Yeong v The General Medical Council

A fitness-to-practise panel assesses a doctor’s present and future fitness, but may consider past misconduct. Remediation and a low risk of repetition do not preclude impairment where regulatory action is required to declare fundamental professional standards and maintain public confidence.

A tribunal rejecting coherent expert evidence should explain why. A deficient explanation does not require remittal where the tribunal could make the assessment without specialist expertise, its substantive reasons are adequate, and the same result is inevitable. A professional sanction should stand if it falls within the panel’s permissible margin of judgment and is appropriate and necessary in the public interest.

A General Medical Council Fitness to Practise Panel found that the appellant doctor’s fitness to practise was impaired and suspended his registration for 12 months. The proceedings followed a Singapore Medical Council determination concerning a prolonged sexual relationship with a patient, improper medical records and disclosure of another patient’s confidential information.

The doctor appealed under CPR Part 52.11(3)(a). He challenged the Panel’s treatment of psychiatric evidence, its findings on recurrence and insight, its application of the impairment test, and the proportionality and independence of the sanction. The central issues were whether the impairment and sanction decisions were wrong and whether any inadequacy in the Panel’s reasons justified quashing or remittal.

1. Appeal dismissed. The Panel was entitled to find current impairment and to suspend the doctor’s registration for 12 months. Neither decision was wrong for the purposes of CPR Part 52.11(3)(a).

2. A tribunal should give a coherent reasoned explanation when rejecting a coherent opinion from a suitably qualified expert. The Panel should therefore have referred expressly to the psychiatrist’s opinion and explained why it did not accept it. The deficiency was comparatively trivial, however. No psychiatric disorder had been identified, and the likelihood of repeated misconduct involved an ordinary assessment of human behaviour on which the psychiatrist had no privileged insight. The Panel gave adequate substantive reasons and would inevitably have reached the same decisions.

3. The Panel could find a low but material risk of recurrence from the doctor’s medical practice, personal circumstances and warm, empathic character. It had heard the witnesses and the doctor. Its finding that his insight was not fully developed was also justified, particularly because he acknowledged only in cross-examination that his conduct could have compromised the patient’s care.

4. The objective in section 1(1A) of the Medical Act 1983 informs impairment under sections 35C and 35D. Fitness to practise is assessed currently and prospectively. Past misconduct does not necessarily establish impairment, and insight, remediation and risk of recurrence ordinarily require consideration. Nevertheless, serious violation of a fundamental doctor-patient boundary may justify impairment to declare professional standards and preserve confidence in the practitioner and profession. In such a case, remediation and a low risk of recurrence may carry substantially less weight than they do in cases of clinical error or incompetence.

5. The Panel was entitled to make its own declaration of the standards governing United Kingdom practice despite the Singapore regulator’s earlier sanction. Its 12-month suspension fell within its margin of judgment. The prolonged relationship and flagrant breach of confidentiality justified a sanction marking the seriousness of the misconduct. Conditional registration was not required merely because an Interim Orders Panel had previously permitted practice subject to conditions; the interim and final stages serve different functions.

6. The Panel formed an independent view of sanction. Its reference to the Singapore determination was permissible because that determination founded jurisdiction under section 35C(2)(e), and it did not impose suspension merely to secure parity.

1. High Court (Administrative Court): Dismissed the doctor’s appeal against the findings of impairment and the 12-month suspension.
2. General Medical Council Fitness to Practise Panel: On 8 January 2009, found the doctor’s fitness to practise impaired by misconduct. On 9 January 2009, suspended his registration for 12 months.
3. Singapore Medical Council: Following guilty pleas to four charges, suspended the doctor’s Singapore registration for 24 months.