Cornish v General Medical Council

On an appeal under section 40 of the Medical Act 1983, the High Court exercises a genuine but secondary judgment. It must correct material errors of fact or law, while respecting the specialist tribunal’s expertise, its assessment of witnesses and its evaluative judgment.

In professional discipline, sanction is directed principally to protecting patients, maintaining public confidence and upholding professional standards, rather than punishing the practitioner. Erasure may be proportionate where serious dishonesty, breach of trust, patient-safety risks and inadequate insight make continued registration fundamentally incompatible with those objectives.

Dr Matthew Cornish 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 as excessive and disproportionate, relying on his rehabilitation, abstinence, clinical competence and expert evidence that he could practise subject to restrictions. The issues were whether the factual finding was sustainable and whether erasure was the appropriate sanction.

1. Appeal dismissed. The Panel’s findings of fact and direction for erasure were upheld.

2. The appeal jurisdiction under section 40 of the Medical Act 1983, governed by CPR Part 52, involves a rehearing, but the High Court’s assessment remains distinctly secondary. Following Meadow v General Medical Council [2007] QB 462 and Raschid v General Medical Council [2007] 1 WLR 1460, appropriate weight must be given to the Panel’s specialist expertise, its opportunity to hear and see witnesses, and its primary factual and evaluative judgments. The court retains power to correct material errors of fact or law.

3. The Panel was entitled to infer, on the balance of probabilities, that the appellant had self-administered drugs in hospital buildings. His persistent dishonesty, chaotic and escalating addiction, inability at times to delay injection, observations of impairment in the anaesthetic room, and drug paraphernalia in his hospital locker formed a coherent body of circumstantial evidence. The absence of cannulae from the locker was not conclusive.

4. In determining sanction, the Panel was required to protect patients, maintain public confidence in the profession and uphold proper standards. Sanction was not principally punitive. The principles in Gupta v General Medical Council [2002] 1 WLR 1691 and Bolton v The Law Society [1994] 1 WLR 512 were applicable.

5. Erasure was proportionate. The misconduct involved persistent theft, serious dishonesty, concealment, breach of trust, self-administration before or during anaesthetic work and a serious risk to patients. Rehabilitation and expert evidence concerning health did not remove the Panel’s wider duty to address misconduct, public protection and confidence in the profession. The Panel was entitled to find insufficient insight and a risk of repetition, and to conclude that suspension or conditional registration would not adequately protect the public interest.

• High Court (Queen’s Bench Division), Administrative Court: appeal under section 40 of the Medical Act 1983 dismissed; the Fitness to Practise Panel’s findings and erasure direction upheld.