An optometrist with an average testing time across 48 patients of just seven-and-a-half minutes has been given a two-year conditional registration order by a General Optical Council fitness to practise committee.
Ateeq Ashraf, who first registered with the GOC in 2015, worked at two unnamed city-centre branches of Specsavers. It was alleged that Ashraf, on four dates between July 20, 2019, and September 21, 2019, took insufficient time to perform eye examinations, with additional concerns over the quality and record keeping. The panel alleged notes were unrecorded, and the same test details were used across multiple patients.
The Council said a routine eye examination should take between 20 and 30 minutes. For the 48 patients listed in the allegation, all were examined in less than 12 minutes, with an average time of seven-and-a-half minutes.
An audit of patient records by expert witness, Professor Robert Harper, raised more than 80 concerns relating to eye examinations that were inadequate and/or incomplete, along with deficient record keeping. The 48 patients in the allegation were just over half of total number of patients that Ashraf had seen over the four days in question.
The registrant admitted the allegations in their entirety and gave no oral evidence at the hearing. With the particulars of the case found proved, the committee then moved on to deciding on the seriousness of misconduct.
Cumulative basis
GOC presenting officer Paul Renteurs invited the committee to consider some of the particulars in the allegation on a cumulative basis to decide the level of misconduct. Some related to specific identifiable instances in respect of specific patients, where the examinations were demonstrably not adequately carried out by Ashraf.
Renteurs said other parts of the allegation, including the time taken to perform eye examinations, were more generalised, meaning it was not possible to say how completing an eye examination in less than 12 minutes would affect their adequacy.
Ashraf’s legal representative, Rebecca Vanstone, accepted that the facts found proved amounted to misconduct, but that the severity was a question of law for the committee to decide.
The Committee considered the Council’s Standards of Practice for Optometrists and Dispensing Opticians and was of the view that the registrant had departed from standard 7 (conduct appropriate assessments, examinations, treatments and referrals) and standard 8 (maintain adequate patient records) by virtue of his conduct.
The committee added that it considered failings to be alarming and demonstrated grossly irresponsible conduct across a large patient cohort. It also considered the issue of time pressure, noting Ashraf had seen 27 patients on July 20, 2019, but this was not the case for the other dates in question (17, 24 and 20 patients on the three dates, respectively).
‘Having considered the parties submissions, the legal authorities and legal advice received, that this was a proper and appropriate case to take the cumulative approach, given the range of patients affected and the similarity of the concerns,’ said the committee in its determination.
Impairment and sanction
As the committee moved to consider Ashraf’s impairment, it noted his document bundle that included clinical statistical reports from Specsavers, CPD statements, colleague references and his own witness statement, containing reflections on his own misconduct.
The chair of the committee said although it was a matter for the registrant whether or not he gave evidence at this stage of the proceedings, and it would not be held against him if he chose not to do so, there were matters arising from the documents that the committee wanted to ask the registrant about. Through his legal adviser, Ashraf confirmed that he did not wish to give oral evidence to the committee.
Renteurs told the committee that despite no evidence of actual harm to patients, it was obvious that if the registrant consistently performed inadequate examinations, in insufficient time, there was an inherent risk of harm, as at some point something would be missed.
He added that Ashraf had plainly brought the profession into disrepute by a pattern of misconduct and a member of the public would be deeply troubled by the misconduct in this case.
On the issue of public protection, Vanstone said the Council’s description of the conduct as being a pattern of behaviour over a significant time period was not accepted by the registrant, as the allegation was based upon four days of his practice between July and September 2019. She added that in the five years since the misconduct, Ashraf had worked entirely unrestricted, with no repetition of the conduct.
In addition, during the time of the investigation, Vanstone said Ashraf had improved his standards of practice, with Specsavers clinical outcome reports submitted as evidence, which showed testing times of just under 17 minutes over a period of eight months.
Ashraf’s perceived lack of insight into the seriousness of the misconduct could be an aggravating factor when considering sanction, argued Renteurs while the committee was considering sanctions.
Deciding the registrant’s conduct was ‘easily remediable’, the committee handed an immediate order of conditional registration. Ashraf must now work alongside a supervisor who will randomly observe five eye examinations each week and identify an independent assessor in consultation with the chairman of his Local Optometric Committee to review randomised patient records.
