General Medical Council v Stone

On a regulator’s appeal against a disciplinary sanction, the court applies the ordinary appellate test while respecting the tribunal’s expertise to the degree warranted by the issue. Less deference may be appropriate in cases of dishonesty or sexual misconduct.

Personal mitigation carries substantially less weight in professional regulation than in criminal sentencing. Psychiatric evidence may be relevant, but tribunals must distinguish clinical explanations from a practitioner’s moral and professional responsibility for prolonged, conscious conduct.

Where serious sexual misconduct involves a vulnerable patient, abuse of trust and additional dishonesty, the tribunal must confront the applicable sanctions guidance and explain how mitigation justifies suspension. If the gravity of the misconduct makes erasure the only sanction sufficient to maintain public confidence and professional standards, the court may substitute erasure.

The General Medical Council appealed under section 40A of the Medical Act 1983 against a Medical Practitioners Tribunal’s decision to suspend a general practitioner for 12 months. The doctor had conducted a prolonged sexual and emotional relationship with a vulnerable patient while continuing to treat her. He had also acted dishonestly by providing supportive letters without disclosing the relationship.

The tribunal accepted psychiatric evidence that the doctor’s condition and personal circumstances had reduced his ability to resist the relationship. It concluded that suspension, followed by review, adequately protected the public. Following that review, it found that the doctor’s fitness to practise was no longer impaired.

The issues were whether the tribunal had adequately addressed the governing sanctions guidance, had placed excessive weight on psychiatric mitigation, had properly assessed the additional dishonesty, and had imposed a sanction sufficient to protect the public.

1. The appeal was allowed and the suspension quashed. Appeals under section 40A of the Medical Act 1983 are governed by the ordinary appellate test. The court must nevertheless respect the tribunal’s expert evaluative judgment to the degree warranted by the context. Dishonesty and sexual misconduct are matters which a court can assess more readily than questions of clinical performance. Deference lies on a spectrum, and intervention becomes harder where the tribunal demonstrably considered every material matter.

2. The tribunal failed to confront the objective gravity of the misconduct and the provisions of the Sanctions Guidance specifically addressing abuse of trust, vulnerable patients, sexual misconduct and dishonesty. A general reference to the Guidance did not demonstrate that those matters had been understood and balanced against the mitigation. That failure also meant that insufficient weight had been given to maintaining public confidence and proper professional standards.

3. Psychiatric evidence may inform personal mitigation and may address the extent to which self-control was impaired. In professional disciplinary proceedings, however, personal mitigation carries far less weight than in criminal sentencing because every element of public protection remains engaged. The tribunal should have distinguished the factors relevant to a mental-health diagnosis from the doctor’s moral and professional responsibility. The misconduct consisted of conscious choices sustained over a prolonged period, rather than an impulsive act. The psychiatric explanation therefore had only a modest permissible connection with sanction, and the tribunal gave it excessive weight.

4. The dishonesty was a serious additional feature. Writing the supportive letters involved separate decisions and was not coextensive with the original decision to begin and continue the relationship. The tribunal’s conclusion that the dishonesty was inextricably bound up with the sexual misconduct failed to recognise its additional contribution to the case’s gravity.

5. The court could substitute a sanction only where the outcome was sufficiently clear to make remission pointless. Given the duration and extent of the relationship, the patient’s vulnerability, the abuse of professional trust and the additional dishonesty, erasure was the only sanction sufficient to meet the statutory overarching objective. Erasure was substituted. The appeal concerning the later review decision was wholly superseded and required no separate order.

• High Court (Administrative Court): Allowed the General Medical Council’s appeal under section 40A of the Medical Act 1983, quashed the 12-month suspension and substituted erasure. The appeal concerning the review decision was superseded.
• Medical Practitioners Tribunal, review hearing, 10 August 2017: Determined that the doctor’s fitness to practise was no longer impaired following remedial steps.
• Medical Practitioners Tribunal, 4 August 2016: Found serious misconduct and impaired fitness to practise, suspended the doctor’s registration for 12 months and directed a review.