Karwal v General Medical Council

At a review following suspension for misconduct, the Fitness to Practise Panel must consider whether the concerns underlying the original impairment finding have been sufficiently addressed. Insight is relevant even where the misconduct is unrelated to clinical practice, because dishonesty may undermine public confidence in the medical profession. A doctor need not admit guilt to demonstrate insight, but must appropriately recognise the findings made and their seriousness. The High Court gives substantial weight to the Panel’s assessment of evidence, credibility and professional judgment. It will intervene where material errors of fact or law are shown, but otherwise exercises only a secondary judgment.

This was a statutory appeal under section 40 of the Medical Act 1983 against findings that Dr Karwal’s fitness to practise remained impaired and against the continuation of her suspension. The Fitness to Practise Panel had originally found three allegations of dishonesty proved and imposed suspension. On review, it concluded that she lacked sufficient insight into the seriousness of the findings and extended the suspension. The appeal challenged the alleged lack of notice, the evidential basis for the finding of lack of insight, and whether such lack of insight could support impairment where the dishonesty was unrelated to medical practice.

1. The appeal against the findings was rejected. At a review, the Panel was required to address all concerns identified in the original impairment finding, including dishonesty and lack of insight. The statutory power to extend suspension under section 35D of the Medical Act 1983 and the Indicative Sanctions Guidance made the relevance of insight and appreciation of the gravity of the offence sufficiently clear.

2. The Panel was entitled to consider whether Dr Karwal had fully appreciated the gravity of the dishonesty findings. Acceptance of guilt was not a condition precedent to insight. A doctor may maintain innocence while recognising the findings made, the issues arising from them and their effect on public confidence. The Panel was entitled to regard assertions that she had been cleared, together with minimisation and continuing dishonesty, as evidence of insufficient insight.

3. Dishonesty need not be connected with clinical treatment before it can impair fitness to practise. Dishonesty by a doctor may damage the reputation of the profession and public confidence in doctors. Conduct which the specialist Panel reasonably considers to have that effect can provide a proper basis for finding impairment.

4. The Panel’s findings on the reliability and truthfulness of the psychiatrists’ evidence were open to it. The High Court must correct material errors of fact or law, but must give significant weight to the Panel’s professional judgment and exercises only a secondary judgment on the application of legal principles to the facts.

5. The judgment determined the appeal as to the findings. Further submissions on sanction were reserved for consideration if necessary.

• High Court (Administrative Court): The statutory appeal under section 40 of the Medical Act 1983 was rejected in relation to the findings of continuing impairment. The question of sanction was reserved.
• Fitness to Practise Panel: In 2008, the Panel found three dishonesty allegations proved and imposed a 12-month suspension. On review in December 2009 and March 2010, it found fitness to practise still impaired and extended the suspension by a further nine months.