as described at paragraph 1 you were
a unsupervised Determined and found proved b working as a consultant Determined and found proved
3 When working as described at paragraphs 1 and 2 you failed to
a notify the GMC within seven calendar days of 9 July 2018 of i your current post including your job title job location and responsible officer (or their nominated deputy) Determined and found proved ii the contact details of your employer andor contracting body including your direct line manager Determined and found proved
b notify the GMC of new posts accepted Not proved c inform the following persons of the interim conditions 1-5
i your employer Determined and found proved ii your line manager Determined and found proved
4 As a result of your actions as described at paragraphs 1 to 3 you were in breach of conditions imposed by the Interim Orders Tribunal on 9 July 2018 a full copy of which is set out at Schedule 1
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Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
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Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
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Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
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Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
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Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 16
Determined and found proved Not proved in relation to paragraph 3b 5 You knew that as a result of your actions as described at paragraphs 1 to 3 you were in breach of the conditions imposed by the Interim Orders Tribunal on 9 July 2018 as referred to at paragraph 4 and set out at Schedule 1 Determined and found proved Not proved in relation to paragraphs 1a and 3b 6 Your actions as described in paragraph 1 to 3 were dishonest by reason of paragraph 5 Determined and found proved Not proved in relation to paragraphs 1a and 3b
Determination on Impairment - 25022020 1 The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether on the basis of the facts which it has found proved as set out before Dr Donadiorsquos fitness to practise is impaired by reason of misconduct Submissions 2 On behalf of the GMC Ms Ferrario submitted that although a finding of impairment does not automatically follow where allegations are found proved the GMC is of the view that Dr Donadio is currently impaired by reason of his misconduct in this case 3 Ms Ferrario submitted that although this type of conduct is not related to Dr Donadiorsquos clinical competence his conduct nonetheless had the potential to put patients at risk 4 Ms Ferrario reminded the Tribunal of the two-stage process it should adopt in firstly determining whether the conduct found proved amounts to serious misconduct Ms Ferrario submitted that from 12 July 2018 Dr Donadio knew about the interim conditions imposed and despite knowing he did not inform the GMC and others She submitted that to fail to do so was dishonest and his actions were deceitful This she submitted amounts to serious misconduct She reminded the Tribunal of Dr Donadiorsquos denial of any knowledge of the conditions She submitted that Dr Donadio has shown no remorse insight regret or responsibility for his actions
5 Ms Ferrario referred the Tribunal to the case of Grant v NMC 2011EWCH92 (Admin) in relation to the comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman which states
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Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
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Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 17
Do our findings of fact in respect of the doctors misconduct deficient professional performance adverse health conviction caution or determination show that hisher fitness to practise is impaired in the sense that she
a has in the past acted andor is liable in the future to act so as to put a patient or patients at unwarranted risk of harm andor
b has in the past brought andor is liable in the future to bring the medical profession into disrepute andor
c has in the past breached andor is liable in the future to breach one of the fundamental tenets of the medical profession andor
d has in the past acted dishonestly andor is liable to act dishonestly in the future
6 Ms Ferrario submitted that the conditions imposed by the interim order Tribunal on 9 July 2020 were put in place to avoid risk and keep patients safe She submitted that Dr Donadiorsquos actions in holding himself out as a Consultant who was allowed to work without supervision had the potential to put patients at risk 7 In relation to the public interest Ms Ferrario submitted that ordinary decent members of the public would have expected Dr Donadio to have complied with the interim conditions and if he did not they would expect something to be done about it 8 She submitted that Dr Donadio has shown himself to be less than open trustworthy and honest She stated that the Tribunal has no evidence that Dr Donadio would conduct himself in any different fashion in the future She submitted that all of the criteria in the case of Grant apply in this case 9 Ms Ferrario referred the Tribunal to the following paragraphs in GMCrsquos guidance Good Medical Practice 2013 (the GMP)
