GMC v Szisz

On an application to continue interim conditions imposed on a doctor, the court must not determine whether the underlying allegations are proved. It must make an evaluative judgment whether interim restrictions are necessary and proportionate in the interests of patients and the doctor, having regard to the allegations and the evidence then available.

The court should respect the specialist tribunal’s repeated assessment, but must scrutinise the quality of the material relied upon. Interim restrictions may be continued where one sufficiently serious allegation establishes an adequate risk, even though other allegations remain factually unresolved. The duration must balance public protection, the doctor’s interests, the need for further investigation and the burden of repeated applications.

The General Medical Council applied under a Part 8 claim form to extend interim conditions imposed on Dr Janos Szisz by the Interim Orders Panel. The conditions arose after concerns about his treatment of four patients while working as a locum orthopaedic doctor.

The GMC relied principally on an expert report. The report contained unresolved factual issues and unclear conclusions concerning three patients, while alleging that the treatment of patients A and D fell below the required standard. The defendant, who practised in Hungary, did not appear or attend the hearing.

The issues were whether continuation of the interim conditions was necessary and proportionate, and, if so, for what period.

1. Applicable approach. Following the principles identified by the Court of Appeal in Hiew, the court was not required to decide whether the allegations had been substantiated. The question was whether suspension or conditions were necessary in the interests of patients and the doctor, pending investigation and any Fitness to Practise proceedings (para [19]).
2. The court was required to give appropriate respect to the specialist tribunal, which had reached the same conclusion on four occasions. That respect did not remove the need to examine the evidence relied upon. The expert report was unsatisfactory, particularly because it did not resolve factual issues concerning patients B and C (para [20]).
3. The evidence concerning patient A was sufficient to demonstrate a risk to the public and patients and to justify continuation of conditions. The evidence concerning patient D provided additional, though less substantial, support. The allegations concerning patients B and C, considered alone, did not justify continuation on the evidence then available (paras [21]–[23]).
4. The period of continuation required a balance between public protection and the doctor’s interests. Relevant considerations included the need for further records and expert analysis, the procedural steps before referral to a Fitness to Practise Panel, the GMC’s limited resources, the burden of repeated court applications, and the doctor’s ability to seek discharge or challenge the outcome (paras [24]–[29]).
5. With hesitation, the court extended the interim conditions order for ten months. The order imposed conditions rather than suspension, and the GMC was expected to refer the matter back to an Interim Orders Panel if further expert evidence showed that one or more allegations could not be sustained. The GMC’s costs were allowed (paras [28]–[36]).