General Medical Council v Chaudhary

When assessing a medical practitioner's fitness to practise, a tribunal must balance all three elements of the statutory public interest: public safety, public confidence in the profession, and proper professional standards and conduct. Remediation and risk of repetition cannot automatically determine the outcome.

An appellate court should respect the specialist tribunal's factual and evaluative judgments. It may substitute its own decision only where confident that it is correct. If more than one outcome is reasonably open, remission is normally appropriate.

The General Medical Council appealed under section 40A of the Medical Act 1983 against Medical Practitioners’ Tribunal determinations concerning Dr Chaudhary. The Tribunal found misconduct involving misleading letters, dishonesty and failure to communicate with the patient's general practitioner. It found impairment in relation to communication but not in relation to the misleading letters or dishonesty, and imposed conditions which were later revoked.

The principal issue was whether the Tribunal had lawfully assessed current impairment by giving adequate weight to public confidence and professional standards, alongside remediation and risk of repetition. A second appeal challenged the later review determination.

1. Appeal allowed in part. The Tribunal had treated remediation and the likelihood of repetition as effectively determinative. It had not properly balanced those matters against maintaining public confidence in the medical profession and proper professional standards, as required by section 40A of the Medical Act 1983.
2. The statutory public interest is tripartite. Public safety is not to be subordinated to the other elements, but all relevant considerations must be placed in the balance. Intervention is ordinarily rare where the Tribunal has properly weighed them.
3. The Tribunal was entitled to distinguish dishonesty for the purposes of the Ghosh test from questions of motive and remediation. Dishonesty is not necessarily an immutable or all-pervading trait, and its context and degree may be relevant to impairment. A finding of dishonesty does not invariably require a finding of impairment.
4. The Tribunal's conclusion that the respondent's motive was not malign was open to it. One irrelevant sentence concerning the absence of criticism of the clinical performance could be severed without affecting the reasoning.
5. The court declined to determine the impairment issue entirely for itself. Although substitution is available under section 40A(6)(c), remission is ordinarily appropriate where more than one outcome is reasonably possible. In the unusual circumstances, including the age and one-off nature of the events and the respondent's subsequent unrestricted practice, the court substituted a finding of impairment but directed that no further action be taken.
6. The second appeal was unnecessary. If the substantive appeal succeeds, the review determination rests on a displaced premise and may be treated as a nullity.

The relevant decision was quashed in part, limited to impairment concerning probity, honesty and trustworthiness. Costs of £15,000 were awarded.

The judgment describes appeals from Medical Practitioners’ Tribunal determinations dated 29 July 2016 and 14 August 2017. The High Court allowed the substantive appeal in part, quashed the impairment determination only on probity, honesty and trustworthiness, substituted a finding of impairment, and directed that no further action be taken. The second appeal was held unnecessary.