Dr Shah Shahin Ali v General Medical Council

An appeal under Medical Act 1983 against a medical practitioners tribunal’s review decision is appellate rather than supervisory. The High Court may substitute its own decision, but must respect the tribunal’s evaluative expertise and the limits imposed by the rehearing procedure.

At a review of suspension, the practitioner may maintain innocence. That does not prevent the tribunal from considering whether the practitioner understands the seriousness and consequences of the established conduct, has developed insight, and has adopted strategies to prevent recurrence. The original criminal conviction and findings cannot be reopened. A suspension may be extended after an adjournment where the facts warrant it. The appeals were dismissed.

The appellant, a doctor, appealed under section 40 of the Medical Act 1983 against two decisions of a Medical Practitioners Tribunal. The first decision continued a finding that his fitness to practise was impaired by his conviction for dangerous driving and extended his suspension. The second imposed a further six-month suspension after the tribunal proceeded in his absence.

The consolidated appeals challenged the tribunal’s jurisdiction, alleged procedural irregularity, double jeopardy, improper reconsideration of the conviction, inadequate consideration of evidence, and the findings concerning insight and sanction. The central issues were whether the tribunal could rely on the criminal conviction without reopening it, whether denial of the offence was compatible with insight, and whether the suspension decisions were wrong or unjust because of serious procedural irregularity.

1. Appeals dismissed. The decisions were neither wrong nor unjust because of a serious procedural or other irregularity.
2. Under section 35D(5) of the Medical Act 1983 and rule 22 of the General Medical Council Fitness to Practise Rules 2004, a review tribunal may extend suspension where an adjournment prevents completion of the review. The power is available whether the adjournment occurs before or after a finding on current impairment, provided the facts warrant its exercise.
3. A practitioner is entitled to deny the conviction and the underlying conduct. The tribunal must not reopen or go behind the criminal court’s findings. Nevertheless, denial may create a tension with insight. The tribunal may assess whether the practitioner appreciates the seriousness and consequences of the established conduct and has developed strategies to recognise, prevent and manage comparable behaviour. Admission of misconduct is not a condition precedent to demonstrating insight.
4. The tribunal was entitled to treat the appellant’s continued attacks on the victim, the criminal court, the regulator and the tribunals, together with his failure to address the established conduct, as demonstrating insufficient insight. The evidence that he had maintained his medical knowledge and skills did not resolve the separate concern about insight.
5. An appeal under section 40 is a rehearing, but ordinarily without oral evidence. The High Court may substitute its own decision and must determine whether the sanction was appropriate and proportionate. It should make due allowance for the tribunal’s advantage in assessing evidence and professional standards.
6. The tribunal was entitled to proceed in the appellant’s absence where he had notice, fairness and the public interest had been considered, and no injustice was shown. It was also entitled to regulate its own procedure, including the order of speeches, provided the appellant had a full and fair opportunity to present his case.
7. The suspension was necessary and proportionate to maintain public confidence and uphold proper standards of conduct. The court could not investigate generic allegations of institutional racism or revisit matters already finally determined.

The judgment states that the two appeals were consolidated by His Honour Judge Tindal, sitting as a High Court judge, who identified five grounds for determination and struck out wider grounds. The High Court dismissed both appeals.