Cornish v General Medical Council

On an appeal from a professional disciplinary panel, the High Court must correct material errors of fact or law and conduct its own secondary judgment, while giving appropriate respect to the specialist tribunal’s expertise, its assessment of witnesses and its evaluative judgments. A panel may draw reasonable inferences from circumstantial evidence where its reasons are clear and the burden and standard of proof are correctly applied. In sanctioning serious misconduct, the central considerations are protection of patients, maintenance of public confidence and proper professional standards, rather than punishment. Erasure may be proportionate where dishonesty, breach of trust, patient risk and lack of sufficient insight make continued registration fundamentally incompatible with those public interests.

The appellant, a consultant anaesthetist, appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel’s findings and sanction. He accepted impairment arising from theft of drugs, misconduct and opioid dependence, but disputed the finding that he had self-administered drugs inside hospital buildings. He also challenged erasure from the medical register, contending that suspension or conditions would adequately protect the public and that his addiction, rehabilitation and clinical competence had been given insufficient weight. The central issues were whether the factual finding was sustainable on the evidence and whether erasure was wrong, unjust or disproportionate.

Appeal dismissed.

1. The appeal jurisdiction under section 40 of the Medical Act 1983, governed by CPR Part 52, requires the High Court to allow an appeal where the decision below was wrong or unjust because of serious procedural or other irregularity. The appeal is by way of rehearing, but the court’s judgment remains distinctly and firmly a secondary judgment. Appropriate weight must be given to the specialist panel’s expertise, its opportunity to hear and see witnesses, and its evaluative judgments: Meadow v General Medical Council [2007] QB 462; Raschid v General Medical Council [2007] 1 WLR 1460.
2. The Panel was entitled to reject the appellant’s evidence in light of his persistent and deliberate minimisation of his drug history. It could infer self-administration within the hospital from the combination of his chaotic and escalating addiction, his inability sometimes to delay injecting, the incident in which he appeared drug-affected in the anaesthetic room, and the contents of his hospital locker. The absence of cannulae was not conclusive. The Panel correctly directed itself on circumstantial evidence and the burden and standard of proof.
3. The Panel’s sanction decision was not punitive or disproportionate. Professional discipline primarily protects patients and the wider public interest, including public confidence in the profession. The Panel was entitled to treat the conduct as involving persistent theft, serious breach of trust, calculated dishonesty, risk to patients and insufficient insight. The appellant’s addiction and rehabilitation were relevant but did not fully explain or mitigate the misconduct.
4. Conditions were not appropriate because they would not be workable and measurable in the circumstances. The health assessors’ opinions concerned future practice and relapse risk, whereas the Panel had the wider task of assessing misconduct, conviction and public confidence. Given the seriousness of the conduct and its fundamental incompatibility with continued registration, suspension would not sufficiently protect the public interest or mark the seriousness of the misconduct. Erasure was therefore upheld.

The judgment does not state a prior appellate decision in the same proceedings. The appeal was brought directly to the High Court under section 40 of the Medical Act 1983 from the Fitness to Practise Panel’s determinations.