1 Patients need good doctors Good doctors make the care of their patients their first concern they are competent keep their knowledge and skills up to date establish and maintain good relationships with patients and colleagues are honest and trustworthy and act with integrity and within the law
10 Ms Ferrario reminded the Tribunal that at the time of Dr Donadiorsquos dishonesty he was under investigation for his clinical practice and competence She submitted that Dr Donadiorsquos conduct at this time did not display honesty respect openness and trustworthiness 11 Ms Ferrario submitted that further paragraphs of the GMC are also relevant to Dr Donadiorsquos conduct in particular
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
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Medical Practitioners Tribunal
MPT Dr DONADIO 18
lsquo22 You must take part in systems of quality assurance and quality improvement to promote patient safety This includes
b regularly reflecting on your standards of practice and the care you provide
24 You must promote and encourage a culture that allows all staff to raise concerns openly and safely 35 You must work collaboratively with colleagues respecting their skills and contributions
36 You must treat colleagues fairly and with respect
49 You must work in partnership with patients sharing with them the information they will need to make decisions about their care15 including
a their condition its likely progression and the options for treatment including associated risks and uncertainties b the progress of their care and your role and responsibilities in the team c who is responsible for each aspect of patient care and how information is shared within teams and among those who will be providing their care d any other information patients need if they are asked to agree to be involved in teaching or research
12 Ms Ferrario that Dr Donadio was not promoting an open culture because he himself was acting in a deceitful manner at this time None of Dr Donadiorsquos colleagues knew that he was subject to these conditions or that he was working in contravention of them Dr Donadio she submitted was not treating colleagues with respect he was deceiving them In respect of Dr Donadiorsquos involvement with patients Ms Ferrario submitted paragraphs 65-73 are relevant
65 You must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the profession
66 You must always be honest about your experience qualifications and current role
68 You must be honest and trustworthy in all your communication with patients and colleagues This means you must make clear the limits of your
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Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
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Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
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Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
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Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 19
knowledge and make reasonable checks to make sure any information you give is accurate
71 You must be honest and trustworthy when writing reports and when completing or signing forms reports and other documents You must make sure that any documents you write or sign are not false or misleading
a You must take reasonable steps to check the information is correct
b You must not deliberately leave out relevant information
73 You must cooperate with formal inquiries and complaints procedures and must offer all relevant information while following the guidance in Confidentiality
13 Finally Ms Ferrario referred the Tribunal to paragraph 76 of GMP which she submitted is of significant importance in this case
lsquo76 If you are suspended by an organisation from a medical post or have restrictions placed on your practice you must without delay inform any other organisations you carry out medical work for and any patients you see independentlyrsquo
14 Ms Ferrario submitted that an ordinary decent member of the public would find Dr Donadiorsquos actions to be dishonest as they would be completely unaware that he was subject to conditions She submitted that paragraph 68 is as good as stating that the doctor must inform others that he is under conditions She submitted that it is also likely that Dr Donadio would have been responsible for signing medical records and times sheets which makes paragraph 71 relevant 15 Ms Ferrario accepted that that Dr Donadio had cooperated with the GMCrsquos investigation but only to a limited extent She reminded the Tribunal that following 9 July 2018 he was silent and has only recommenced communicating fully prior to this hearing She stated that it is the GMCrsquos case that Dr Donadio has fabricated the information that all his emails were deleted and he has not provided any evidence to corroborate this Ms Ferrario stated that paragraph 76 is highly significant as the Tribunal found that Dr Donadio acted in direct contravention of this paragraph She stated that Dr Donadio did not inform anyone at all about the interim conditions 16 Ms Ferrario submitted that a reasonable conclusion would be that Dr Donadiorsquos fitness to practise is impaired She submitted that there is no evidence before the Tribunal that Dr Donadiorsquos misconduct will not be repeated or that it has been remediated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
