Dr Itrat Khan v GMC

An appeal under section 40 of the Medical Act 1983 is a rehearing, but the court must give appropriate weight to the specialist tribunal’s factual and evaluative judgments. Misconduct requires conduct falling below the standard properly expected of a doctor and, on the approach accepted in this case, the shortcoming must be serious. Personal difficulties do not excuse conduct where professional obligations could reasonably have been observed. A doctor’s continuing sexual or improper emotional relationship with a patient falls within guidance prohibiting the pursuit of such a relationship, even where the relationship began before the person became a patient. Misconduct and impairment are separate stages. Impairment may be established by limited insight, inadequate remediation and the resulting risk to public confidence or professional standards.

Dr Itrat Khan appealed under section 40 of the Medical Act 1983 against a Medical Practitioners’ Tribunal determination finding misconduct and current impairment of fitness to practise. The findings concerned prescribing medication to, and accessing the records of, a patient with whom Dr Khan had been in a sexual and later emotional relationship, knowing the patient was vulnerable through depression and drug addiction. The Tribunal imposed a six-month suspension, which was not separately challenged. The central issues were whether the admitted conduct amounted to serious misconduct, whether the Tribunal unfairly relied on lack of integrity or misapplied the professional guidance, and whether its assessment of insight, remediation and risk justified a finding of current impairment.

1. Appeal dismissed. No material error of law, principle or fact was identified in the Tribunal’s determination.
2. The appeal was a rehearing without hearing the evidence again. The court applied its own judgment, while giving appropriate deference to the Tribunal’s specialist expertise and its advantage in evaluating evidence.
3. Misconduct involves conduct falling short of what is proper or reasonably expected of a doctor. The court accepted, for this appeal, that the conduct must also be serious. The Tribunal was entitled to find seriousness from the cumulative course of conduct, including prescribing on three occasions and repeatedly accessing the records of a vulnerable patient with whom the doctor had a sexual or emotional relationship.
4. The Tribunal was entitled to find a lack of integrity. The finding rested on the admitted and pleaded conduct and did not introduce an uncharged factual case. A separate express allegation of lack of integrity was unnecessary where the facts gave adequate notice and a fair opportunity to respond.
5. The Tribunal did not err by treating “pursuing” an improper relationship as including continuing one. The prohibition applied whether the relationship began before or after the person became a patient.
6. Misconduct and impairment were distinct questions. The Tribunal was entitled to find current impairment after considering insight, remediation, likelihood of repetition, public protection, public confidence and professional standards. Limited self-directed reading, without further substantive remediation, was insufficient on its assessment. The appeal was dismissed.

The appeal was brought directly to the High Court under section 40 of the Medical Act 1983 against the Medical Practitioners’ Tribunal’s findings on misconduct and impairment. The citation of the Tribunal’s decision is not stated in the judgment.