Lawrence v The General Medical Council

A specialist disciplinary tribunal must remain within the issues canvassed by the parties. If it identifies an important factual or expert issue independently, it must give the parties an opportunity to address it before relying on that issue. In an exceptional and complex case, adequate reasons must explain how central evidence, expert evidence and materially conflicting accounts were resolved. A tribunal’s unexplained reliance on its own expertise, together with inadequate reasons, may make its findings unsafe. On appeal, the court should respect findings based on live credibility assessments unless the tribunal was plainly wrong or the evidence was misread. Findings may nevertheless be quashed where procedural unfairness or inadequate reasoning creates a realistic possibility of a different outcome.

A Fitness to Practise Panel found that Dr Lawrence had engaged in various inappropriate and sexually motivated acts during his psychotherapy of Patient B. It found most disputed allegations proved, concluded that his fitness to practise was impaired and directed erasure from the Medical Register.

Dr Lawrence appealed under section 40 of the Medical Act 1983. He challenged procedural rulings, factual findings, the impairment decision and erasure. The court first determined the procedural and factual challenges, including the admission of evidence by video link and typed psychotherapy notes, the Panel’s treatment of erotic transference, and the adequacy of its reasons.

1. Video evidence. The Panel was entitled to treat Patient B as a vulnerable witness under rules 36(1)(b) and 36(1)(e) of the General Medical Council (Fitness to Practise) Rules 2004. A sexual allegation need not involve sexual touching. A mental disorder in remission may fall within rule 36(1)(b) where the evidence showed a real prospect of relapse when the witness gave evidence. The Panel was entitled to conclude that travelling to the United Kingdom, separation from family and the nature of the allegations were likely to affect the quality of the evidence. It had a discretion under rule 34(1), as well as rule 36, to admit relevant and fair evidence by video link. The challenge failed.
2. Typed psychotherapy notes. The Panel was entitled to admit Ms Barnett’s typed notes under rule 34. Their non-contemporaneous and thematic character affected weight rather than admissibility. The destruction of the original notes did not make admission unfair where there was no suggestion of bad faith and the accuracy and provenance of the typed notes could be tested in evidence and submissions. The challenge failed.
3. Natural justice and specialist expertise. The Panel’s statement that, from its own expertise, a woman with low self-esteem was unlikely to fantasise that she was attractive unless encouraged addressed an issue that had not been canvassed. It was procedurally unfair to rely on that finding without giving Dr Lawrence an opportunity to adduce evidence or make submissions. A specialist tribunal may use its expertise in deciding issues properly before it, but it must not give evidence to itself on a new and material issue.
4. Reasons and expert evidence. The Panel’s further conclusion that erotic transference would not itself be likely to cause Patient B to believe that Dr Lawrence had reciprocal feelings was unexplained. The expert evidence gave some support to the possibility that erotic transference could produce such a mistaken belief. The Panel did not identify which expert evidence it accepted or rejected, nor explain how it assessed that evidence. In this exceptional case, it was required to explain its reasoning on that central issue.
5. Other important evidence. The Panel also failed adequately to explain its treatment of Patient B’s email of 11 September 2006 and material evidence from Ms Dowd and Ms Sutcliffe. It was unclear whether that evidence had been accepted, rejected, discounted because of the witnesses’ relationship with Dr Lawrence, or reconciled with the Panel’s conclusions. The deficiencies meant that Dr Lawrence could not understand why he had lost.
6. Disposition. The errors created a realistic possibility that the Panel’s assessment of the evidence and its disputed findings might have been different. The disputed findings of fact and findings of misconduct were therefore quashed. The court did not hold that the allegations were disproved or that the Panel had been plainly wrong on the evidence. Consequential orders, including any remission to a freshly constituted Panel, were reserved for further submissions.

• Fitness to Practise Panel: found most disputed allegations proved, found impairment of fitness to practise and directed erasure from the Medical Register.
• High Court (Administrative Court): quashed the disputed findings for procedural unfairness and inadequate reasons. Consequential orders were reserved.