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Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
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Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
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Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
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Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 20
The Relevant Legal Principles 17 The Tribunal reminded itself that at this stage of proceedings there is no burden or standard of proof and the decision of impairment is a matter for the Tribunalrsquos judgement alone 18 The Tribunal reminded itself of the two-stage process to be adopted First whether the facts proved amount to serious misconduct Second whether the doctorrsquos fitness to practise is currently impaired by reason of the serious misconduct 19 In considering current impairment the Tribunal reminded itself that it must take into account the conduct in question in these proceedings and any other relevant factors such as conduct in the past whether the misconduct is remediable has been remedied and the likelihood of repetition Misconduct 20 The Tribunal considered that Dr Donadiorsquos dishonesty in continuing to work unsupervised at consultant level beyond 12 July 2018 when he knew he was subject to interim conditions breached the trust of his colleagues at Kettering and his employers 21 The Tribunal considered that Dr Donadiorsquos misconduct was not an isolated incident of dishonesty as he continued to work the additional shifts after 12 July 2018 in the knowledge that he was subject to interim conditions 22 The Tribunal is of the opinion that following the imposition of the conditions Dr Donadio worked outside the limits of his interim conditions working unsupervised as a consultant and as a result his standard of work went unsupervised Dr Donadiorsquos actions had the potential to put patients at risk The Tribunal was also mindful of Dr Donadiorsquos lack of candour in his communication with the GMC and the MPTS 23 The Tribunal was satisfied that Dr Donadio chose to put his own interests above the interests of others and above his professional duties as a medical practitioner 24 The Tribunal considered that Dr Donadiorsquos conduct represented a significant departure from the expected standards of conduct and behaviour relating to honesty and integrity referred to in paragraphs 1 65 68 and 71 of GMP Further the Tribunal considered paragraph 76 of GMP significant In respect of this paragraph it noted that Dr Donadio failed to inform anyone of the interim conditions on his registration
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 21
25 The Tribunal concluded that Dr Donadiorsquos conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct Impairment 26 The Tribunal having found that the facts found proved amounted to serious misconduct went on to consider whether as a result of that misconduct Dr Donadiorsquos fitness to practise is currently impaired 27 The Tribunal recognises that dishonesty is a breach of a fundamental tenet of the profession Being honest and trustworthy and acting with integrity are at the heart of medical professionalism The Tribunal also determined that Dr Donadiorsquos dishonesty had the potential to put patients at risk
28 The Tribunal has borne in mind the case of Grant v NMC 2011 EWCH 92 (Admin) and it was satisfied that limbs a b c and d are engaged in this case
29 The Tribunal noted that Dr Donadiorsquos misconduct occurred in 2018 To the Tribunalrsquos knowledge there has been no repetition of the misconduct albeit he is not currently working in the UK It considered that dishonesty is difficult to remediate although it is of the opinion that this type of dishonesty is capable of remediation 30 The Tribunal is of the view that a doctor must develop insight before any remediation can take place The Tribunal noted that at the start of this hearing Dr Donadio remained in complete denial of the allegations Because Dr Donadio was in denial the Tribunal considered it was more likely than not that he has failed to develop any insight The Tribunal has not been provided with any evidence of insight or remediation by Dr Donadio Therefore the Tribunal determined that there remains a risk of repetition 31 The Tribunal found that even had Dr Donadio demonstrated that he had developed insight and remediated his misconduct a finding of impairment would have been necessary in order to uphold public confidence in the profession Doctors occupy a position of privilege and trust They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct 32 The Tribunal is in no doubt that public confidence in the medical profession and the need to uphold proper standards for that profession would be adversely affected if it were not to make a finding of impairment in this case The Tribunal has therefore determined that Dr Donadiorsquos fitness to practise is currently impaired by reason of misconduct
