General Medical Council v Bawa-Garba

On an appeal against a sanction imposed by a Medical Practitioners Tribunal, the court must respect the Tribunal’s expertise but intervene where its decision is wrong. A criminal conviction for manslaughter by gross negligence conclusively establishes the basis of the conviction for regulatory purposes. The Tribunal must therefore treat the practitioner’s personal failings as having been truly exceptionally bad, notwithstanding systemic failures, failures by others or personal mitigation considered at trial.

Those matters may remain relevant to sanction, remediation and future risk, but cannot reduce the established seriousness of the failings. Where the misconduct involved very serious harm, a particularly serious departure from professional standards and conduct fundamentally incompatible with continued registration, erasure may be required to maintain public confidence and proper professional standards, even where the practitioner presents little future risk and has remediated the relevant deficiencies.

The General Medical Council appealed under section 40A of the Medical Act 1983 against a Medical Practitioners Tribunal decision suspending Dr Bawa-Garba for 12 months. Her fitness to practise had been found impaired following her conviction for manslaughter by gross negligence arising from the death of a six-year-old patient.

The Tribunal accepted that her clinical deficiencies had been remedied, that the future risk to patients was low and that wider systemic failures had contributed to the circumstances. It considered suspension sufficient to maintain public confidence and proportionate, rejecting erasure. The central issue was whether that sanction was wrong and whether erasure was required to protect the public, maintain confidence in the medical profession and uphold proper professional standards.

1. Appeal allowed. The Tribunal’s sanction was wrong. The court substituted erasure for suspension.
2. The court applied the approach to appeals under section 40A stated in GMC v Jagjivan and PSA [2017] EWHC 1247 (Admin). The court had to decide whether the Tribunal was wrong, while respecting factual findings and deferring to the Tribunal’s specialist evaluation where appropriate.
3. Under rule 34 of the GMC (Fitness to Practise) Rules Order in Council 2004, the certificate of conviction was conclusive, subject only to disputed identity. This required the Tribunal to respect not merely the fact of conviction, but the basis on which the jury convicted Dr Bawa-Garba. The conviction established that her personal failings were truly exceptionally bad.
4. Systemic failures, failures by other professionals and personal mitigation could be considered in relation to sanction. They could not, however, reduce the seriousness of the personal failings below the level established by the jury. The Tribunal’s reasoning treated those matters as reducing culpability and therefore failed to respect the verdict.
5. The court rejected any general presumption that manslaughter by gross negligence necessarily requires erasure. Each case turns on its facts. Nevertheless, the relevant issue was whether suspension could maintain public confidence and proper professional standards where the misconduct involved a series of truly exceptionally bad failings, serious harm to a patient and a particularly serious departure from Good Medical Practice.
6. Remediation and the absence of continuing patient risk were material. They did not eliminate the need for erasure where the misconduct was fundamentally incompatible with continued registration and erasure was indicated by the Sanctions Guidance. The Tribunal therefore gave insufficient weight to the public-confidence and professional-standards objectives.
7. Bijl v GMC [2001] UKPC 41 provided an incomplete statement of the law and was effectively superseded by the statutory framework and the later authorities. The Tribunal’s approach had to be governed by the separate statutory requirements concerning patient safety, public confidence and professional standards.

• High Court (Administrative Court): Allowed the GMC’s appeal under section 40A of the Medical Act 1983 and substituted erasure for the Tribunal’s 12-month suspension.