Bux v The General Medical Council

An expert witness has an actual conflict of interest where personal interests actually influence, or are capable of influencing, the expert’s opinions. A potential conflict arises where the facts reasonably suggest such a conflict. The expert must disclose the relevant facts to those instructing the expert and to the court at the earliest opportunity, even if the expert considers the conflict immaterial. In regulatory proceedings, a tribunal may admit evidence that is fair and relevant, but expert evidence is unnecessary where the issue is legal or factual rather than technical. A deliberate false statement by an expert, assessed under the Ivey test, may justify a finding of dishonesty and erasure from the professional register.

Dr Zuber Bux appealed against findings by the Medical Practitioners Tribunal that he had acted in a conflict of interest, dishonestly and for financial gain, had prepared improper medico-legal reports, and had improperly performed a circumcision. The Tribunal found his fitness to practise impaired and directed his erasure from the Medical Register.

The appeal challenged the conflict finding, the alleged duty to disclose the relationship between Dr Bux and the solicitors instructing him, the findings concerning his reports and dishonesty, and the proportionality of erasure. The circumcision ground was not pursued. The central issues concerned the proper test for an expert’s conflict of interest, the scope of the disclosure duty, the admissibility of expert evidence before the Tribunal, and the effect of the Tribunal’s findings on sanction.

1. Appeal dismissed. The Tribunal was entitled to reach its own findings after considering the earlier County Court judgment, which was admissible but not binding and did not create an issue estoppel because there was no privity.
2. An expert is conflicted where personal interests actually influence, or are capable of influencing, the expert’s opinions. A potential conflict exists where facts reasonably suggest such a conflict. The expert must disclose all relevant facts and matters to those instructing the expert and to the court at the earliest opportunity. The duty under the GMC guidance did not materially differ from the legal duty.
3. The Tribunal correctly found an actual and serious conflict. Dr Bux’s financial interests, his wife’s position in the instructing firm, his failure to disclose the relationship despite previous advice, and his deliberately false Part 35.6 answers provided ample evidence. The Tribunal was entitled to distinguish the earlier County Court judge’s narrower finding.
4. The reports were improperly prepared. They diagnosed food poisoning without sufficient evidence or differential diagnosis, failed to identify a range of opinions or give adequate reasoning, and did not comply with CPR Part 35. The Tribunal’s reliance on medically qualified witnesses concerning the legal test was improper in principle, because the issues were legal and factual rather than medical or technical. That evidence was inadmissible or irrelevant, but its admission did not materially affect the result.
5. The Tribunal applied the Ivey test correctly. Its additional finding that Dr Bux knew his conduct was dishonest was unnecessary but did not invalidate the decision. Once dishonesty was established, impairment and erasure followed inevitably on the authorities cited.

The judgment describes an appeal from findings of fact, impairment and sanction made by the Medical Practitioners Tribunal on 9, 14 and 16 October 2019. The High Court dismissed the appeal.