General Medical Council v Nooh

On an appeal against a restoration decision, the court must respect the specialist tribunal’s evaluative judgment unless the decision is wrong or unjust because of a serious procedural or other irregularity. A tribunal considering restoration may assess where the original misconduct falls on the spectrum of seriousness, provided it does not reopen the original findings of fact, misconduct, impairment or sanction. It must apply the statutory over-arching objective, including public protection, public confidence and proper professional standards. The length of an existing erasure may be relevant to whether continued erasure remains necessary. Dishonesty remains serious, but its seriousness is a matter of fact and degree. A tribunal’s decision will not be invalid merely because some expressions are unfortunate, if its reasons, read as a whole, disclose a lawful and intelligible basis for restoration.

The General Medical Council appealed under section 40A of the Medical Act 1983 against a Medical Practitioners Tribunal’s decision to restore Dr Nooh’s name to the medical register. His name had been erased in 2009 following findings concerning clinical shortcomings in the treatment of one patient and three dishonest employment applications.

The Tribunal accepted that Dr Nooh did not pose a risk to patients, considered his subsequent professional activity and training, and concluded that the period of erasure had sufficiently addressed public confidence and professional standards. The GMC alleged that the Tribunal had reassessed the original misconduct impermissibly, gave inadequate weight to lack of insight and dishonesty, failed to apply the over-arching objective, and gave inadequate reasons.

1. The appeal was dismissed. The court applied the appellate approach stated in GMC v Jagjivan [2017] EWHC 1247 (Admin), as appropriately modified for a restoration appeal. The court could correct material errors of fact or law and serious procedural irregularity, but had to approach the Tribunal’s specialist evaluative conclusions with respect.

2. The Tribunal was not entitled to reopen the original findings of fact, misconduct, impairment or the decision that erasure was appropriate. It was, however, entitled to consider the seriousness of the misconduct in the context of restoration. Cases warranting erasure occupy a spectrum, and restoration may require an assessment of whether continued erasure remains necessary.

3. Although the Tribunal’s references to taking a different view of seriousness were unfortunate, its decision, read as a whole, did not amount to a quasi-appeal. It accepted the original findings and treated the clinical failings as significant misconduct. Its conclusion was properly understood as addressing the seriousness of the Patient A allegations in isolation, rather than contradicting the original sanction based on the cumulative misconduct.

4. The Tribunal was also entitled to regard the dishonesty as limited in nature and to assess its seriousness as a matter of fact and degree. Dishonesty by a professional is always serious and commonly results in erasure, but the Tribunal did not have to treat every case as equivalent. The dishonesty here consisted of three incorrect answers and did not involve fabricated documents.

5. The Tribunal had considered the over-arching objective, the limited insight, the low risk of repetition, the absence of patient risk, Dr Nooh’s subsequent professional evidence and the seven-and-a-half years already spent erased. The absence of a continuing patient-risk justified the conclusion that continued erasure was not necessary for health, safety and well-being. The Tribunal could also consider the period already served when assessing public confidence and professional standards.

6. While the Tribunal should not have described the issue as further punishment, its reasoning was directed to the protective purposes of the statutory scheme. Its decision was open to it in this unusual case, and it gave adequate reasons despite some imprecise wording.

• Medical Practitioners Tribunal: restored Dr Nooh’s name to the medical register after considering his application for restoration.
• High Court (Administrative Court): dismissed the GMC’s appeal under section 40A of the Medical Act 1983.