Hosny v General Medical Council

On an appeal under section 40 of the Medical Act 1983, the court must exercise a secondary judgment and allow the appeal only where the Fitness to Practise Panel’s decision was wrong. Particular respect is due to the Panel’s assessment of professional standards, facts and sanction. A doctor applying for employment must give complete and accurate answers about current or previous regulatory proceedings, restrictions and relevant gaps in employment. Employer checks do not remove that primary duty. Repeated dishonesty may establish current impairment, particularly where it demonstrates lack of insight, breach of a fundamental professional tenet and unreliable integrity. Erasure may be proportionate where suspension would not maintain public confidence or uphold proper standards.

Dr Mona Hosny appealed under section 40 of the Medical Act 1983 against findings and sanction imposed by a GMC Fitness to Practise Panel in April 2012. The Panel found that she had dishonestly and misleadingly failed to disclose regulatory proceedings, suspension orders and employment gaps in applications for medical employment, and had failed to return an Employer Details Form. It found current impairment and erased her from the Medical Register.

The appeal challenged the factual findings, dishonesty finding, impairment, sanction and alleged interference with article 8 rights. The appeal did not challenge the earlier 12-month suspension imposed in 2010 except insofar as its findings were relevant to the later assessment of impairment and sanction.

1. Appeal approach. The appeal was dismissed. Under section 40 of the Medical Act 1983, the court’s function is not confined to conventional judicial review, but it must not interfere unless persuaded that the Panel was wrong. The Panel’s expertise warrants particular respect, especially on professional standards, factual assessment and sanction. Its findings should not be disturbed without material error.
2. Disclosure obligations. The Panel was entitled to find that the application questions covered current GMC proceedings, an order of suspension not yet in force, previous interim restrictions and employment gaps caused by suspension. The primary duty to provide accurate and complete answers rested on the applicant doctor. The possibility that employers would check the GMC register did not discharge that duty.
3. Dishonesty and impairment. The Panel applied the correct civil standard and the two-stage dishonesty test in R v Ghosh. It was entitled to reject the explanations advanced and to treat the repetition of substantially similar dishonest conduct shortly after the earlier hearing as relevant to current impairment. The Panel was also entitled to rely on the absence of insight and the findings that the conduct breached a fundamental tenet of the profession and undermined reliance on the doctor’s integrity. It was not entitled, and was not required, to reopen the earlier findings.
4. Sanction. The Panel considered proportionality, the doctor’s interests, public protection, public confidence and the maintenance of professional standards. Repeated dishonesty and lack of insight justified the conclusion that conditions or a further period of suspension would be insufficient. Erasure was not disproportionate. The Panel was not required to address every submission expressly.
5. Article 8. Any interference with private or family life was lawful and necessary in the interests of public safety, having regard to section 1(1A) of the Medical Act 1983. The appeal failed on all grounds. The appellant was ordered to pay the GMC’s costs, summarily assessed at £6,453.70.

The judgment records an earlier appeal against the 2010 Fitness to Practise Panel decision, which was dismissed by HHJ Behrens in the High Court on 17 May 2011. The present court dismissed the appeal against the 2012 Panel’s findings, impairment determination and erasure order.