Sheela Jogula Ramaswamy v General Medical Council

On an application to revoke an interim conditional registration order, the court exercises an original jurisdiction. It considers the current evidence and arguments, while giving appropriate weight to the specialist tribunal’s assessment.

The task is one of risk assessment, not definitive fact-finding. The court must consider the nature and quality of the evidence, the possibility of further incidents, the risks to patients and public confidence, necessity and proportionality. No evidential threshold beyond the statutory requirements applies.

An unresolved absence of a health assessment may be a relevant fact even where alleged non-compliance is put aside. Tribunal reasons are read fairly and as a whole. A tribunal need not repeat the statutory test in every paragraph if its reasoning shows that the test was applied.

The claimant sought revocation under section 41A(10)(b) of the Medical Act 1983 of an interim conditional registration order imposed by an Interim Orders Tribunal under section 41A(1)(b). The order followed concerns about the claimant’s correspondence, possible health impairment and alleged misconduct towards a patient.

The order had been maintained on statutory reviews. Earlier proceedings concerning alleged non-compliance with health assessment directions had resulted in a suspension order, which was later quashed for procedural unfairness. The present claim concerned whether the renewed interim conditions were necessary and proportionate pending investigation.

1. Claim dismissed. The interim conditional registration order was upheld. The claimant was ordered to pay the defendant’s costs, summarily assessed at £8,000 for the hearing and £2,750 for preparation of the earlier skeleton argument. Permission to appeal was refused.
2. The court exercised its original jurisdiction. It considered the evidence and arguments available at the hearing, rather than restricting itself to the material before the Tribunal. Nevertheless, the Tribunal was a specialist body and its view was entitled to such weight as the court considered appropriate. The court should not lightly substitute its own assessment where the Tribunal’s view was justified.
3. The statutory and Guidance framework required a comprehensive risk assessment. The Tribunal was not required to determine disputed facts finally. It had to assess the nature and seriousness of the concerns, the cogency and weight of the information, the likelihood of further incidents, the possible effect on patients and public confidence, and whether an order was necessary and proportionate.
4. Although alleged non-compliance with directions for health assessment was put aside as a separate regulatory issue, the absence of an up-to-date health assessment remained a relevant fact. It meant that current information about the claimant’s mental health was unavailable and that the health concern remained unresolved.
5. The evidence, including the claimant’s correspondence and the expert material, provided a sufficient basis for concerns that a potential unmanaged health condition might affect fitness to practise and create a risk of harm. The court was not required to wait until risk crystallised into harm or until a definitive assessment became available.
6. The Tribunal’s reasons had to be read fairly and as a whole. Its opening statement accurately set out the statutory test. Later references to the statutory test being met did not show that it had forgotten the impairment requirement. The reasons adequately explained why conditions, rather than suspension, were necessary, workable and proportionate, and why an 18-month period was selected.

First-instance claim under section 41A(10)(b) of the Medical Act 1983. The court upheld the Interim Orders Tribunal’s order and refused permission to appeal.