DR. ANANDAGOPAL SRINIVASAN v GENERAL MEDICAL COUNCIL

An appellate court hearing a medical disciplinary appeal should respect primary findings of fact made by the tribunal that heard the evidence. It may interfere only in exceptional circumstances, such as where the findings are plainly wrong, unsupported by evidence, or cannot be explained by the tribunal’s advantage in seeing and hearing witnesses. A rehearing does not materially reduce that deference for primary facts.

A tribunal must give sufficient reasons to explain to the parties why they won or lost and to enable effective appellate review. Minor inconsistencies do not necessarily undermine a witness’s core account. The civil standard remains the balance of probabilities, even where allegations are serious and criminal proceedings have ended in acquittal.

Dr Srinivasan appealed under section 40 of the Medical Act 1983 against a Medical Practitioners’ Tribunal decision dated 26 May 2021. The Tribunal found that, during separate clinical examinations of two young female patients, he had exposed one patient’s breasts and stared at them, and had touched the other patient’s pubic region and attempted digital penetration.

The Tribunal found other allegations unproved, but concluded that Dr Srinivasan’s fitness to practise was impaired by sexual misconduct and ordered erasure from the Medical Register. He challenged the primary factual findings as wrong or irrational and argued that the Tribunal’s reasons were inadequate. The central issues were the appellate approach to factual findings, the adequacy of reasons, and the effect of the criminal acquittals.

1. The appeal was dismissed. The Tribunal’s findings of fact were sustainable, its reasons were adequate, and the sanction of erasure could not be challenged once the findings were upheld.
2. Under section 40 of the Medical Act 1983, an appeal is a rehearing without evidence and may succeed where the Tribunal’s decision was wrong or unjust because of a serious procedural or other irregularity. The court must respect the Tribunal’s specialist role and conduct a secondary judgment, but will not interfere merely because it might have reached a different conclusion.
3. For primary facts, the court should be very slow to interfere because the Tribunal saw and heard the witnesses and had comprehensive familiarity with the evidence. Interference remains possible in exceptional circumstances, including where the evidential advantage cannot explain the conclusion, the evidence was misread, or the finding was plainly wrong or one which no reasonable tribunal could reach. There is little relevant distinction between review and rehearing in this context.
4. The Tribunal was entitled to assess credibility by reference to contemporaneous documents, the consistency of the core allegations, the witnesses’ evidence, and the Appellant’s evolving and inconsistent accounts. Corroboration is not required. A complainant’s oral evidence may be preferred where the core allegation is established, notwithstanding peripheral inconsistencies.
5. The Tribunal’s reasons were sufficient. It was not required to analyse every item of evidence or submission, provided the parties could understand why they had won or lost and the appellate court could assess sustainability. The Tribunal properly treated the criminal acquittals as requiring careful assessment, while applying the single civil standard of proof, namely the balance of probabilities. The seriousness of the allegations did not create a heightened civil standard.
6. The similarities between the two incidents were a permissible factor enhancing the probability of the allegations after each allegation had been considered separately. The absence of DNA evidence did not preclude a finding of touching, and the Tribunal had resolved the issue of penetration in the Appellant’s favour.

• Medical Practitioners’ Tribunal: On 26 May 2021, found specified acts of sexual misconduct proved, determined that fitness to practise was impaired, and ordered erasure from the Medical Register.
• High Court (Administrative Court): The appeal under section 40 of the Medical Act 1983 was dismissed. The Tribunal’s factual findings, reasons and sanction were upheld.