Watson v General Medical Council

Medical assessors advising a disciplinary tribunal on factual or medical issues should give their advice openly, in the presence of the parties, and before the tribunal determines the case. The parties must have a proper opportunity to address the advice and, where it is controversial, to seek an adjournment or respond through their own experts. Assessors may explain the medical significance of information before the tribunal, but should not express personal views on the practitioner’s attitude, diagnosis or prognosis beyond that remit. A failure to follow these safeguards may make the hearing unfair and justify quashing the decision.

Dr Sandra Watson appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel decision continuing to find her fitness to practise seriously impaired and extending conditions on her registration for 12 months.

The appeal concerned the role of two medical assessors. They retired with the Panel, gave advice privately, and then rehearsed that advice before the parties immediately before the Panel announced its determination. Dr Watson argued that the assessors had exceeded their remit and that she had not been given a fair opportunity to respond. The central issue was whether the procedure complied with the Rules and Article 6.

1. Appeal allowed. The Panel’s determination was quashed and the case was remitted to a differently constituted Panel advised by different medical assessors.
2. Under rule 24(2) of the 1987 Rules, an underlying condition capable of causing serious impairment if it recurs may justify treating current fitness to practise as seriously impaired. The likelihood of recurrence is relevant to whether conditions should be imposed and to their duration, but the existence of the potentially impairing condition is sufficient to found jurisdiction. Any conditions must be necessary and proportionate.
3. Article 6 required the medical assessors’ advice on the medical significance of information before the Panel to be given openly, in the presence of the parties, before the Panel determined the case. The parties had to be able to make submissions on the advice and, where appropriate, seek an adjournment to obtain responses from other medical experts.
4. The assessors were entitled to identify matters such as the significance of the practitioner’s history, gaps in testing and the risk of relapse. They exceeded their proper role when they expressed personal opinions about the practitioner’s attitude to opioid dependence and the reliability of her assessment of future risk. Those matters were more properly addressed by medical examiners or treating doctors who had clinically assessed her.
5. The defect was not cured by the assessors’ advice being repeated in public. The circumstances indicated that the Panel had already, or appeared to have, reached its decision before the advice was disclosed, and the appellant was not given a genuine opportunity to address its substance. An informed and impartial observer would have perceived unfairness.

The appeal was brought directly to the High Court under section 40 of the Medical Act 1983 against the Fitness to Practise Panel’s determination of 2 March 2005. The High Court allowed the appeal, quashed the determination and remitted the case to a differently constituted Panel with different medical assessors.