Hosny v The General Medical Council

In an appeal from a fitness to practise decision, dishonesty is established on the balance of probabilities. The seriousness of the allegation affects the inherent probabilities and the strength of evidence required, but does not create a higher standard of proof.

Fitness to practise is assessed by reference to the practitioner’s current and future position. Remediation may carry less weight where misconduct involves dishonesty and undermines public confidence, rather than clinical error or incompetence.

An expert regulatory tribunal’s decision on sanction merits considerable respect. The High Court should intervene only where the decision is clearly inappropriate or wrong. A proportionate suspension may be justified even where erasure would ordinarily be considered for dishonesty.

Dr Mona Hosny appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel decision. The Panel found two allegations of dishonesty proved: creating and sending a false employment reference, and failing to disclose restrictions on her registration in applications for employment.

The Panel found that her fitness to practise was impaired and suspended her registration for 12 months. The appeal challenged the findings of dishonesty and impairment, the proportionality of the sanction, and its compatibility with article 8 of the ECHR.

The central issues were whether the Panel’s factual and evaluative conclusions were open to it, whether remediation had been properly assessed, and whether the sanction was disproportionate.

1. Appeal dismissed. The Panel was entitled to find both allegations of dishonesty proved on the balance of probabilities. The court applied the approach in In Re B and In re H (Minors) (Sexual Abuse: Standard of Proof): seriousness affects the assessment of inherent probability and the evidence required, but does not alter the standard of proof.
2. The evidence concerning the false reference was strongly circumstantial. It concerned Dr Hosny, was written on hospital writing paper, was held and sent by her to five agencies, and lacked a credible alternative explanation. The Panel was entitled to reject her account and infer authorship. The conduct remained objectively and subjectively dishonest even if it was motivated by convenience rather than personal gain.
3. Fitness to practise is directed to present and future fitness, although past conduct is relevant. The Panel was entitled to treat dishonesty as misconduct which undermined confidence in the profession. Consistently with General Medical Council v Meadow and Yeong v GMC, remediation may carry less weight in cases of dishonesty than in cases of clinical error or incompetence, particularly where the practitioner has not shown sufficient insight.
4. On an appeal under section 40, the High Court must give considerable respect to the specialist tribunal’s assessment of professional standards and sanction. Following Azzam v GMC and Salsbury v Law Society, intervention was justified only if the decision was wrong or clearly inappropriate. The 12-month suspension was within the range of sanctions open to the Panel. The Panel had considered the mitigating factors, including language difficulties, lack of repetition, absence of personal gain, later disclosure and developing insight.
5. Even if article 8 was engaged, the sanction was proportionate and justified under article 8(2), consistently with Whitefield v GMC. The appeal was dismissed.

High Court (Administrative Court): Appeal under section 40 of the Medical Act 1983 against the Fitness to Practise Panel’s findings of dishonesty and impairment and its 12-month suspension order. Appeal dismissed.