Pool v General Medical Council

A doctor offering expert evidence must possess relevant expertise and confine opinions to matters within that expertise and professional competence. Expertise may arise from training or experience, but experience in a different clinical setting or speciality may not qualify a doctor to assess a professional’s fitness to practise. Expert reports must explain the reasoning linking the evidence to the conclusions. On an appeal against sanction, substantial respect is owed to the disciplinary panel, but the court must intervene where the sanction is legally flawed or disproportionate. A sanction should bear a reasonable relationship to the misconduct and should not restrict competent clinical or expert work unrelated to it.

The appellant, a psychiatrist, appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel decision. The Panel found that he had acted outside his expertise when preparing a report on a paramedic’s fitness to practise, had failed to explain adequately his opinions, and had failed to understand and explain the role of an expert witness. It found misconduct and impairment of fitness to practise, and suspended his registration for three months. The central issues were whether the findings were wrong or inadequately reasoned, whether impairment could properly be found, and whether the sanction was lawful and proportionate.

1. The appeal was allowed in part. The Panel’s findings that the appellant was not an expert in the relevant field, had exceeded his professional competence, had failed to restrict his opinions, had failed to give adequate reasons, and had failed to understand the responsibilities of an expert witness were not wrong.

2. Expertise may be acquired through training or day-to-day experience. The relevant question was whether the appellant had expertise in assessing the effect of psychiatric conditions on a healthcare professional’s ability to perform the requirements of the occupation. His experience in secure settings and in learning-disability psychiatry did not provide the necessary direct experience of community practice, occupational functioning, or fitness-to-practise proceedings.

3. The report was inadequate because it did not explain why the symptoms and behaviour prevented the paramedic from performing her duties, nor why the impairment was likely to be indefinite. The Panel’s reasons, read fairly and as a whole, sufficiently explained its conclusions. The appeal test was whether the Panel’s decision was wrong, applying the principles stated in Cheatle v General Medical Council [2009] EWHC 645 (Admin). The duty to give reasons was applied in accordance with Flannery v Halifax Estate Agencies Ltd [2000] 1 W.L.R. 377.

4. The Panel was entitled to find impairment and to regard the misconduct as serious. However, the suspension was flawed. The Panel’s reasoning about the practicability of conditions was internally inconsistent, and it failed to explain why a targeted condition would not suffice. Suspension also prevented the appellant from practising clinically and acting as an expert in fields in which he was competent. It was therefore disproportionate.

5. Under section 40(7) of the Medical Act 1983, the suspension direction was replaced by a condition that, for three months, the appellant must not accept instructions to act as an expert witness in fitness-to-practise proceedings.

The judgment does not state any further appellate history. This was an appeal to the High Court under section 40 of the Medical Act 1983 from the Fitness to Practise Panel’s decision of 13 June 2014.