Dr Sherine Amin Hendawy Ibrahim v General Medical Council

On a statutory appeal from a Medical Practitioners Tribunal, the High Court must conduct the prescribed rehearing and exercise its own judgment, while giving appropriate weight to factual findings based on live evidence.

Dishonesty requires the tribunal first to determine the person’s actual knowledge or belief as to the facts and then to apply the objective standards of ordinary decent people. Timesheets may be dishonest where they represent that a doctor worked on site until a stated finish time, although the doctor left earlier and knew the representation was misleading. Persistent financial dishonesty, coupled with limited insight and potential patient-safety consequences, may justify erasure.

The appellant, a doctor, appealed under Medical Act 1983, section 40, against findings by a Medical Practitioners Tribunal that he had dishonestly submitted inaccurate timesheets, committed serious misconduct, remained impaired, and should be erased from the medical register.

The Tribunal also found that he had dishonestly misrepresented the origin of his practice of leaving work early. The appeal challenged the factual findings, the dishonesty finding concerning that representation, misconduct, impairment and sanction. The central issues were whether the Tribunal had fairly understood the pleaded allegations and evidence, whether the timesheets established dishonesty, and whether erasure was proportionate.

1. Appeal framework. An appeal under section 40 is by way of rehearing. The court may substitute its own decision, but must give appropriate deference to primary factual findings based on the Tribunal’s assessment of witnesses.
2. Allegation concerning the interview. The finding of dishonesty on allegation 6(a) was quashed. The allegation depended on the proposition that the appellant knew he had not been told to adopt the practice of taking his break at the end of the shift. He had never claimed that he had been expressly told to do so. His case was that he inferred permission from a conversation. The allegation could not fairly be reinterpreted after the event to allege that he lacked a genuine belief that the practice was authorised.
3. Timesheet dishonesty. The findings on allegations 3(a) and 3(b) were upheld. The timesheets represented that the appellant had worked on site until the stated finish times. The Tribunal was entitled to find that he knew the entries were misleading. The break defence could not explain departures substantially exceeding 30 minutes; the Maidstone explanation was reasonably accepted only for some earlier departures; and early arrival did not offset leaving before rostered finishing times because the contract was not one of flexitime.
4. Dishonesty test and fairness. Applying Ivey, the Tribunal was entitled to find dishonesty. The allegation was sufficiently particularised, and the appellant understood that the case concerned fraudulent claims for hours not worked and financial advantage.
5. Misconduct and impairment. The remaining dishonesty amounted to serious misconduct. Impairment followed from the need to maintain public confidence, uphold professional standards and address potential risks to patient safety. The fact that patient harm had not occurred did not prevent the statutory objective from being engaged.
6. Sanction. Applying the approach in Sastry and Okpara, the court independently assessed proportionality. Persistent and repeated dishonesty over approximately one year, involving payment for hours not worked, limited insight and potential patient-safety risks, made erasure appropriate and necessary in the public interest.

The appeal was dismissed except that the finding of dishonesty on allegation 6(a) was quashed.

• Medical Practitioners Tribunal: On 12, 14 and 20 September 2022, found dishonesty, serious misconduct and current impairment, and directed erasure from the medical register.
• High Court (Administrative Court): Appeal under section 40 of the Medical Act 1983. The finding concerning allegation 6(a) was quashed; the findings on the timesheets, misconduct, impairment and erasure were upheld.