Dowson v The General Medical Council

An appeal from a fitness to practise decision is a rehearing, but the court must respect the specialist tribunal’s evaluation of primary facts and professional standards. The court may interfere where the decision is wrong or the hearing was unjust through serious irregularity.

Professional duties of honesty, integrity and candour in clinical research may require disclosure to an ethics committee and research colleagues even where a contract, undertaking or legal advice does not expressly require it. The tribunal decides whether conduct amounts to misconduct; expert evidence informs the context but does not determine the legal conclusion. A tribunal should not impose misconduct liability for reporting research findings in accordance with an ethics committee-approved protocol where competing expert assessments are unresolved.

Dr Andrew Dowson appealed under Medical Act 1983, section 40, against a Fitness to Practise Panel decision imposing a four-month suspension. The Panel had found seven charges proved, concerning undisclosed payments, non-disclosure of research misconduct and GMC proceedings, a false clinical trial warranty, and the reporting of clinical trial results.

The appeal challenged the evidential and evaluative basis of the findings, including two findings of dishonesty. The central issues were the proper approach to an appeal from a specialist professional tribunal, the role of expert evidence in assessing professional misconduct and dishonesty, and whether the Panel was entitled to find misconduct in relation to disclosure obligations and the reporting of trial data.

1. Appeal standard. The appeal was by way of rehearing. Under Medical Act 1983, section 40, and the applicable procedural rules, the court could allow the appeal where the Panel’s decision was wrong or the hearing was unjust because of a serious procedural or other irregularity. The court nevertheless had to respect the Panel’s specialist expertise, its opportunity to hear witnesses, and its evaluative judgments.
2. Professional duties in research. General duties of honesty and integrity, together with the applicable research guidance and Helsinki principles, required candour about relevant financial interests, prior research misconduct, GMC proceedings and matters affecting colleagues’ ability to assess their participation. The Panel was entitled to determine these duties itself. It was not confined by whether an expert witness or an ethics committee chair considered the conduct unacceptable.
3. Dishonesty. It was unnecessary on the facts to resolve the precise adaptation of the two-stage Ghosh test proposed for professional disciplinary proceedings. The relevant standard was materially the same whether expressed by reference to reasonable and honest people or reasonable and honest doctors, provided the notional arbiter understood the context and purpose of the conduct.
4. Charges upheld. The findings concerning non-disclosure of the Botox Trial misconduct, the false CTA warranties, the hourly remuneration, disclosure to MIST Trial colleagues, and disclosure of the GMC outcome to the Steering Committee and MREC were open to the Panel and were upheld. Legal advice about the scope of undertakings could mitigate or exclude dishonesty, but did not answer a distinct professional duty of transparency.
5. TCT charge. The finding concerning the reporting of the 94% closure rate was quashed. The appellant’s conference presentation accorded with the subsequently published, MREC-approved, per-protocol results. The competing ad hoc reviews had not been approved as valid research data, and the Panel had impermissibly transformed a complex collective and expert dispute into misconduct by one individual.

The judgment records an appeal from a Fitness to Practise Panel of the Medical Practitioners Tribunal Service. The Panel had directed a four-month suspension and found seven charges proved. The High Court upheld six findings and quashed the finding on the TCT charge.