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
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Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 22
Determination on Sanction - 26022020 1 Having determined that Dr Donadiorsquos fitness to practise is impaired by reason of misconduct the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction if any to impose Submissions 2 In submitting that the GMCrsquos position is that the appropriate and proportionate sanction to impose in this case is one of erasure Ms Ferrario reminded the Tribunal that it should impose only the minimum sanction required to protect the public irrespective of the impact it may have on Dr Donadio She reminded the Tribunal that paragraphs 17-19 in the Sanctions Guidance (November 2019) (The SG) makes it clear that patients need to be able to trust doctors and the medical profession as a whole and the reputation of that profession is more important than the interests of any individual doctor 3 Ms Ferrario submitted that taking no action under paragraph 68 is not appropriate because the circumstances of this case do not meet the criteria required to take no action as there are no exceptional circumstances to justify doing so 4 Ms Ferrario then referred to paragraph 73 of the SG and submitted that this is not a case where undertakings are appropriate Undertakings she submitted are often appropriate in circumstances where there are shortcomings in clinical practice which is very different to the facts and circumstances of this case 5 Ms Ferrario then referred to paragraph 79 and reminded the Tribunal that Dr Donadio had previously failed to comply with conditions imposed upon his practice She submitted that conditions were not appropriate in the circumstances of this case as the tribunal cannot be assured that he would comply with any conditions imposed There would therefore be a risk of him failing to comply She referred the Tribunal to the criteria applicable to the imposition of conditions and submitted that these are not present in this case and conditions would not be workable 6 Ms Ferrario referred the Tribunal to paragraph 91 and 92 which states
lsquo91 Suspension has a deterrent effect and can be used to send out a signal to the doctor the profession and public about what is regarded as behaviour unbefitting a registered doctor Suspension from the medical register also has a punitive effect in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension although this is not its intention
92 Suspension may be appropriate for example where there may have been acknowledgement of fault and where the tribunal is satisfied that
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 23
the behaviour or incident is unlikely to be repeated The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actionsrsquo
7 In submitting that a sanction of suspension would be neither proportionate or sufficient in upholding public confidence Ms Ferrario informed the Tribunal that the GMC is of the view that Dr Donadiorsquos conduct has been found to be so serious and in flagrant disregard of the conditions that it lsquofalls in linersquo with being fundamentally incompatible with continued registration She submitted that whilst it is not impossible it is difficult to remediate dishonesty The findings of this Tribunal she submitted are so in contrast to Dr Donadiorsquos position that remediation would not be possible She suggested to the Tribunal that paragraph 92 of the SG which gives guidance of when the sanction of suspension would be proportionate lsquois the crux of the matterrsquo She submitted that whilst public safety is relevant in this case it falls more heavily in protecting the reputation of the profession She submitted that it is the GMCrsquos position that the public would be extremely dissatisfied if Dr Donadio was permitted to continue with his registration She reminded the Tribunal that Dr Donadio acted only in his best interest without any thought to his patients has failed to acknowledge any fault on his behalf and has continued to deny knowledge of the conditions She reminded the Tribunal that there is no evidence that Dr Donadio will accept the findings of this Tribunal and take steps to remediate his misconduct She reminded the Tribunal of the deceitful manner in which he has acted and that the tribunal did not find that his dishonesty related to an isolated incident 8 Ms Ferrario then referred the Tribunal to paragraphs 97a to 97g which provide
lsquo97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate
a A serious breach of Good medical practice but where the doctorrsquos misconduct is not fundamentally incompatible with their continued registration therefore complete removal from the medical register would not be in the public interest However the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors b In cases involving deficient performance where there is a risk to patient safety if the doctorrsquos registration is not suspended and where the doctor demonstrates potential for remediation or retraining chellip dhellip
