Lawrance v The General Medical Council

An appellate court hearing a professional disciplinary appeal by way of rehearing must not retry the evidence or substitute its own view for that of the specialist tribunal. It may intervene where the tribunal’s decision was wrong or unjust because of a serious procedural or other irregularity.

Where dishonesty is alleged, the tribunal must apply the two-stage approach in R v Ghosh. In assessing sanction, the protection of patients, public confidence and the standing of the profession take priority over punishment or personal hardship. Erasure may be proportionate where serious dishonesty is persistent, the practitioner lacks insight, and the misconduct cannot be remedied by retraining or supervision.

Dr Catherine Ann Lawrance appealed under section 40 of the Medical Act 1983 against a Fitness to Practise Panel decision dated 8 October 2015. The Panel found that she had made misleading and dishonest statements and given dishonest oral evidence in earlier County Court proceedings, and ordered the erasure of her name from the Medical Register.

An earlier appeal had partly succeeded before Collins J, who left the factual findings undisturbed and remitted the matter for fresh determinations on dishonesty, misconduct, impairment and sanction. The second Panel upheld the relevant findings, proceeded to sanction in Dr Lawrance’s absence and ordered erasure. The central issues were whether the Panel could revisit the factual findings, whether it was entitled to proceed in her absence, and whether its conclusion on erasure was wrong or unjust.

1. Scope of appeal. The appeal was a rehearing under Part 52 of the Civil Procedure Rules 1998, but that did not require the court to rehear the evidence or retry the case. Under rule 52.11, intervention was justified only if the Panel’s decision was wrong or unjust because of a serious procedural or other irregularity. The factual findings of the first Panel had been left undisturbed by the earlier order and could not be reopened.
2. Dishonesty. The second Panel was entitled to proceed on the basis that Dr Lawrance had made false statements over approximately two years, in two written statements and oral evidence. It correctly applied the two-stage test for dishonesty identified in R v Ghosh. The repetition and solemn context of the statements made innocent mistake or misunderstanding difficult to accept, particularly since Dr Lawrance continued to deny wrongdoing and offered no innocent explanation.
3. Proceeding in the appellant’s absence. The Panel had waited, had allowed time for submissions and had no information explaining Dr Lawrance’s non-attendance or indicating when she might return. She could have sought an adjournment or provided written submissions. There was therefore no serious irregularity or injustice in the Panel continuing to sanction in her absence.
4. Sanction. The court was required to give appropriate respect to the specialist tribunal’s assessment of professional standards and the measures necessary to protect the public. Professional discipline is concerned principally with public protection, the reputation of the profession and public confidence, rather than punishment. The court could not substitute its own view or conduct a resentencing exercise. Given the serious and persistent dishonesty, continuing lack of insight, and absence of any realistic remedy through retraining or supervision, the Panel was entitled to conclude that suspension would be insufficient and that erasure was necessary and proportionate.
5. Disposition. The appeal was dismissed.

• High Court (Administrative Court): Collins J allowed the earlier appeal in part and remitted the matter to the GMC for fresh determinations on dishonesty, misconduct, impairment and sanction. The citation of that decision was not stated.
• Fitness to Practise Panel: On 8 October 2015, the second Panel found serious misconduct and impairment and ordered erasure from the Medical Register.
• High Court (Administrative Court): The present appeal was dismissed.