Squier v General Medical Council

An expert witness does not commit professional misconduct merely by explaining or challenging opinions outside the witness’s own speciality, provided the limits of expertise are made clear and appropriate deference is shown to specialists. An expert must, however, present research accurately and fairly. A paper must not be cited without qualification as supporting a proposition which it does not support. Disciplinary tribunals must assess expert evidence in its forensic context, including the circumstances in which answers were elicited. A finding of dishonesty should not be made where it adds nothing material to the real allegation and no ulterior purpose is alleged.

Dr Squier appealed under section 40(1)(a) of the Medical Act 1983 against findings of the Medical Practitioners Tribunal that her expert evidence in family and criminal proceedings concerning suspected non-accidental head injury was outside her expertise, insufficiently founded, misleading, irresponsible and dishonest. The proceedings followed an earlier judicial review concerning the adequacy of the GMC’s charges. The appeal concerned whether the Tribunal’s factual findings could be sustained and, consequently, whether its decisions on impairment and erasure could stand.

1. The appeal court was required by CPR 52.11(3) to allow an appeal where the Tribunal’s decision was wrong or unjust because of a serious procedural or other irregularity. The Tribunal’s principal finding that Dr Squier had effectively committed perjury was unjust. She had been told that declining to answer questions because of possible later criminal or disciplinary consequences could not be held against her. The Tribunal gave no warning that it might nevertheless treat the refusal as proof of dishonesty.
2. Ordinarily, appellate courts defer to a fact-finding tribunal’s credibility assessments. Here, that deference was not unqualified because the critical finding of untruthfulness was unsustainable. The remaining findings had to be assessed from the objective evidence and from inferences drawn from primary facts without relying on the unjust finding.
3. It was permissible for a neuropathologist to explain why he or she supported or doubted the prevailing view about the triad of subdural haemorrhage, retinal haemorrhage and encephalopathy, even though that necessarily involved commenting on matters outside the witness’s own speciality. The boundary was imprecise. The witness had to identify the limits of expertise and defer to specialists where appropriate.
4. An expert citing research had a duty not to mislead. Research must not be presented as supporting a proposition when it did not do so. If it supported the proposition only with significant qualification, that qualification had to be stated. Selective citation of the Vinchon, Hoskote, Greenes and Schutzman, Christian, Arbogast, Hylton and Martinez-Lage papers justified findings of misleading or deliberately misleading conduct in the respects identified.
5. The Tribunal had materially misunderstood or overstated several items of evidence, including the radiological evidence, the evidence about choking, the Rooks paper, the Oehmichen paper and evidence elicited in cross-examination. The guidance in Meadow v General Medical Council [2007] QB 462 required the conduct to be assessed in its forensic context.
6. The Tribunal should not have made findings of dishonesty. In a case principally concerned with repeated breaches of the duties of an expert witness, dishonesty added nothing material where Dr Squier’s views were genuinely held and no ulterior purpose was alleged. The determination was flawed in many significant respects, requiring the decisions on impairment and sanction to be retaken.

1. Medical Practitioners Tribunal found factual charges proved, determined that Dr Squier’s fitness to practise was impaired and directed erasure from the medical register.
2. High Court (Administrative Court) reviewed the factual findings on appeal under section 40(1)(a) of the Medical Act 1983. The determination was held materially flawed in significant respects, and the decisions on impairment and sanction were to be retaken.