Arunachalam vThe General Medical Council

In professional disciplinary proceedings, sexual misconduct is inherently serious and may justify erasure even for a first-time offender with a good clinical record. Erasure is not, however, automatic. A tribunal must evaluate and balance the mitigating and aggravating features when considering each available sanction, including suspension. Merely identifying mitigation is insufficient if the tribunal does not show what weight it gave to it or how it affected proportionality. An appellate court must respect the tribunal’s factual findings and should not conduct a general re-sentencing exercise, but it may intervene where the sanction decision is flawed by an error of approach. The court may substitute a sanction where the material permits a just outcome and remission would cause further unnecessary uncertainty.

Dr Ganeshmoorthi Arunachalam appealed against the decision of a medical practitioners’ tribunal, upheld by the General Medical Council, to erase his name from the medical register. The tribunal found proved sexually motivated misconduct towards two junior female doctors: persistent inappropriate messages to Dr A and repeated unwanted touching and other physical contact towards Dr B. It found misconduct, impairment of fitness to practise and limited insight.

The GMC had supported suspension before the tribunal, while leaving erasure open. The central issue was whether erasure was disproportionate or whether the tribunal’s reasoning on sanction was legally defective.

1. Appeal allowed. The tribunal’s findings of fact and sexual motivation were not open to challenge. Sexual misconduct is inherently serious, particularly where a doctor abuses professional authority towards colleagues, and may warrant erasure even for a first offence.
2. The tribunal nevertheless erred in its approach to sanction. It listed mitigating factors, including previous good character, an unblemished record before the incidents, the absence of further offending and favourable testimonials, but did not evaluate or weigh them against the aggravating factors when considering suspension. The later reference to the professional and financial impact of erasure read as an afterthought and did not cure the defect.
3. The error was material. Although the tribunal was entitled to regard erasure as a possible response, the court had to reconsider whether that sanction was proportionate. The assessment required attention to public confidence, professional standards, the dignity and freedom of colleagues to work without molestation, the seriousness of the conduct, the absence of risk to patient safety and the available mitigation.
4. Applying the appellate principles stated in Assicurazioni Generali SpA v Arab Insurance Group [2003] 1WLR 577 and the guidance concerning deference in GMC v Jagjivan [2017] 1WLR 4438, the court did not substitute its view merely because it would have imposed a different sanction. The tribunal’s failure to conduct the required balancing exercise justified intervention.
5. Erasure was disproportionate in the particular circumstances. The court set aside the tribunal’s decision and substituted the maximum available suspension of 12 months, running from the date of the order. Remission was unnecessary and would have prolonged the appellant’s inability to practise and the uncertainty surrounding the proceedings.

• Medical practitioners’ tribunal: On 23 May 2017, the tribunal found the misconduct charges proved, found impairment of fitness to practise and ordered erasure, with immediate suspension pending appeal.
• High Court (Administrative Court): The tribunal’s decision was set aside. The court substituted a 12-month suspension.