Hill v General Medical Council

An appellate court hearing a professional disciplinary appeal must decide whether the tribunal’s decision was wrong, while giving appropriate deference to its assessment of witnesses, specialist practice and evidence heard over an extended hearing. Findings of dishonesty and deficient performance may properly support impairment where the practitioner lacks insight and repetition is reasonably likely. The court should not conduct a resentencing exercise or substitute its own view of sanction. A poorly phrased or potentially unfair question may nevertheless have a clear meaning; fairness and construction are distinct issues. Failure to disclose lapsed interim registration conditions may amount to dishonesty, although the fact that the conditions were lapsed and non-substantive is relevant to mitigation and sanction.

Dr Ruth Rhona Bronwyn Hill appealed under section 40 of the Medical Act 1983 against a Medical Practice Tribunal Service decision. Following a 62-day contested hearing, the tribunal found dishonest misleading conduct in answering “no” to an online question about conditions on her registration, found deficient professional performance, determined that her fitness to practise was impaired, and imposed a 12-month suspension.

The appeal challenged the construction of the online question, the findings on dishonesty and performance, the impairment determination, and the sanction. The central issues were whether the tribunal’s decision was wrong and whether its findings and sanction could properly stand on appeal.

1. Appeal dismissed. The tribunal’s decision was not shown to be wrong.

2. The appeal was governed by the principles summarised in GMC v Jagjivan [2017] 1 WLR 4438. Dishonesty is very serious; lack of insight increases seriousness; credibility findings based on oral evidence are virtually unassailable; appropriate deference is due to the tribunal’s expertise; and the appellate court’s judgment on applying principle to fact is secondary. The court must not conduct a resentencing exercise.

3. The online question asked whether conditions had ever been made on the doctor’s registration. It did not distinguish between interim and substantive conditions, or between lapsed and current conditions. Although the question may have been poorly phrased and potentially unfair, its meaning was clear. The tribunal was entitled to reject the suggested present-tense interpretation and to find that the negative answer was dishonest and misleading.

4. The fact that the conditions were lapsed interim conditions, and had not resulted in a finding of impaired fitness to practise, reduced the seriousness of the dishonesty but did not prevent the finding. The approach to dishonesty was not undermined by Ivey v Genting Casinos Ltd (t/a Crockfords Club) [2017] 1 WLR 679.

5. The tribunal was entitled to prefer the assessors’ evidence, reject the challenges based on withdrawn criticisms, assessment methodology, expert disagreement and third-party interviews, and conclude that the performance findings were not clearly wrong. The court’s disadvantage in assessing evidence from transcripts reinforced the need for restraint.

6. The findings of serious misconduct and deficient performance justified the impairment determination. The tribunal was entitled to find insufficient insight and a likelihood of repetition, notwithstanding positive evidence from colleagues.

7. The 12-month suspension was within the tribunal’s permissible range and was not disproportionate. Conditions were reasonably rejected because previous conditions had not produced the necessary improvement or insight. Immediate suspension was a separate issue and had properly been lifted pending the appeal.

• High Court (Administrative Court): appeal against the tribunal’s findings, impairment determination and 12-month suspension dismissed. The tribunal’s decision was not shown to be wrong.
• Medical Practice Tribunal Service: found dishonesty, deficient professional performance and impaired fitness to practise, and imposed a 12-month suspension on 29 September 2017.