Sastry v General Medical Council

In an appeal from a medical disciplinary tribunal, professional conduct occurring abroad must be judged by UK professional standards, while taking account of local conditions and practices. Registration with the General Medical Council carries an obligation to comply with Good Medical Practice, whether or not the doctor holds a licence to practise.

An appellate court should show considerable restraint when reviewing specialist findings of fact, evaluative decisions about impairment and sanction, and assessments of public protection. It may correct material errors of fact or law, but should not substitute its own view for that of the tribunal merely because it might have reached a different conclusion. A tribunal may rely on credibility findings arising from evidence given about the allegations without charging dishonesty as a separate offence.

The appellant, a registered medical practitioner, appealed under section 40 of the Medical Act 1983 against three determinations of the Medical Practitioners Tribunal. The tribunal found that he had acted improperly in treating a patient in India, found misconduct and impairment of fitness to practise, and ordered erasure from the medical register.

The appeal challenged the tribunal’s treatment of the Indian clinical context, the fairness of the hearing under Article 6, its reliance on expert evidence, the findings of impairment, the proportionality of erasure, and findings said to amount to dishonesty. The central issues were the applicable professional standards for conduct abroad and the proper intensity of appellate review.

1. Appeal dismissed. The tribunal had jurisdiction under section 35C of the Medical Act 1983 to consider conduct occurring outside the United Kingdom. Because the regulator’s remit is directed to protecting the UK public and maintaining UK professional standards, conduct abroad is judged by UK standards. The tribunal must, however, take account of local limitations, facilities, practices and other relevant circumstances. It must not simply transpose the conduct into a UK setting.
2. The tribunal was entitled to use Good Medical Practice as the reference standard. Doctors who choose to remain registered with the GMC must comply with it, whether or not they hold a licence to practise. Its high-level principles can be applied flexibly in different jurisdictions.
3. The tribunal had taken the Indian context into account. In this case its findings were principally based on the appellant’s own evidence, including findings that he knew the CD34 cell count was inadequate, understood its significance, ignored an Indian second opinion, lacked credibility and had proceeded without fully informed consent. The local context was therefore of marginal relevance to the outcome.
4. There was no breach of Article 6. There is no free-standing duty on disciplinary prosecutors to gather every potentially relevant item of evidence. Fairness depends on the circumstances of the individual case. The tribunal had medical records, evidence about India, expert evidence and evidence from the appellant himself.
5. The tribunal was entitled to reject the relevant evidence of Professor Advani for the reasons it gave, including concerns about independence, impartiality and expertise in CD34 cell assessment.
6. The tribunal correctly considered impairment at the date of the hearing and was entitled to assess future risk by reference to the appellant’s lack of insight and remediation, notwithstanding that he was not expected to perform the same procedure in the United Kingdom.
7. Erasure was not disproportionate. The appellate court should approach specialist evaluations of clinical conduct, public protection and professional reputation with particular caution. The tribunal was not bound by the sanction sought by the GMC and had adequately considered the aggravating and mitigating features.
8. Findings that the appellant had given dishonest evidence did not require a separate dishonesty charge. Credibility and the manner in which evidence is given are relevant to fitness to practise when they arise in relation to the allegations being determined.

• High Court (Administrative Court): appeal under section 40 of the Medical Act 1983 dismissed. The court upheld the Medical Practitioners Tribunal’s Stage 1 findings, Stage 2 findings of misconduct and impairment, and Stage 3 decision to erase the appellant from the medical register.