Belal v General Medical Council

On a statutory appeal from a Fitness to Practise Panel, the Administrative Court conducts a rehearing but gives appropriate weight to the Panel’s expertise. It corrects material errors of fact or law and exercises a distinctly secondary judgment on the application of principle to fact. A notification condition applies only where its terms are satisfied, including the existence of a binding contract where that is required. Applying for overseas medical employment may breach a condition requiring notification even if the application is at an early stage and no employment results. Misleading or dishonest conduct may independently establish impairment, particularly where it is serious, deliberate, financially motivated, unremedied and accompanied by poor insight. Erasure may remain proportionate despite setting aside one finding where the remaining misconduct would inevitably produce the same outcome.

Dr Karem Belal appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel determination erasing him from the medical register. The Panel had found deficient professional performance and misconduct, including failures to comply with interim conditions, attempts to obtain medical employment overseas without notifying the GMC, and failure to disclose suspended registration to the Abu Dhabi Health Authority.

The appeal challenged findings of fact, misconduct, impairment and sanction. The court had to determine whether the Panel had erred in finding a breach concerning a prospective New Zealand post, whether other breaches and misleading or dishonest conduct were established, and whether impairment and erasure could stand after removal of that finding.

1. Appeal partly allowed on one factual finding. The Panel’s finding that Dr Belal breached the condition requiring disclosure of conditions to a person employing or contracting with him was set aside. The objective evidence established only a provisional arrangement subject to further contractual documents, satisfactory references, immigration approval and New Zealand registration. There was no binding contract with Dr Upsdell.
2. The finding that Dr Belal breached the separate condition requiring him to inform the GMC when applying for medical employment outside the United Kingdom was upheld. The obligation arose when he applied through recruitment agencies. The fact that the GMC learned of the application fortuitously, and that no job was obtained, did not make the breach technical. The condition was intended to enable the GMC to notify overseas authorities of his regulatory status.
3. The finding concerning Abu Dhabi was upheld. The Panel was entitled to admit the signed personal data form under Rule 34(2) of the General Medical Council (Fitness to Practise) Rules Order of Council 2004, despite its inadmissibility in criminal proceedings, because it was highly relevant and its admission caused no unfairness. The word “Active” in context represented that the registration was current and effective, which was inconsistent with suspended registration.
4. In the absence of a specific notification condition, the duty to disclose suspended registration to the Abu Dhabi authority arose from the general professional duty of good faith. The findings that the New Zealand and Abu Dhabi conduct was misleading and dishonest were supported by the evidence.
5. The Panel correctly applied the two-stage approach identified in Cheatle v General Medical Council [2009] EWHC 645 (Admin): first determining whether misconduct or deficient professional performance existed, and then whether fitness to practise was impaired. Misconduct does not automatically establish impairment; the gravity of the misconduct must be assessed at both stages.
6. Applying Calhaem v General Medical Council [2007] EWHC 2606 (Admin), a negligent act or omission may amount to misconduct where particularly serious, although a single negligent act is less likely to cross the threshold. The Panel was entitled to regard the failure to disclose the Luton listing and conditions as serious misconduct.
7. The court applied the appellate approach in Ghosh v General Medical Council [2001] 1 WLR 1915 and Raschid v General Medical Council [2007] 1 WLR 1460. Removal of the New Zealand finding did not undermine impairment or sanction. The remaining dishonest misconduct, together with deficient professional performance, justified the conclusion that fitness to practise was impaired and that erasure was proportionate. The court was satisfied that the Panel would inevitably have imposed the same sanction on the remaining findings.

Further submissions were invited on the precise terms of the order.

Fitness to Practise Panel of the General Medical Council The Panel determined on 20 May 2011 that Dr Belal’s fitness to practise was impaired and directed erasure from the medical register.

High Court (Administrative Court) The appeal under section 40 of the Medical Act 1983 succeeded only in relation to the finding concerning the alleged New Zealand contract. The findings concerning the overseas application, Abu Dhabi disclosure, impairment and erasure were upheld.