Naheed v General Medical Council

An appellate court reviewing a professional disciplinary sanction conducts a rehearing, but intervention requires a material error of fact or law or a sanction that is clearly inappropriate. The regulator’s judgment attracts respect, particularly on sanction and on the assessment of honesty and insight. Fundamental dishonesty in a medical job application may justify erasure where it is persistent, concealed or accompanied by lack of insight. Mitigation, good clinical competence, remorse, possible retraining and supportive testimonials do not compel suspension where the misconduct undermines public confidence and is not shown to be readily remediable. The panel is better placed than the appellate court to assess the doctor’s insight from the evidence. Any Article 8 interference must remain proportionate.

Dr Naheed appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel’s finding that her fitness to practise was impaired and its decision to erase her name from the medical register. The finding of impairment was not challenged.

The alleged misconduct involved copying another person’s career history into job applications, maintaining false explanations, producing false supporting material and misleading an Interim Orders Panel. The appeal challenged only the sanction. Dr Naheed relied on admissions, remorse, previous good character, possible retraining, supportive testimonials and the allegedly similar case of Dr Elkhider. The central issue was whether erasure was disproportionate, including in the light of the panel’s finding that she lacked sufficient insight.

The appeal was dismissed. The decision to erase Dr Naheed’s name from the medical register was not disproportionate.

1. The appeal under section 40 of the Medical Act 1983 was by way of rehearing, but the burden remained on the appellant to establish a material error of fact or law. The court had to accord respect to the professional judgment of the panel, especially on sanction, while intervening if the sanction was clearly inappropriate. The approach was supported by Raschid v GMC [2007] 1 WLR 1470, Cheatle v GMC [2009] EWHC 645 (Admin) and Salsbury v Law Society [2009] 1 WLR 1286.
2. The purpose of sanction was the protection of patients and the wider public interest, including maintaining public confidence in the profession and upholding proper professional standards. Dishonesty affecting the integrity of a medical job application could undermine something fundamental to the medical system. The court accepted the proposition in Macey v GMC [2009] EWHC 3180 (Admin) and regarded the approach in Farah v GMC [2008] EWHC 731 (Admin) as applicable: persistent or concealed dishonesty accompanied by lack of insight was likely to require erasure.
3. The panel had considered the mitigating factors, but was entitled to treat the dishonesty as a fundamental character issue rather than a remediable clinical failing. Possible education or probity training did not make suspension proportionate where the evidence disclosed no obvious means of inculcating the importance of honesty.
4. Insight was a matter for the panel’s judgment. The panel had the advantage of seeing and hearing the doctor and evaluating her evidence as a whole. The court considered the reasoning issue raised by Brennan v Health Professional Council [2011] EWHC 41 (Admin), but found material capable of supporting the panel’s conclusion, including continued resistance to the allegation concerning the Somali patient.
5. The comparison with Dr Elkhider did not establish disproportionality. Two material differences justified different outcomes: Dr Elkhider had not misled the Interim Orders Panel and his panel accepted that he had genuine insight.
6. Article 8, if engaged, added nothing. Article 8(2) permitted public-interest considerations relating to patient health and safety, subject to proportionality, and the sanction satisfied that requirement. The court also considered £8,827.10 fair and reasonable as the respondent’s costs.

1. High Court (Administrative Court) — On 23 February 2011, the court dismissed the appeal under section 40 of the Medical Act 1983: [2011] EWHC 702 (Admin).
2. GMC Fitness to Practise Panel — Found Dr Naheed’s fitness to practise impaired and ordered erasure from the register. The finding of impairment was not challenged in the High Court.