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 24
e No evidence that demonstrates remediation is unlikely to be successful eg because of previous unsuccessful attempts or a doctorrsquos unwillingness to engage fhellip g The Tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviourrsquo
9 Ms Ferrario submitted that paragraph e was relevant in the circumstances of this case because the Tribunal has no evidence that a period of remediation would be successful She further submitted that he has shown no insight whatsoever although she accepts that there has been no repetition of his behaviour She submitted that the public should be protected and for that reason the sanction of suspension is not sufficiently serious a sanction nor is it proportionate 10 Ms Ferrario submitted that in accordance with paragraph 107 the only means of protecting the public is erasure 11 Ms Ferrario referred the Tribunal to paragraphs 109a to 109j which provides
lsquo109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive)
a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor b A deliberate or reckless disregard for the principles set out in Good medical practice andor patient safety c hellip d Abuse of positiontrust (see Good medical practice paragraph 65 lsquoYou must make sure that your conduct justifies your patientsrsquo trust in you and the publicrsquos trust in the professionrsquo) e hellip f hellip g hellip h Dishonesty especially where persistent andor covered up (see guidance below at paragraphs 120ndash128)
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 25
i Putting their own interests before those of their patients j Persistent lack of insight into the seriousness of their actions or the consequencesrsquo
12 Ms Ferrario submitted that this was a particularly serious departure and that save for c e f and g all other sub-paragraphs are relevant in this case She submitted that Dr Donadio has abused the trust of the patients he treated and attempted to cover up the existence of his conditions She stated that he has put his own interests before that of patients and demonstrated no insight whatsoever 13 Ms Ferrario referred the Tribunal to paragraph 120 of the SG which provides
lsquo120 Good medical practice states that registered doctors must be honest and trustworthy and must make sure that their conduct justifies their patientsrsquo trust in them and the publicrsquos trust in the professionrsquo
14 Ms Ferrario submitted that the SG attempts to establish standards of honest practice by a doctor She submitted that as soon as Dr Donadio walked into Kettering after 12 July 2018 he was acting in a dishonest manner in a whole series of ways 15 Ms Ferrario reminded the Tribunal that the purpose of a sanction was not to punish the doctor but may be punitive She referred the Tribunal to paragraph 167 which provides
167 Where a tribunal has found that the doctor has not complied with the conditions on their registration it will need to consider carefully whether the breach was wilful ie the doctor is culpable If it finds that the breach was wilful a more serious outcome is likely to be appropriatersquo
16 Ms Ferrario submitted that Dr Donadiorsquos conduct was a wilful breach and it should consider whether a more serious outcome is likely to be appropriate 17 Finally Ms Ferrario submitted that the only mitigating factor in this case is that there has been no repetition of the misconduct and confirmed that Dr Donadio has not previously come before the MPTS save for the circumstances surrounding this case The Tribunalrsquos Approach 18 The decision as to the appropriate sanction to impose if any in this case is a matter for this Tribunal exercising its own judgement In reaching its decision the Tribunal has taken account of the SG It has borne in mind that the purpose of the
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 26
sanctions is not to be punitive but to protect patients and the wider public interest although they may have a punitive effect 19 Throughout its deliberations the Tribunal has applied the principle of proportionality balancing Dr Donadiorsquos interests with the public interest The public interest includes amongst other things the protection of patients the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour 20 The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction Mitigating and Aggravating factors 21 The Tribunal considered the aggravating factors in this case It has borne in mind that Dr Donadiorsquos misconduct was as a result of his dishonest behaviour which had the potential to put patients at risk The Tribunal considered that Dr Donadiorsquos continued denial that he had never received the outcome of the IOT compounded his dishonest behaviour Further it considered that Dr Donadiorsquos attempted to mislead the GMC by saying that all of his emails were deleted when he was clearly corresponding from the same email address with Ms G on 12 July 2018 22 The Tribunal found that Dr Donadio failed to acknowledge his dishonest conduct and has thus far he has not demonstrated any insight The Tribunal noted that that although the dishonest acts only covered a short period it was repeated dishonesty