Bale v The General Medical Council

A professional tribunal must distinguish an unsuccessful factual denial from dishonesty. A finding that a doctor touched a patient, contrary to the doctor’s evidence, does not by itself establish dishonesty. The tribunal must assess the evidence carefully and apply the applicable dishonesty test without treating disputed facts as proof of moral culpability.

Professional misconduct may nevertheless be established independently where a doctor’s manner towards patients falls below the standards of politeness, consideration, dignity and partnership required by the relevant professional guidance. Where the relevant sanction has already been served, the court may allow the appeal without remitting the matter for reconsideration if no practical benefit would result.

The appellant, a doctor, appealed against a Medical Practitioners Tribunal decision finding several charges proved and imposing a nine-month suspension. The allegations arose from two consultations with female patients during his general-practice training.

He had been acquitted of an assault allegation concerning Patient A. In relation to Patient B, his criminal conviction was overturned because, although the Crown Court found that he had taken hold of her arm, it found no hostile intent. The Tribunal nevertheless found that he had been dishonest in denying that he touched her and had committed perjury in the criminal proceedings.

The central issues were whether the Tribunal had properly assessed the evidence, whether its dishonesty findings were justified, and what consequence should follow if the remaining findings concerning the consultations were upheld.

1. Appeal allowed. The Tribunal was wrong to find that the appellant had acted dishonestly or committed perjury. The evidence relied upon to establish that he had touched Patient B did not justify the further conclusion that his denial was dishonest. A factual finding against a doctor does not, without more, establish dishonesty.
2. The Tribunal had to take particular care because Patient B was unreliable in important respects and the appellant’s account was consistent with his belief that any contact, if it occurred, was an attempt to continue a medical discussion rather than hostile conduct. The Tribunal’s distinction between an initially dishonest denial and a later genuinely mistaken belief was also insufficiently explained.
3. The Tribunal had correctly recorded the twofold dishonesty test associated with R v Ghosh: the objective standard of ordinary reasonable and honest people, together with the question whether the appellant realised that his conduct would be regarded as dishonest. The application of that test did not justify the findings made.
4. The Tribunal was entitled to find, independently of dishonesty and the alleged assault, that the appellant’s manner towards both patients fell below the professional standards requiring doctors to be polite, considerate, honest, dignified and to work in partnership with patients. Those findings could support misconduct, although the seriousness and appropriate sanction without dishonesty were uncertain.
5. The court declined to remit the matter. The appellant had already served about eight months of the immediate suspension, and further proceedings would produce no practical benefit. The appeal was allowed and the costs of the appeal were ordered in the sum of £7,368, incorporating the outstanding interlocutory costs order.

• High Court (Administrative Court): the appeal from the Medical Practitioners Tribunal was allowed. The dishonesty and perjury findings were set aside, and the matter was not remitted.
• Medical Practitioners Tribunal: charges arising from two patient consultations were found proved and a nine-month suspension was imposed.
• Crown Court: the appellant’s appeal against conviction concerning Patient B was allowed. The court found that he had taken hold of her arm but that the conduct lacked hostile intent.