Dr Antonio Metastasio v General Medical Council

An appeal under section 40 of the Medical Act 1983 is a rehearing in which the High Court may substitute its own decision, but it must respect the tribunal’s advantage in assessing witnesses. Particular caution is required when findings of fact or evaluative inferences depend on oral evidence and credibility.

In disciplinary proceedings involving sexual conduct with a former patient, the transactional nature of the conduct does not reduce its seriousness. A doctor’s repeated pursuit of sexual contact with a vulnerable former patient, while knowing the former professional relationship, may amount to a serious abuse of professional position and justify erasure to protect public confidence, even where there is good character, insight, remediation and a low risk of repetition.

The appellant, a consultant psychiatrist, appealed under section 40 of the Medical Act 1983 against a Medical Practitioners Tribunal decision directing erasure for misconduct.

The Tribunal found that he had knowingly followed, contacted and paid a former vulnerable patient for sexual contact, and later sought further contact. The appeal challenged the Tribunal’s findings of knowledge, consequential findings, impairment and sanction. The central issues were whether the Tribunal’s factual conclusions were wrong and whether erasure was excessive or disproportionate.

1. Appeal dismissed. The court dismissed all five grounds. Grounds 3 and 4 depended on the failure of Grounds 1 and 2 and therefore also failed.
2. Under section 40 of the Medical Act 1983, read with CPR r.52.21 and CPR PD 52D, the appeal was by way of rehearing. The court could substitute its own decision, correct material errors and draw justified inferences. However, it should be slow to interfere with findings dependent on the Tribunal’s assessment of witnesses. The Tribunal’s credibility findings were central to the case, and no proper basis for interference was established.
3. The Tribunal was entitled to infer that the appellant knew of the patient’s work in the sex industry and later recognised her as his former patient. The medical records, staff briefings, direct ward-round interactions, photographs, films and the parties’ conversation provided a coherent evidential basis. The Tribunal did not adopt an impermissible chain of reasoning or speculate improperly about witness credibility.
4. On sanction, the question was whether erasure was appropriate and necessary in the public interest or excessive and disproportionate. The court applied the approach in Khan v General Pharmaceutical Council [2016] UKSC 64; [2017] 1 WLR 169. The appellant’s good character, insight, remediation and low risk of repetition required serious consideration of suspension, but did not outweigh the seriousness of the misconduct.
5. Following and repeatedly contacting a vulnerable former patient, paying her for sexual contact and seeking further contact, all with knowledge of the former doctor-patient relationship, constituted a serious abuse of professional position. The fact that the contact was transactional did not make it less inappropriate and could intensify the power imbalance. Erasure was therefore neither excessive nor disproportionate.

The judgment itself records the Medical Practitioners Tribunal’s decision of 8 December 2022 directing erasure. The High Court dismissed the statutory appeal.