Yanah v General Medical Council

An appeal from a specialist professional tribunal is not confined to judicial review. The court will interfere where the decision is wrong, although appropriate respect must be given to the tribunal’s expertise. Where a tribunal departs from its specialist medical adviser, particularly in a case decided on written reports, careful reasons are required. A finding of mild or moderate cognitive impairment does not itself establish impaired fitness to practise. The tribunal must assess its effect on the practitioner’s actual performance and functioning, especially where there is no evidence of deterioration or previous performance concerns.

The appellant, a surgeon, appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel decision imposing conditions on his registration for a further 12 months. The proceedings arose from concerns about possible dementia or cognitive impairment. Later assessments found no progressive condition, but some reports identified mild to moderate cognitive impairment.

The Panel relied on the reports and concluded that the appellant’s fitness to practise was impaired by reason of cognitive impairment. The central issue was whether the Panel had adequately assessed the effect of that impairment on the appellant’s ability to practise, and whether its reasons properly addressed the advice of its specialist health adviser.

1. Appeal allowed. The appeal under section 40 of the Medical Act 1983 was not limited to a review. The court applied the approach stated in Meadow v General Medical Council, [2006] EWHC 146 (Admin), and endorsed in the Court of Appeal at [2006] EWCA Civ 1390: the court should not interfere unless the tribunal’s decision is wrong, while avoiding unnecessary glosses on that formulation.
2. Appropriate deference was required because the Panel was a specialist tribunal, including members with medical qualifications. However, its specialist health adviser had analysed the reports and concluded that they did not demonstrate a disorder of significance. Although the ultimate decision remained with the Panel, a departure from that advice required particularly careful reasoning in a case determined on written material.
3. The Panel was entitled to find that there was mild to moderate cognitive impairment. It nevertheless had to address two distinct questions: whether there was impairment rather than no impairment, and how any impairment affected the appellant’s performance and functioning as a surgeon. The absence of deterioration and the absence of previous concerns about his surgical performance made the second question especially important.
4. The Panel had effectively sidestepped that question. Its brief statement that the advice concerning cognitive impairment was inconsistent did not adequately explain why the adviser’s overall assessment was rejected or how the identified impairment impaired fitness to practise. The reasons were therefore inadequate in the circumstances.
5. The court followed the course adopted in Cullen v General Medical Council, [2005] EWHC 353 (Admin). The matter was remitted for redetermination by a differently constituted Panel. The respondent was ordered to pay the appellant’s costs, summarily assessed at £5,529.50.

• Fitness to Practise Panel: On 20 February 2006, the Panel imposed conditions on the appellant’s registration for a further 12 months, finding that his fitness to practise was impaired by reason of cognitive impairment.
• High Court (Administrative Court): The appeal was allowed. The matter was remitted to a differently constituted Panel for redetermination.