which was compounded by his lack of candour in his communications with the GMC and MPTS 23 In mitigation the Tribunal noted that the misconduct occurred in July 2018 and August 2018 and there has been no repetition since that time The Tribunal also noted that the circumstances surrounding this case are the only time Dr Donadio has appeared before the MPTS No Action 24 In coming to its decision as to the appropriate sanction if any to impose in Dr Donadiorsquos case the Tribunal first considered whether to conclude the case by taking no action 25 The Tribunal found that there are no exceptional circumstances that justify taking no action against Dr Donadiorsquos registration The Tribunal determined that in view of the seriousness of the facts found proved and its finding of impairment it would be neither sufficient proportionate nor in the public interest to conclude this case by taking no action
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 27
Conditions 26 The Tribunal next considered whether it would be sufficient to impose conditions on Dr Donadiorsquos registration It has borne in mind that any conditions imposed would need to be appropriate proportionate workable and measurable 27 The Tribunal determined that a period of conditional registration would not adequately reflect the serious nature of Dr Donadiorsquos misconduct Further the Tribunal noted that Dr Donadio breached the interim conditions and therefore it cannot be confident that he would comply with further conditional registration 28 The Tribunal considered that in a case involving this type of dishonesty conditions could not be formulated to adequately protect the public interest and maintain public confidence in the medical profession Further the Tribunal concluded that conditions would not send the appropriate message to Dr Donadio the profession and the public with regard to the high standards of conduct and behaviour expected of registered doctors at all times The Tribunal has therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Donadiorsquos registration Suspension 29 The Tribunal then went on to consider whether suspending Dr Donadiorsquos registration would be appropriate and proportionate In doing so the Tribunal took into account paragraphs 91 and 92 of the SG 30 Dr Donadiorsquos dishonesty was a serious departure from the principles of Good Medical Practice and the high professional standards expected of members of the medical profession The Tribunal noted that although Dr Donadiorsquos misconduct did not relate to his clinical competence it did relate to his conduct and behaviour within the context of his professional role The Tribunal considered that dishonesty whilst performing a professional function is particularly serious The Tribunal determined that Dr Donadiorsquos misconduct undermined the trust and confidence in the medical profession as a whole 31 Having considered paragraph 97 of the SG and whether suspension was the appropriate sanction the Tribunal also considered paragraph 109 relating to erasure Paragraph 109 lists a number of non-exhaustive factors and the Tribunal considered that a b d h and j are engaged in this case 32 The Tribunal considered the issue of Dr Donadiorsquos compatibility with continued registration It noted a finding of fundamental incompatibility with continued registration as stated in paragraph 92 of the SG amounts to a determination that there are no circumstances in which the doctor should be permitted to practise medicine
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 28
33 The Tribunal found that whilst the actions of Dr Donadio and the dishonest conduct proven had the potential to be fundamentally incompatible with continued registration it was satisfied that in the circumstances of this case it fell just short of the same In reaching this decision the Tribunal noted that not every case of dishonesty must result in erasure Whilst Dr Donadiorsquos misconduct was deliberate and repeated on more than one occasion it took place over a short period of time after which he removed himself from the workplace The Tribunal had regard to the fact that Dr Donadio ceased his dishonest conduct before it had been discovered The Tribunal also had regard to the fact that there has been no repetition of the behaviour since August 2018 The Tribunal is of the view that a period of suspension would be both appropriate and proportionate notwithstanding the punitive effect it will have on Dr Donadio 34 Having balanced these factors carefully the Tribunal concluded that this was a case where the wider public interest could properly be served by imposing a period of suspension The Tribunal was satisfied that permanent removal from the medical register would be disproportionate 35 The Tribunal found that an order of suspension will send a clear signal to Dr Donadio the public and wider profession reaffirming the standards of conduct and behaviour expected of all registered doctors Whilst the Tribunal noted that an order of suspension is punitive in nature it also took the view that it is necessary to maintain public confidence and uphold and maintain high standards of behaviour within the profession 36 The Tribunal determined that