S v The General Medical Council

Professional disciplinary sanctions are protective rather than punitive. A Fitness to Practise Panel must apply proportionality, balancing the practitioner’s interests against patient protection, public confidence and proper professional standards.

Health problems may explain or contribute to misconduct, but they do not necessarily prevent erasure. Serious misconduct, deficient performance, continuing risk and lack of insight may justify erasure even where illness contributed to the conduct. An appellate court should not interfere with factual conclusions that were reasonably open to the Panel on the evidence. The Panel may take relevant post-charge conduct into account when assessing the risk of repetition.

The appellant, a doctor, appealed against the decision of a Fitness to Practise Panel of the General Medical Council to erase him from the Medical Register. The allegations concerned deficient professional performance, serious misconduct and impaired fitness to practise arising from alcohol dependence, depression and a possible affective disorder.

He argued that his conduct resulted from illness and that suspension, rather than erasure, was the proportionate sanction. He also challenged the Panel’s assessment of the medical evidence and its consideration of later conduct. The central issues were whether the Panel’s factual conclusions were reasonable and whether erasure was disproportionate in light of the appellant’s health problems.

1. Appeal dismissed. The Panel’s decision to erase the appellant from the Medical Register was lawful and proportionate. The appeal was dismissed with costs assessed at £4,755.50.
2. Sanctions imposed by a Fitness to Practise Panel are protective, not punitive. The Panel must apply proportionality by balancing the public interest, including patient protection, public confidence in the profession and the maintenance of proper standards, against the practitioner’s interests.
3. Health and conduct cases cannot always be separated strictly. Health problems may contribute to misconduct or deficient performance, and a health-based disposal may sometimes be appropriate. Nevertheless, misconduct may be so serious that erasure remains necessary notwithstanding the practitioner’s illness.
4. Relevant considerations include the seriousness of the misconduct, harm caused, the risk of repetition, the practitioner’s insight, compliance with treatment and the likelihood that treatment, training or conditions could restore safe and trusted practice. The Panel was entitled to regard the conduct as a serious breach of professional standards, creating a significant risk of repetition because the appellant continued to drink, had failed to act on professional advice and lacked adequate insight.
5. The Panel was entitled to find that affective disorder was a possibility rather than a proven cause of the misconduct. That conclusion accorded with the medical evidence and was reasonably open to it. An appellate court must not substitute its own view where the Panel has reached a reasonable conclusion on the evidence.
6. The Panel was also entitled to consider two later assaults when assessing the risk of repetition, although they were not the subject of specific charges. Even if an affective disorder existed, the Panel was entitled to conclude that it did not justify a lesser sanction in the circumstances.

1. Fitness to Practise Panel of the General Medical Council: following a hearing completed on 17 July 2006, directed that the appellant be erased from the Medical Register.
2. High Court (Administrative Court): dismissed the appeal and ordered costs of £4,755.50.