An NHS Scotland doctor who slapped a patient attending A&E in Ayr during the Covid pandemic has been cleared of misconduct allegations by a tribunal, despite objections by a medical watchdog. Dr Ziyad Al-Janabi admitted that he said "that felt good" after the incident.
He was in front of the Medical Practitioners Tribunal Service (MPTS) in Manchester on Wednesday, December 7, where it was heard that he slapped the patient on his cheek and shook their head and shoulders. The General Medical Council argued that Dr Al-Janabi’s actions had fallen short of professional standards and public confidence in the profession would be "undermined" if his fitness to practice was not found impaired.
Despite the GMC's reservations, the tribunal said the 45-year-old's actions were "not aggressive and did not cause the patient harm" and were only done for the "purpose of getting Patient A's attention and calming him". The MPTS determined that Dr Al-Janabi’s fitness to practice was not impaired and a warning was also not appropriate.
Dr Al-Janabi was working as Speciality Doctor in Emergency Medicine at the University Hospital Ayr when the incident happened, on the evening of May 23, 2020. He was on shift in the 'Red Resus' area which was being used for patients who were very unwell and to treat suspected Covid cases at the time.
Patient A had been admitted following a suspected drug and alcohol overdose while semiconscious and became "agitated and combative". Staff were unable to restrain the patient, described as a "large man", as he was trying to shuffle off the trolley so they called for Dr Al-Janabi's help.
When he arrived, two nurses and a junior doctor witnessed him "shaking" Patient A when repositioning him back on the trolley, then slapping him before saying "that felt good". The colleagues raised their concerns about the incident to senior staff.
The GMC said the case was not about Dr Al-Janabi's abilities as a clinician but "standards of conduct". They stated: "When looking at the case overall, it was one in which a slap or slaps were administered to a patient in circumstances which caused other team members to describe themselves as being frightened and upset.
"Dr Al-Janabi did something that was not a recognised procedure towards Patient A and set out clearly examples of other ways he should have interacted with the patient. Dr Al-Janabi overstepped the mark and then added a comment that compounded, rather than alleviated, the situation."
The tribunal heard that there were contextual factors that led to Dr Al-Janabi's actions, including the effects of Covid outbreak and that Patient A was posing "immediate danger" to the doctor and hospital staff. It concluded that clearing Dr Al-Janabi of misconduct claims would be unlikely to jeopardise professional standards.
The tribunal stated: "Dr Al-Janabi had moved swiftly to take control of a difficult situation in which colleagues were struggling to restrain an agitated patient who had removed himself from his trolley, causing his monitoring leads to become detached. Patient A was lashing out and putting himself and others at risk.
"Dr Al-Janabi lifted Patient A back on to the trolley, held Patient A’s head in his hands while shaking it up and down and shouting at him to get his attention; that shaking had been neither vigorous nor harmful. On failing to get Patient A’s attention by other means, Dr Al-Janabi had then slapped the patient on the cheek, a little harder than he might have done had he been administering a tap in a calm clinical setting.
"On realising that his actions had startled those present, Dr Al-Janabi had said words to the effect of ‘that felt good’ in an ill-judged attempt to lighten the atmosphere. The Tribunal considered that the only evidence which suggested harm to the Patient was the reddening of the patient’s cheek, following Dr Al- Janabi’s slap.
"The Tribunal was satisfied that Dr Al-Janabi’s first concern had been Patient A’s safety and the safety of staff in the room. The Tribunal acknowledged that shaking a patient and slapping them on the face to get a response was a departure from accepted practice. However, the Tribunal considered that this was not sufficiently serious a departure as to reach the threshold for a finding of Misconduct."
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