Jain v General Medical Council

An appeal against a Medical Practitioners Tribunal’s decision may succeed only where the tribunal’s decision was wrong or unjust because of a serious procedural irregularity. The appellate court must give appropriate deference to the tribunal’s specialist expertise, findings of fact and credibility assessments. It must not conduct a resentencing exercise or substitute its own view of sanction. A procedural irregularity warrants intervention only where it is sufficiently serious to create a real risk of unfairness or contamination of the evidence. A tribunal may find professional misconduct where a doctor’s conduct, record keeping or prescribing fell below proper standards, including where the doctor failed to address mannerisms likely to cause patient discomfort.

Dr Rajesh Raju Jain, a psychiatrist, appealed against conditions imposed on his registration by a Medical Practitioners Tribunal following findings of misconduct and impairment of fitness to practise. The findings arose from consultations with four patients in 2015 and included inappropriate questioning and communications, inaccurate records and inappropriate prescribing.

The disciplinary process lasted nearly four years and included interim orders, a health assessment and a procedural issue concerning assistance given to a vulnerable witness by video link. The appeal challenged delay, factual findings, the handling of patient C’s evidence, the findings concerning Dr Jain’s mannerisms and the proportionality of the sanction.

1. The appeal was dismissed. The tribunal’s findings that Dr Jain’s conduct amounted to serious misconduct and that his fitness to practise was impaired were not shown to be wrong or unjust.
2. On an appeal of this kind, the court may intervene only if satisfied that the tribunal’s decision was wrong or unjust because of a serious procedural irregularity. Appropriate deference is due to the tribunal’s specialist expertise. Findings of fact, particularly credibility findings, should not be overturned merely because another view of the evidence is possible. The court must not conduct a resentencing exercise in relation to sanction.
3. The tribunal was entitled to find that Dr Jain was aware of his longstanding mannerisms, even if he was not aware of each movement as it occurred, and that professional conduct required him to explain them in advance where they might cause patient discomfort.
4. The criticisms of the findings concerning patients A, B and D were forensic challenges to factual conclusions. They did not demonstrate material error. The tribunal was entitled to prefer the evidence of the patients and other witnesses and to rely on the evidence as assessed in its determination.
5. There had been a procedural irregularity in allowing a person involved in the factual history to assist vulnerable patient C and in permitting another person to remain present unseen at the video link. However, the tribunal addressed the matter carefully, removed the additional person, required the intermediary to be visible and balanced the patient’s vulnerability against hearing fairness. The irregularity was not serious and created no real risk of contamination of the evidence.
6. The delay in the disciplinary process did not establish that the tribunal’s findings were unreliable. The conditions were also not shown to be disproportionate, particularly since Dr Jain’s counsel had accepted that conditions were the appropriate sanction. The court noted, but could not alter, the rule under which conditions may continue during an unsuccessful appeal.

Medical Practitioners Tribunal Service: The tribunal found 17 allegations proved, determined that they amounted to misconduct and that Dr Jain’s fitness to practise was impaired, and imposed conditions on his registration for 18 months, subject to review.

High Court (Administrative Court): The appeal against those findings and the sanction was dismissed.