General Medical Council v MMono

On an appeal under section 40A of the Medical Act 1983, the court applies the ordinary appellate test. It may correct material errors of law, fact or reasoning, but ordinarily shows considerable restraint towards a specialist tribunal’s evaluative conclusions.

Where the Sanctions Guidance points clearly towards erasure, a tribunal imposing suspension must give cogent, case-specific reasons. Mitigation must be relevant to the central public-protection concerns. Dishonesty which deliberately misleads a professional regulator is exceptionally serious, particularly where the practitioner shows little insight or remediation.

Where the correct sanction is clear from the tribunal’s findings and evaluation, the appellate court may substitute erasure instead of remitting the matter.

The General Medical Council appealed under section 40A of the Medical Act 1983 against a Medical Practitioners Tribunal decision suspending Dr Mmono’s registration for 12 months.

The Tribunal had found repeated breaches of interim chaperone conditions, dishonesty in misleading an earlier Tribunal and the Interim Orders Tribunal, lack of insight and impaired fitness to practise. It concluded that suspension, rather than erasure, would protect the public and maintain confidence in the profession.

The central issues were whether the Tribunal had adequately reasoned its choice of sanction, whether it had given sufficient weight to the Sanctions Guidance, and whether the High Court should remit the matter or substitute the correct sanction.

1. The appeal was allowed. The Tribunal’s determination was quashed and the sanction of erasure was substituted.

2. Section 40A appeals are appeals governed by CPR Part 52. The court may allow an appeal where the decision was wrong or unjust because of a serious procedural or other irregularity. It may correct material errors of fact and law, but should be cautious before disturbing primary factual findings, especially those based on witness credibility. Greater caution is not required where the issue is an inference or where the seriousness of dishonesty and its impact on public confidence can readily be assessed by the appellate court.

3. The Sanctions Guidance is non-statutory guidance. The Tribunal must evaluate the particular facts, aggravating and mitigating features, the public interest and the doctor’s interests. However, where the Guidance points clearly towards a particular sanction, the Tribunal must explain why that sanction is not imposed.

4. Six erasure indicators were engaged, including a particularly serious departure from Good Medical Practice, deliberate or reckless disregard for professional principles or patient safety, abuse of trust, persistent and covered-up dishonesty, placing personal interests above patients’ interests, and persistent lack of insight. The Tribunal identified dishonesty in dealings with the regulator as the central and most serious feature.

5. The Tribunal failed to identify any good or cogent reason why suspension was proportionate instead of erasure. Most of the stated mitigation concerned matters unrelated to the central probity issue. Good character was insufficient in the context of previous disciplinary proceedings, repeated dishonesty and lack of insight. The determination therefore contained a missing link in its reasoning and failed to give sufficient weight to the Sanctions Guidance.

6. Dishonesty which deliberately misleads a professional regulator undermines the regulatory system on which the public is entitled to rely. The correct outcome was clear from the facts found and the Tribunal’s own evaluation. Remittal was unnecessary because the case was not finely balanced or on the cusp of erasure.

High Court (Administrative Court): The General Medical Council appealed under section 40A of the Medical Act 1983 against the Medical Practitioners Tribunal’s decision of 23 March 2018. The appeal was allowed, the suspension was quashed and erasure was substituted.