General Medical Council (GMC) v Raychaudhuri

On an appeal under section 40A of the Medical Act 1983, the court may correct material errors of fact or law, while giving substantial deference to a specialist tribunal on credibility, insight, remediation and regulatory judgment. The appellate court may assess dishonesty with less deference where appropriate. The applicable dishonesty test requires the fact-finder first to ascertain the person’s actual knowledge or belief as to the facts, then to apply the objective standards of ordinary decent people. Not every dishonest act requires a finding of impairment, but probity and integrity are central to medical practice. Where misconduct already falls just short of impairment, a further finding of dishonesty in dealings with a senior colleague may cross the threshold.

The General Medical Council appealed under section 40A of the Medical Act 1983 against findings by a Medical Practitioners Tribunal that Dr Raychaudhuri’s fitness to practise was not impaired and that a five-year warning was sufficient. The Tribunal found that he had made misleading entries in a paediatric assessment form before examining a child and had made misleading statements to colleagues, but found dishonesty unproved. The appeal challenged the findings concerning statements to two nurses and to a consultant paediatrician, the impairment decision and the absence of a sanction under section 35D. The central issues were the proper appellate approach, dishonesty after Ivey v Genting Casinos UK Limited, and whether the Tribunal’s decision sufficiently protected the public.

1. The appeal was governed by section 40A of the Medical Act 1983 and CPR Part 52. The court could correct material errors of fact and law and draw inferences from established facts. It nevertheless gave substantial deference to the specialist Tribunal on credibility, insight, risk of repetition, remediation and the evaluative question whether fitness to practise was impaired. The court could attach less weight to the Tribunal’s expertise when assessing dishonesty and the protection of public confidence.

2. Ground 1 failed. The Tribunal was entitled to find that the respondent’s initial statement to the nurses was misleading but that the GMC had not proved that he knew it was false or that he was dishonest. The court found no inconsistency in the Tribunal’s nuanced findings and no improper reliance on the respondent’s good character.

3. Ground 2 succeeded. The Tribunal had found that the respondent denied writing examination findings before seeing the patient, that the denial was false and misleading, and that he knew it was false. Those findings were inconsistent with its conclusion that dishonesty was not proved. Applying both R v Ghosh and the correct test in Ivey v Genting Casinos UK Limited, the respondent’s actual knowledge of the material facts, assessed against the standards of ordinary decent people, meant that the denial was dishonest.

4. Not every dishonest act necessarily results in impairment. The assessment remains fact-sensitive and must consider current fitness to practise, the protection of the public, proper professional standards and public confidence. Here, the Tribunal had already regarded the misconduct as falling just short of impairment. The additional finding of dishonesty in the respondent’s later dealings with a consultant concerned about his probity crossed the relevant threshold.

5. The finding that the respondent was not impaired and the five-year warning were quashed. A finding of impairment and a finding that the denial to the consultant was dishonest were substituted. The case was remitted to the Medical Practitioners Tribunal for further consideration of sanction.

1. High Court (Administrative Court): allowed the appeal in part against the Medical Practitioners Tribunal’s decisions of 7 and 9 February 2017. Ground 1 failed, but Grounds 2 and 3 succeeded. The findings concerning dishonesty and impairment were substituted, and the case was remitted for sanction.