Council for the Regulation of Healthcare Professionals, R (on the application of) v The General Medical Council & Anor

A conviction for manslaughter by a doctor should ordinarily prompt consideration of erasure from the medical register, although erasure is not automatic. The disciplinary tribunal must assess the seriousness of the professional failure, any other misconduct, the risk to the public and whether the doctor has demonstrated insight or taken steps to prevent recurrence. Mitigating features such as defective institutional procedures may reduce culpability but cannot eclipse gross negligence or serious violence. Where the overall circumstances show conduct fundamentally incompatible with continued registration, and there is no evidence that the risk will cease, suspension is inadequate and erasure is required.

The Council for the Regulation of Healthcare Professionals appealed against a Professional Conduct Committee decision suspending Dr Feda Mulhem’s registration for 12 months. The suspension followed his conviction for manslaughter after the fatal intrathecal administration of a drug intended for intravenous use, together with convictions for assaults on his wife and children.

The Committee had recognised defective hospital procedures and the doctor’s immediate response to the medical error, but concluded that suspension was sufficient. The General Medical Council accepted that the sanction could not be upheld. The central issue was whether the only proper disciplinary penalty was erasure from the medical register.

1. The appeal was allowed. In place of the 12-month suspension, the appropriate penalty was erasure from the medical register.

2. The Committee gave insufficient weight to the basis of the manslaughter conviction. A guilty plea to manslaughter in these circumstances necessarily involved acceptance of gross negligence. Institutional failures did not remove the doctor’s serious personal responsibility for administering the drug by the wrong route.

3. A conviction for manslaughter does not automatically require erasure. It should, however, be sufficient to cause a disciplinary committee to consider erasure, because the public may reasonably be concerned about the continued practice of a doctor convicted of that offence.

4. The manslaughter conviction had to be assessed together with the serious assaults on the doctor’s wife and children, including conduct followed by lies about the causes of injury. The Committee had also failed to give proper weight to the sentencing judge’s view that loss of the medical profession was an inevitable consequence of the convictions.

5. The absence of the doctor from the disciplinary proceedings meant that there was no evidence of insight or of steps taken to ensure safe future practice. The evidence instead indicated a continuing risk, particularly because the violence had occurred in circumstances of stress and some violence pre-dated the manslaughter.

6. Against that background, suspension, even if capable of extension, could not adequately protect the public or maintain confidence in the profession. The only sensible decision was erasure.

1. High Court (Administrative Court): on appeal under the statutory disciplinary jurisdiction, the court allowed the appeal and substituted erasure for the Professional Conduct Committee’s 12-month suspension.