Lawrance v General Medical Council

In a professional disciplinary appeal, fairness may require a tribunal to proceed in stages where a practitioner withdraws, allowing evidence to be heard but preserving an opportunity to address dishonesty and sanction. A finding that evidence was inaccurate does not, without more, establish dishonesty. Although the civil standard applies, dishonesty or a serious offence requires cogent evidence, assessed in the full factual context. The tribunal must consider whether disputed evidence has been properly tested and must give the practitioner a fair opportunity to make representations before imposing erasure. The reviewing court may intervene where the tribunal’s approach or reasoning was materially flawed.

The appellant, a doctor, appealed under section 40 of the Medical Act 1983 against findings by a Fitness to Practise Panel that she had committed misconduct by making misleading and dishonest statements and giving dishonest evidence in earlier county court proceedings. The panel proceeded after she left the hearing, found the allegations proved and erased her from the Medical Register.

Before the Administrative Court, she challenged the decision to proceed in her absence, the findings of dishonesty and the sanction. The central issues were whether the hearing remained fair after her withdrawal, whether the evidence established dishonesty rather than mere inaccuracy or misleading conduct, and whether erasure could properly be imposed without further representations.

1. The appeal was allowed and the case was remitted to the Fitness to Practise Panel. The appellant’s withdrawal did not make it irrational for the panel to continue in her absence. The panel had been entitled to conclude that she voluntarily waived her right to attend, having been given an adjournment and information about representation.
2. The panel nevertheless had to exercise the power to proceed with great care and with close regard to fairness. Where disputed evidence is central, a panel should be circumspect about admitting and relying on written witness statements without cross-examination. It should test the case as far as the evidence permits. It should also consider whether evidence can be heard first and the practitioner notified or recalled for the issue of dishonesty.
3. A finding that a party’s account was not accepted on the balance of probabilities does not itself establish dishonesty. In a case effectively alleging perjury, particularly cogent evidence is required. The tribunal must consider the whole context, including pressures created by a bitter dispute, limitations in the witnesses’ evidence and findings leaving open a reasonable possibility that some work was done.
4. The civil standard of proof remains applicable. However, decision-makers must recognise the need for cogent evidence before finding dishonesty or a serious offence. The panel’s reasoning that rejection of the appellant’s account necessarily meant that she knew it was false was unsafe.
5. Before imposing sanction, especially erasure, fairness required the panel to give the appellant an opportunity to make representations and provide mitigation. The absence of insight or testimonials could not fairly be relied on when she had not been given that opportunity.
6. Under CPR 52.11, the court’s task was to decide whether the sanction decision was wrong, not to conduct a resentencing exercise. The case was returned to the panel so that the appellant could seek to establish that her conduct was misleading rather than dishonest and that erasure was excessive.

The judgment records an appeal under section 40 of the Medical Act 1983 from the Fitness to Practise Panel’s decision of 28 April 2014. The Administrative Court allowed the appeal and remitted the case to the panel.