Brookman v General Medical Council

On an appeal from a professional disciplinary tribunal, the court must give appropriate respect to specialist professional judgment, but may intervene where material factual, procedural or reasoning errors make the decision wrong or unjust. Where a tribunal identifies significant uncertainty about a practitioner’s health, medication or ability to participate effectively, it must obtain sufficient evidence to resolve those concerns before making adverse findings. It must also give adequate reasons and evaluate material mitigation before imposing the most serious sanction. A failure to do so may taint findings of fact, misconduct, impairment and sanction. Dishonesty remains a fact-sensitive conclusion assessed by the applicable objective and subjective principles; deliberate concealment may satisfy the test, but unresolved health evidence may affect the assessment of intention and plausibility.

Dr Michael Brookman appealed under section 40(1) of the Medical Act 1983 against a Medical Practitioners Tribunal decision finding that he had engaged in misleading and dishonest conduct, finding his fitness to practise impaired, directing erasure from the medical register and imposing immediate suspension.

The Tribunal’s findings concerned failures to disclose interim registration conditions to a locum agency and NHS Trust, misleading descriptions of the interim-order hearing, and non-disclosure of employment and probity matters to Swansea University. The Tribunal rejected the principal patient allegations. The central issue was whether the Tribunal had acted fairly and reached proper conclusions without obtaining further medical evidence about the effects of medication, possible autistic traits, the appellant’s mental state and his ability to conduct the proceedings.

1. Appeal allowed. The Tribunal’s findings adverse to the appellant, its direction for erasure and its immediate suspension order were quashed under section 40(7)(b) of the Medical Act 1983. The case was not remitted to the MPTS.
2. The Tribunal had correctly identified serious concerns about the possible effects of medication on the appellant’s decision-making during the relevant period and during the hearing, his ability to represent himself, possible dependence on medication, the effect of stress, and possible autistic traits. Those concerns affected both the factual allegations and the later questions of misconduct, impairment and sanction.
3. The Tribunal acted wrongly and unjustly by deciding that no further health assessment was needed after relying principally on a short telephone examination by a psychiatrist who had not read the allegations or relevant transcripts, and on the appellant’s opposition to an adjournment. The psychiatrist had not withdrawn his view that further psychiatric evaluation was appropriate and had accepted that medication might cause the appellant to ignore important matters.
4. The Tribunal failed to explain which concerns had been resolved, which remained unresolved and why the remaining issues did not need resolution. It also failed to consider adequately the possible effect of the health evidence on the appellant’s state of mind, the plausibility of his explanations, his awareness of obligations, his ability to participate in the hearing, insight and risk of repetition.
5. The errors tainted the findings of dishonesty, misconduct, impairment and erasure. The Tribunal’s failure to evaluate important mitigating circumstances, including the rejected patient allegations, the stress caused by them and the possible effect of mental health and medication, independently tainted the erasure decision. The same errors removed the legal foundation for immediate suspension under section 38.
6. The court rejected the free-standing challenges to the Tribunal’s factual findings, procedural handling in the appellant’s absence, dishonesty analysis and approach to sanction. On dishonesty, the Tribunal had received proper directions and was entitled to conclude that deliberate concealment or knowingly untrue statements could satisfy the applicable principles. The court expressed no concluded view on whether recklessness alone could establish dishonesty.
7. The court declined to remit. The patient allegations had been rejected, only a limited number of non-patient allegations had been upheld, a fresh hearing would cause substantial delay, further medical evidence might materially alter the outcome, and the GMC did not seek remittal. The respondent was ordered to pay the appellant’s net costs of £9,343.29 inclusive of VAT.

High Court (Administrative Court): The appeal under section 40(1) of the Medical Act 1983 was allowed. The Tribunal’s adverse findings, erasure direction and immediate suspension order were quashed under section 40(7)(b), without remittal to the MPTS.