Sastry & Anor v General Medical Council

A medical practitioner's appeal against sanction under section 40 of the Medical Act 1983 is an unrestricted appeal by way of rehearing. The court must exercise its own judgment on whether the sanction was appropriate and necessary in the public interest or excessive and disproportionate. It must accord the tribunal appropriate respect without confining intervention to supervisory grounds. The degree of deference depends on the circumstances, including the tribunal's expertise and composition. In dishonesty and sexual misconduct cases, the court is better placed to assess public protection and professional reputation and may attach less weight to tribunal expertise. The review approach applicable to the regulator's limited appeal under section 40A does not restrict the practitioner's right of rehearing.

Dr Pantula Sastry and Dr Udodiri Okpara were registered medical practitioners whose names the Medical Practitioners Tribunal directed should be erased from the medical register. The General Medical Council, the statutory regulator of the medical profession, opposed their appeals.

Dr Sastry's case concerned treatment of a patient with lymphoma in India. The tribunal found that he had recommended and administered high-dose chemotherapy and stem cell transplantation despite knowing that insufficient stem cells had been collected. Dr Okpara's case concerned a prolonged course of sexually motivated misconduct towards a junior nursing colleague in a hospital.

May J dismissed Dr Sastry's statutory appeal in [2019] EWHC 390 (Admin). Julian Knowles J dismissed Dr Okpara's statutory appeal in [2019] EWHC 2624 (Admin). Their second appeals were joined. The central issues were the High Court's approach to sanction appeals under section 40 of the Medical Act 1983, the weight accorded to tribunal expertise in sexual misconduct cases, and whether erasure was proportionate in each case.

1. Both appeals were dismissed. Although each High Court judge had adopted an incorrect approach to the statutory appeal, the Court of Appeal independently assessed the sanctions and concluded that erasure was justified in both cases.

2. Section 40 of the Medical Act 1983 conferred an unrestricted right of appeal on a medical practitioner, without requiring permission. Under the Civil Procedure Rules and Practice Direction 52D, that appeal proceeded by rehearing. Section 40A conferred a different, limited right on the regulator to challenge a decision as insufficient for public protection, ordinarily by review (paras 97–99).

3. The jurisdiction under section 40 was appellate rather than supervisory. Following Ghosh v General Medical Council [2001] 1 WLR 1915 and Khan v General Pharmaceutical Council [2017] 1 WLR 169, the court had to decide whether the sanction was appropriate and necessary in the public interest or excessive and disproportionate. It could substitute another sanction or remit the matter. Restricting intervention to public law grounds would undermine the breadth of the statutory right (paras 101–109).

4. The tribunal deserved appropriate respect, calibrated to the circumstances, but the court retained its own duty to decide whether the sanction was wrong. Tribunal composition and the relevance of its medical expertise could affect the degree of deference. The approach in Bawa-Garba v General Medical Council [2019] 1 WLR 1929 was endorsed for section 40A review appeals, but its restrictive approach could not govern a practitioner's section 40 rehearing. May J had impermissibly deferred to the tribunal instead of analysing proportionality (paras 103–112).

5. In dishonesty or sexual misconduct cases, the court was well placed to assess public protection and professional reputation and was less dependent on tribunal expertise. Julian Knowles J had failed to apply that approach or independently assess whether erasure was necessary and proportionate (para 113).

6. Dr Sastry knowingly recommended clinically inappropriate radical treatment and withheld the information needed for informed consent. Differences in Indian healthcare systems and the absence of other regulatory findings did not diminish the gravity of that misconduct. Erasure was necessary and appropriate for public protection and public confidence (paras 115–116).

7. Dr Okpara's sustained, escalating and predatory sexual misconduct involved a marked professional hierarchy and included aggressive and threatening behaviour. His denials combined with counterclaims supported the finding of a complete lack of insight. The misconduct was fundamentally incompatible with continued registration and warranted erasure (para 117).

• Court of Appeal: In [2021] EWCA Civ 623 , dismissed both joined second appeals after independently assessing the sanctions, while finding errors in the High Court judges' approaches.
• High Court, Administrative Court: May J dismissed Dr Sastry's appeal under section 40 of the Medical Act 1983 in [2019] EWHC 390 (Admin) . Julian Knowles J dismissed Dr Okpara's statutory appeal in [2019] EWHC 2624 (Admin) .
• Medical Practitioners Tribunal: Directed erasure of Dr Sastry's name on 1 August 2018 following clinical misconduct findings, and erasure of Dr Okpara's name on 9 January 2019 following sexual misconduct findings.