Farah, R (on the application of) v General Medical Council

For the purposes of Medical Act 1983, a criminal conviction does not automatically establish impaired fitness to practise. The nature of the offence and its surrounding circumstances must be assessed. Deliberate dishonesty involving a doctor’s professional position is especially serious. Where the doctor also demonstrates a persistent lack of insight into that dishonesty, erasure may be a proportionate and practically inevitable sanction, even where there is no direct patient harm and substantial mitigation is advanced.

The claimant appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel decision. The Panel found his fitness to practise impaired following convictions for theft and forgery involving prescription forms used to obtain medication for himself. It directed that his name be erased from the Medical Register.

The appeal challenged both the finding of impairment and the proportionality of erasure. The central issue was whether the Panel was entitled to conclude that the claimant’s inconsistent evidence demonstrated a persistent lack of insight into his dishonest conduct.

1. Appeal dismissed. The Panel’s decision was upheld.
2. Section 35C of the Medical Act 1983 does not mean that the mere existence of any criminal conviction or caution automatically establishes impaired fitness to practise. The nature of the conviction and all the surrounding circumstances must be considered. The claimant’s conduct involved stealing and forging prescriptions in his capacity as a doctor, and therefore directly affected his fitness to practise.
3. An appellate court conducting a rehearing may form its own view of the evidence. However, where the first-instance tribunal has heard oral evidence, an appellate tribunal reviewing the papers should be very slow to disagree with its assessment of that evidence.
4. The Panel was entitled to place particular weight on the claimant’s evidence before it. His earlier denials, fabrications and evasions, together with inconsistencies in his accounts to the police, probation service, employers and psychiatrists, justified the conclusion that he had shown a persistent lack of insight into the matters giving rise to impairment.
5. The Panel had considered the mitigating factors, including the absence of direct patient harm, the claimant’s guilty pleas, personal stress, lack of previous convictions and absence of prior professional misconduct. Nevertheless, deliberate dishonesty combined with abuse of a doctor’s professional position and persistent lack of insight meant that suspension would be insufficient. Erasure was proportionate and, in practical terms, inevitable.
6. The respondent was awarded costs, summarily assessed at £5,700, with the usual 14-day payment period extended to two months.

• Fitness to Practise Panel: found the claimant’s fitness to practise impaired and directed erasure from the Medical Register on 16 March 2007.
• High Court (Administrative Court): dismissed the statutory appeal under section 40 of the Medical Act 1983 and upheld the Panel’s decision.