Dr Kamran Ali v The General Medical Council

On an appeal under Medical Act 1983 s 40, the High Court must conduct a rehearing, but must give appropriate respect to the specialist tribunal’s findings. It should interfere with primary factual findings only where objective grounds show that the tribunal’s conclusion was plainly wrong or so out of tune with the evidence as to be unreasonable. Oral evidence may properly be relied on, but it should be tested against contemporaneous documents, known facts and the fallibility of memory. A tribunal need not begin with a global assessment of witness credibility or demeanour. It may determine the primary facts first and then assess whether the conduct was clinically indicated or sexually motivated. Reasons need not address every item of evidence, provided they explain why the losing party lost.

Dr Kamran Ali appealed under s 40 of the Medical Act 1983 against a Medical Practitioners Tribunal’s direction erasing his name from the medical register. The Tribunal had found several allegations proved concerning consultations with four patients, including that conduct towards Patient C was sexually motivated. It subsequently found Dr Ali’s fitness to practise impaired by misconduct and imposed erasure.

The appeal principally challenged the Tribunal’s primary factual findings, its assessment of sexual motivation, the adequacy of its reasons and its application of the balance of probabilities. The central issues were whether the Tribunal had impermissibly assessed Patient C’s credibility globally, reversed the burden of proof, or reached conclusions that were plainly wrong or unreasonable.

1. Appeal dismissed. The Tribunal’s determination was neither wrong nor unjust, and it had correctly applied the burden of proof. The appeal was dismissed under s 40(7) of the Medical Act 1983.
2. An appeal under s 40 is a rehearing rather than a mere review, but it is not a process of starting afresh without regard to the Tribunal’s decision. Appropriate weight must be given to the Tribunal’s specialist expertise, its familiarity with the evidence and its opportunity to hear and see the witnesses. The appellate court must not defer more than the circumstances warrant.
3. The Tribunal’s approach to disputed facts was lawful. It considered the relevant evidence allegation by allegation, including oral testimony, police interviews, text messages, clinical records and expert evidence. It did not begin with a general assessment that Patient C was credible, nor did it treat her account as correct unless disproved. Oral evidence may properly carry substantial weight where appropriate, and corroboration is not an absolute requirement.
4. The challenged primary findings were not plainly wrong or so out of tune with the evidence as to be unreasonable. There were objective grounds for the Tribunal’s findings, including the consistency of Patient C’s early account and the absence or presence of relevant clinical records. The Tribunal was entitled to reject the submission that compelling evidence was needed before rejecting Dr Ali’s account.
5. The Tribunal was also entitled to determine the primary facts before assessing sexual motivation. It considered whether inexperience, incompetence or an unfortunate manner provided an alternative explanation, addressed the alleged inherent unlikelihood of the conduct, and took account of Dr Ali’s good character before concluding that sexual motivation was proved.
6. The reasons were adequate. The Tribunal explained why it accepted or rejected the competing accounts, why it reached different conclusions concerning similar hand-holding allegations involving Patients A and C, and why it found sexual motivation. It was not required to address every submission or item of evidence.

• High Court (Administrative Court): Dr Ali’s appeal under s 40 of the Medical Act 1983 was dismissed.
• Medical Practitioners Tribunal: on 15 May 2023, allegations were found proved, including sexual motivation concerning Patient C. The Tribunal later found impairment by misconduct and directed erasure on 18 May 2023.