Dr Donadiorsquos registration should be suspended for a period of 12 months with a review The Tribunal concluded that imposition of the maximum period of suspension was necessary to mark the seriousness of Dr Donadiorsquos conduct and to send a clear message to Dr Donadio the profession and the wider public that repeated misconduct particularly dishonesty is not acceptable Further the period of 12 months will give Dr Donadio the opportunity to demonstrated that he has gained insight into his dishonesty and that he has fully remediated his misconduct Review 37 The Tribunal determined to direct a review of Dr Donadiorsquos case A review hearing will convene shortly before the end of the period of suspension unless an early review is sought The Tribunal wishes to clarify that at the review hearing the onus will be on Dr Donadio to demonstrate how he has remediated his misconduct It therefore may assist the reviewing Tribunal if Dr Donadio provides
bull A personal statement setting out his reflections on his misconduct bull Evidence of remediation and learning
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 29
bull Evidence that he has maintained his clinical skills and his Continuing Professional Development is up to date
bull Testimonials from colleagues 38 Dr Donadio will also be able to provide any other information that he considers will assist Determination on Immediate Order - 26022020 1 Having determined to suspend Dr Donadiorsquos registration for a period of 12 months the Tribunal has considered in accordance with Rule 17(2)(o) of the Rules whether his registration should be subject to an immediate order Submissions 2 On behalf of the GMC Ms Ferrario Counsel submitted that in the light of the findings made by the Tribunal an immediate order of suspension was necessary for the protection of the public and in the public interest The Tribunalrsquos Determination 3 The Tribunal had regard to the paragraphs of the Sanctions Guidance (November 2019) which deal with the matter of immediate orders in particular paragraph 172 and 173 which provide
lsquo172 The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public or is otherwise in the public interest or is in the best interests of the doctor The interests of the doctor include avoiding putting them in a position where they may come under pressure from patients andor may repeat the misconduct particularly where this may also put them at risk of committing a criminal offence Tribunals should balance these factors against other interests of the doctor which may be to return to work pending the appeal and against the wider public interest which may require an immediate order 173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety For example where they have provided poor clinical care or abused a doctorrsquos special position of trust or where immediate action must be taken to protect public confidence in the medical professionrsquo
4 The Tribunal also had regard to the principle of proportionality and balanced Dr Donadiorsquos interests with the public interest The Tribunal found that Dr Donadiorsquos dishonest conduct was serious It also considered that there was a potential risk to
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 30
patient safety in this case and was of the view that given the lack of insight into Dr Donadiorsquos misconduct it would not be appropriate for him to be permitted to resume unrestricted practice before the substantive suspension comes into effect 5 The Tribunal has had regard to the fact that Dr Donadio is currently subject to GMC undertakings and continues to be so Whilst the substantive order of suspension does not revoke the undertakings issued by the GMC they will remain dormant until such time as the order suspension expires at which time the undertakings will become once again applicable 6 The Tribunal having had regard to the seriousness of Dr Donadiorsquos misconduct and all the circumstances in this case was satisfied that an immediate order was necessary for the protection of the public and in the public interest 7 This means that Dr Donadiorsquos registration will be suspended from when notification is deemed to have been served upon him The substantive direction as already announced will take effect 28 days from when written notice has been served upon Dr Donadio unless an appeal is made in the interim If an appeal is made the immediate order will remain in force until the appeal has concluded 8 There is no interim order to revoke Confirmed Date 26 February 2020 Mrs Ness Sharkett Chair
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 31
ANNEX A ndash 19022020
Application on Service
1 Dr Donadio is neither present nor represented at these proceedings
74 The Tribunal has seen the GMC Notice of Allegation letter dated 6 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to an alternative address provided by him The letter which was sent to Dr Donadiorsquos alternative address was signed for on 8 January 2020
2 The Tribunal has seen the MPTS Notice of Hearing letter dated 7 January 2020 sent by recorded delivery to Dr Donadiorsquos registered address and to his alternative address Both of the MPTS Notice of Hearing letters were returned stating lsquoAddress doesnrsquot existrsquo
