Khan v The General Medical Council

On a statutory appeal from a specialist professional tribunal, the court should respect the tribunal’s expertise, its assessment of witnesses, and its findings of fact and evaluative judgment. It must nevertheless intervene where a finding is wrong.

Safe conscious sedation requires a suitably trained person, other than the practitioner conducting the procedure, to have responsibility for monitoring patient safety and making a written record. Proper clinical care may also require the timing of sedative administration and vital signs to be recorded. A practitioner remains professionally responsible for the overall management of patients and for inappropriate delegation or inducements arranged within a clinic under the practitioner’s control.

Dr Aamer Khan appealed under section 40 of the Medical Act 1983 against a Fitness to Practise panel decision dated 1 June 2012. The panel found misconduct, impairment of fitness to practise, and imposed conditions on his registration for 12 months.

The proceedings arose from a cosmetic BodyTite procedure performed under conscious sedation. The appeal challenged factual findings concerning an inappropriate group discount, monitoring and recording during sedation, and post-operative care, together with the findings of misconduct, impairment and sanction. The central issues were whether the panel’s findings were properly made and whether its consequential decisions should stand.

1. Appeal dismissed. The panel’s findings on allegations 1, 6, 7 and 10, and its conclusions on misconduct, impairment and sanction, were upheld.

2. On a statutory appeal, respect was owed to the specialist tribunal’s understanding of professional standards, its opportunity to see and hear witnesses, and its findings of primary and secondary fact and overall value judgment. That deference did not remove the court’s duty to intervene where a finding was wrong, applying Meadow v General Medical Council [2006] EWCA Civ 1390; Bhatt v General Medical Council [2011] EWHC 783 (Admin).

3. The finding concerning the group discount was properly made. Dr Khan was jointly responsible for the clinic, had professional responsibilities for delegation and overall patient management, and had access to records showing the arrangements. His responsibility was professional, not merely a question of private-law liability.

4. The safe-sedation guidance required a suitably trained individual to be present throughout the procedure with defined responsibility for monitoring patient safety and making a written record. The practitioner conducting the procedure could not discharge that recording responsibility while also performing the procedure. The absence of such a person justified the finding on allegation 6.

5. The finding on allegation 7 was properly based on expert evidence and the circumstances of a lengthy procedure under conscious sedation. It was good clinical care to record the timing of sedative administration and the patient’s vital signs, particularly where monitoring was intermittent rather than constant.

6. The panel was entitled to find post-operative care inadequate because appropriate physiological monitoring had not been undertaken. It had not, however, determined the separate issue of whether failure to contact the patient’s GP constituted inadequate care.

7. The findings of misconduct, impairment and conditions on registration were coherent, reasonable and right. The appeal was dismissed.

1. High Court (Administrative Court): Appeal under section 40 of the Medical Act 1983 dismissed. The Fitness to Practise panel’s decision dated 1 June 2012 was upheld.