Cullen v General Medical Council

A statutory appeal from a professional health tribunal must be meaningful. The appellate court should respect the tribunal’s expertise and its assessment of live evidence, but the appeal is not confined to judicial-review grounds where Parliament has removed that restriction.

Reasons may be concise, but they must explain the reasoning process where the tribunal resolves conflicting expert evidence. This is especially important where it rejects a substantial body of cogent medical opinion and adopts a minority view. A tribunal must not find serious impairment on evidence that is insufficient to support that conclusion, particularly where further medical investigation is indicated.

Dr Cullen appealed under the Medical Act 1983 against a determination of the General Medical Council Health Committee. The Committee found that his fitness to practise was seriously impaired by mild cognitive disorder and imposed stringent conditions on his registration.

He contended that the evidence was insufficient, that the Committee acted irrationally in preferring Dr Katz’s evidence, and that it failed to give adequate reasons for rejecting the other expert evidence. The central issues were the scope of the statutory appeal, the adequacy of the Committee’s reasons, and whether the evidence justified the finding of serious impairment.

1. Appeal allowed. The Committee’s determination was quashed and the case remitted for hearing by a differently constituted Committee.
2. The statutory appeal was not equivalent to judicial review. Although the court should accord appropriate respect to the Health Committee’s professional expertise and its assessment of evidence from live witnesses, the appeal remained a meaningful one and could involve errors of law, fact or judgment. The court was not limited to the former restriction to questions of law under the Medical Act 1983 (paras [46]-[47]).
3. Reasons need not be elaborate. They must nevertheless explain in broad terms why the decision was reached. Where expert evidence conflicts, the tribunal should identify the evidence accepted and rejected and give reasons showing the reasoning process. That obligation is particularly important where the tribunal rejects most of the expert evidence and adopts a minority opinion (paras [48]-[50]).
4. The Committee’s reasons were inadequate. It did not properly explain why it rejected the cogent and unshaken opinions of Professors Pitt and Trimble. Its reliance on the consistency between two neuropsychological assessments was opaque, and those assessments did not establish cognitive decline or illness. The Committee also failed to address material evidence from Dr Bradley, Dr Frank and Group Captain Kiralfy (paras [51]-[57]).
5. The evidence was insufficient to justify a finding that Dr Cullen’s fitness to practise was seriously impaired by mild cognitive disorder. Dr Katz’s conclusion was materially weakened by the absence of earlier baseline testing, the non-diagnostic nature of neuropsychological testing, the lack of supporting objective evidence, and her failure to see the CT scan before maintaining her opinion. Further testing, including an EEG or MRI, was indicated (paras [53], [59]-[64]).
6. The judge made wider procedural observations. Health Committee proceedings are regulatory, not criminal. There was much to be said for hearing factual evidence in the presence of available medical experts and then hearing the expert evidence, so that experts could comment on the practitioner’s behaviour and oral evidence. Medical experts whose good faith was not in issue should not ordinarily be excluded (paras [66]-[67]).

The judgment records a statutory appeal to the Administrative Court from the determination of the General Medical Council Health Committee dated 8 October 2004. The determination was quashed and the matter remitted to a differently constituted Committee.