Simawi v General Medical Council

On an appeal under section 40 of the Medical Act 1983, the High Court should respect the specialist tribunal’s assessment of sanction and intervene only if its decision was wrong. That deference remains important where the tribunal has assessed insight, remediation and protection of public confidence, although dishonesty is an area in which the appellate court may assess professional standards with less restraint.

A suspension may properly be imposed for long enough to permit remediation and preparation for review. A direction under section 35D(4A) for review of a suspension is not itself an appealable decision. If the suspension is quashed or replaced on appeal, the review direction falls away, although the court may impose its own review condition.

The appellant, a doctor, appealed against a Medical Practitioners Tribunal’s decision imposing a nine-month suspension under section 35D(2)(b) of the Medical Act 1983, together with a direction under section 35D(4A) that the suspension be reviewed before expiry.

The Tribunal had found two instances of dishonesty, involving a copied conference programme and altered revalidation information, together with other misconduct. It found current impairment, limited insight and a risk of repetition that had not been wholly eliminated, although repetition was unlikely. The appeal challenged the length of suspension and the review direction.

1. Appeal against suspension. The appeal was dismissed. Under CPR Part 52 and section 40 of the Medical Act 1983, the court had to allow the appeal only if the Tribunal’s decision was wrong. The appeal was by way of rehearing without hearing the evidence again.
2. The Tribunal’s decision was entitled to appropriate respect because it was a specialist body with experience of professional standards and had assessed the appellant’s insight and remediation. Its decision on sanction involved an evaluative judgment. The court would intervene only where the decision exceeded the range of decisions reasonably open to the Tribunal.
3. The Tribunal was entitled to impose nine months’ suspension. It had found that the appellant had acknowledged fault but had limited insight, that the risk of repetition had not been wholly eliminated, and that further work was required to develop insight and remediate the dishonesty. The period was therefore capable of providing adequate time for remediation and preparation for a review. Its punitive effect did not make it impermissible, since the principal purposes of professional discipline are public protection and maintaining confidence in the profession.
4. Review direction. The court expressed its view on the second ground because full submissions had been received, although the issue did not affect the outcome. Section 40(1) identifies the appealable decisions and does not include a direction under section 35D(4A) for a review. Section 40(3)(a), which treats an extension of suspension following review as a direction for suspension, reinforces that a review direction itself is not appealable.
5. A review direction is parasitic upon the Tribunal’s suspension direction. If that direction is quashed under section 40(7)(b), there is nothing to review. If the court substitutes its own direction under section 40(7)(c), the Tribunal’s review direction also falls away because it relates to the Tribunal’s direction, not the court’s substituted direction. The court may impose its own review condition if appropriate.

The judgment records no prior appellate decision. The appeal was brought to the High Court under section 40 of the Medical Act 1983 against the Medical Practitioners Tribunal’s sanction decision of 21 November 2019.