General Medical Council v Arnaot

On an application to extend an interim suspension order, the court is the primary decision-maker and exercises original statutory powers. It applies the criteria governing the original order, including protection of the public, the public interest and the practitioner’s interests. The applicant bears the civil burden of proof. The court must examine the evidence carefully, considering the gravity of the allegations, the evidence, the risk of harm, delay, and prejudice caused by continuation. It is not required to determine the underlying facts or merits, although an obviously weak case may be relevant. The court must give appropriate weight to the regulator’s expertise without deferring to it, and must adopt a proportionate response.

The General Medical Council applied under section 41A(6) of the Medical Act 1983 to extend an interim suspension order imposed on Dr May Arnaot. The order had been repeatedly reviewed by the regulator and temporarily extended by the court to allow preparation for the application.

The application arose against a background including two criminal convictions, alleged misconduct towards professional colleagues, an alleged breach of the interim order, and evidence concerning the defendant’s health and psychological condition. The defendant accepted that there was sufficient evidence for the court to consider the matters but opposed continuation, relying on the absence of patient complaints, expert evidence of a low risk to patients, and the serious personal consequences of continued suspension. The central issue was whether a further extension was necessary and proportionate.

1. Statutory role and applicable test. The court applied the framework in General Medical Council v Hiew [2007] EWCA Civ 369. On an application under section 41A(7) of the Medical Act 1983, the court is the primary decision-maker. It exercises original powers, rather than merely reviewing the panel’s decision. The criteria are those governing the original interim order: protection of the public, the public interest, or the practitioner’s own interests.
2. The GMC bore the burden of satisfying the court on the balance of probabilities. The court had to assess the evidence before it, giving careful consideration to the gravity of the allegations, the nature of the evidence, the risk of harm, the reasons for delay, and prejudice to the practitioner. It was not the court’s function to make primary findings about the underlying events or determine the merits of the disciplinary case, although a plainly weak case could be relevant to the decision.
3. The court was not bound by, and should not defer to, the opinion of the GMC or its panel. It had to give that opinion such weight as the circumstances warranted, taking account of the panel’s statutory responsibilities and relevant expertise. Proportionality was required under the common law, even though article 6 of the Convention did not apply.
4. Applying those principles, the combination of the defendant’s psychiatric and medical history, two serious criminal convictions, alleged abuse of fellow professionals, and alleged deliberate prescribing in breach of the suspension order justified continuation of the suspension. The absence of evidence that patients had been harmed did not outweigh the wider public-interest considerations.
5. The period sought was reduced. The application was granted for eight months, rather than twelve, to the end of 2007. The GMC was expected promptly to arrange the substantive fitness-to-practise hearing, and the court indicated that any further extension would need to be short. The defendant’s costs were ordered to be assessed on the standard basis, subject to detailed assessment; no costs order was made in favour of the GMC.

This was a first-instance application under section 41A(6) of the Medical Act 1983. The interim suspension order had been made by the GMC and had been reviewed on several occasions. On 18 April 2007, Sullivan J extended it temporarily to 1 July 2007 to allow preparation for the present application. The court then granted a further extension for eight months.