3 The Tribunal noted that it is Dr Donadiorsquos responsibility to ensure that his registered address is kept up to date
4 The Tribunal noted that the MPTS Notice of Hearing letter was also sent to Dr Donadio by email on 27 January 2020 In a response email from Dr Donadio dated 7 February 2020 he confirmed that he received the email containing the MPTS Notice of Hearing letter
5 The Tribunal was initially concerned that the GMC Notice of Allegation and the MPTS Notice of Hearing contained an incorrect date of 29 February 2020 for the commencement of the hearing However the time and venue of the hearing was set out correctly The Tribunal was satisfied that Dr Donadio received the letter dated 6 January 2020 and that by 20 January 2020 there is also documentary evidence to show that Dr Donadio was aware that the first date of the hearing was 19 February 2020 and not the 29 February 2020 which was stated in both of the GMC and MPTS letters
6 In the circumstances the Tribunal is satisfied that Dr Donadio is aware of the hearing and notice of this hearing has been properly served in accordance with Rule 15 and 40 of the GMC (Fitness to Practise) Rules 2004
ANNEX B ndash 19022020
Application on Proceeding in Absence
1 The Tribunal has noted the email from Dr Donadio dated 7 February 2020 in which he stated
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 32
lsquoI have informed Mr I that I will not be able to be present to the hearing due to personal circumstances and short notice given and I will not be able to organize a representation through a Solicitor from Ukraine (the Country where I am a resident) but I have asked Mr I that all the emails I sent him be presented and considered for the hearingrsquo
2 The Tribunal noted that Dr Donadio was properly informed of the hearing approximately four weeks ago It also noted that Dr Donadio did not request a postponement of the hearing in any of his email correspondence
3 The Tribunal was satisfied that Dr Donadio has decided not to attend todayrsquos hearing It has borne in mind that were it to adjourn todayrsquos hearing there is no indication that Dr Donadio would be more likely to attend or be legally represented in the future
4 The Tribunal was also satisfied that the GMC will provide it with all of Dr Donadiorsquos emails as requested by him
5 Given that Dr Donadio is aware of the hearing and has stated that he will not be attending the Tribunal determined that the public interest would be best served by proceeding with the hearing in the absence of Dr Donadio in accordance with Rule 31 of the Rules and that given the nature of the Allegation no injustice would arise through its doing so
SCHEDULE 1 In accordance with Section 41A of the Medical Act 1983 as amended the Tribunal has determined based on the information before it today that it is necessary to impose an interim order It has determined to impose an interim order of conditions for a period of 12 months as follows 1 He must notify the GMC within seven calendar days of the date these conditions become effective a of the details of his current post including his job title job location and responsible officer (or their nominated deputy) information b of the contact details of his employer andor contracting body including his direct line manager c of any organisation where he has practising privileges andor admitting rights d of any training programmes he is in e of the contact details of any locum agency he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with
Record of Determinations ndash
Medical Practitioners Tribunal
MPT Dr DONADIO 33
2 He must notify the GMC a of any post he accepts before starting it b if any formal disciplinary proceedings against him are started by his employer andor contracting body within seven calendar days of being formally notified of such proceedings c if he applies for a post outside the UK 3 He must allow the GMC to exchange information with his employer andor any contracting body for which he provides medical services 4 He must only work at a level lower than that of Consultant 5 a He must be directly supervised in all of his posts by a clinical supervisor as defined in the Glossary for undertakings and conditions His clinical supervisor must be approved by his responsible officer (or their nominated deputy) b He must not startrestart work until his responsible officer (or their nominated deputy) has approved his clinical supervisor c He must seek a report from his supervisor(s) for consideration by this tribunal prior to any review hearing by this tribunal 6 He must inform the following persons of the conditions listed at 1 to 5 a his employer andor contracting body b his responsible officer (or their nominated deputy) c his immediate line manager at his place of work at least one working day before starting work (for current and new posts including locum posts) d any prospective employer andor contracting body at the time of application e the responsible officer of any organisation where he has or has applied for practising privileges andor admitting rights at the time of application f any locum agency or out-of-hours service he is registered with