Nabili v General Medical Council

In a regulatory appeal, an adjournment is not justified merely because a practitioner is unrepresented or fails to attend. The tribunal must balance fairness to the practitioner against the public interest in the fair, economical and expeditious resolution of disciplinary proceedings. A practitioner relying on ill-health should provide contemporaneous, independent and verifiable medical evidence explaining why participation is impossible. The decision to proceed in absence is distinct from the decision to refuse an adjournment and requires separate consideration. Where the tribunal carefully tests the evidence and safeguards the absent practitioner’s interests, the resulting decision may stand. Persistent impairment, serious professional misconduct, lack of insight and failure to remediate may make erasure the proportionate sanction where it is necessary to protect patients and maintain public confidence.

Dr Aqdas Nabili appealed under section 40 of the Medical Act 1983 against a Medical Practitioners Tribunal decision erasing her name from the medical register. The Tribunal had previously suspended her registration after finding deficient professional performance. At the review hearing, it also found proved allegations that she had stored identifiable patient records insecurely at her home and had breached patient confidentiality.

Dr Nabili challenged repeated refusals to adjourn for legal representation or ill-health, the decision to proceed in her absence, refusal of telephone participation, the findings on misconduct, and the sanction. The central questions were whether the Tribunal’s decision was wrong or unjust because of a serious procedural or other irregularity, and whether erasure was proportionate.

1. Appeal test. The court applied section 40(7) of the Medical Act 1983 and CPR 52.21(3). The appeal could succeed only if the sanction was wrong or unjust because of a serious procedural or other irregularity.
2. Adjournments and representation. Applying General Medical Council v Adeogba [2016] EWCA Civ 162, the Tribunal was entitled to give substantial weight to patient protection, public confidence, and the fair, economical, expeditious and efficient disposal of regulatory proceedings. Dr Nabili had ample notice of the review, had no satisfactory explanation for obtaining representation late, and supplied no reliable evidence that an adjournment would secure representation or attendance. The refusals were carefully reasoned and proportionate.
3. Ill-health and absence. The Tribunal was entitled to require independent, contemporaneous and verifiable medical evidence. The hospital attendance document did not explain Dr Nabili’s condition, treatment or inability to participate. The court distinguished Brabazon-Drenning v UK CCNWH (2001) HRLR 6, where unchallenged medical evidence established that the practitioner was unfit to withstand the disciplinary process. Refusal of an adjournment and proceeding in absence were separate decisions, and both were properly considered. The Tribunal also took adequate steps to test the witnesses’ evidence.
4. Fresh evidence and merits. Fresh evidence explaining absence required consideration, at least de bene esse, but evidence going to the merits which could have been deployed at the hearing did not justify reopening the proceedings. The Tribunal’s findings on the unsecured records and confidentiality breaches were therefore unimpeachable.
5. Sanction. The combination of serious misconduct, deficient professional performance, persistent lack of insight and failure to remediate justified the conclusion that erasure was the only proportionate sanction capable of protecting patients and maintaining public confidence. The appeal was dismissed. Dr Nabili was ordered to pay the GMC’s costs, summarily assessed at £5,155.20.

• Medical Practitioners Tribunal: previously suspended Dr Nabili’s registration for 12 months after finding deficient professional performance. On review, it found misconduct and continuing deficient performance, and ordered erasure from the medical register.
• High Court (Administrative Court): dismissed the appeal under section 40 of the Medical Act 1983.