General Medical Council v Sathananthan

When deciding whether to extend an interim order under section 41A of the Medical Act 1983, the court exercises an original jurisdiction and acts as the primary decision-maker. It applies the statutory criteria governing the initial order, on the balance of probabilities, with the burden on the GMC. Relevant considerations include the gravity of the allegations, the evidence, patient risk, delay and prejudice to the practitioner. The court must give appropriate weight to the GMC’s view but is not bound by it. Serious and repeated irresponsible prescribing may justify interim suspension on public-safety and public-interest grounds, even where the practitioner has ceased the particular practice giving rise to the allegations. Any extension must remain proportionate and supported by adequate evidence explaining the period sought.

The GMC applied under section 41A(6) and (7) of the Medical Act 1983 to extend an interim suspension order imposed on Dr Sathananthan by the GMC Interim Orders Panel. Dr Sathananthan made a separate claim under section 41A(10) to terminate the order. The suspension had replaced an interim conditional-registration order imposed in August 2006, following concerns about his prescribing of controlled drugs, patient assessment, liaison and record-keeping.

The central issues were whether suspension remained necessary and proportionate for public protection or otherwise in the public interest, and whether the GMC had justified the further period sought. The court had previously ordered a six-month extension and gave its reasons in this judgment.

1. The court applied the principles stated in General Medical Council v Hiew (2007) EWCA Civ 369. Its jurisdiction under section 41A(7) was original. It was not a judicial-review exercise, although the court was not required to make primary findings of fact about the allegations.

2. The relevant criteria were those governing an initial interim order under section 41A(1): protection of the public, the public interest or the practitioner’s own interests. The GMC bore the burden of satisfying the court, and the applicable standard was the balance of probabilities. The court could consider the gravity of the allegations, the nature of the evidence, the risk of harm to patients, the reasons for delay and prejudice to the practitioner. It was not bound by, and need not defer to, the opinion of the GMC or the IOP.

3. The allegations disclosed repeated and irresponsible prescribing of large quantities and combinations of controlled drugs, inadequate assessment and follow-up, inadequate liaison with other professionals and prescribing for a patient who had not been seen. These were general patient-safety concerns, not concerns confined to addiction medicine. The fact that the doctor had stopped treating addiction patients did not remove the wider risk.

4. Suspension was necessary for public protection and was proportionate. Irresponsible prescribing of controlled drugs could endanger patients and the wider public through diversion to the illicit market, and could bring the profession into disrepute. The case was one of the relatively rare cases in which interim suspension was appropriate, consistent with the approach in R (on the application of Sheikh) v General Dental Council (2007) EWHC 2972.

5. The GMC had established the need for an extension, but had not provided sufficient detail to justify the full 12 months sought. Balancing public protection against the doctor’s livelihood and the interim nature of the order, the court extended the suspension for six months only. As emphasised in General Medical Council v Uruakpa (2007) EWHC 1454 (Admin), interim matters should be dealt with as speedily as reasonably possible. A further extension would require careful, detailed and cogent evidence. The doctor’s claim for termination was dismissed, and the GMC’s claim succeeded to the extent of the six-month extension.

The judgment concerned two related first-instance applications arising from orders made by the GMC Interim Orders Panel. The court had already extended the interim suspension order for six months on 13 February 2008 and gave its reasons in this judgment.