Nikhilesh Rao Vardhineni v General Medical Council

On an appeal under the Medical Act 1983, a tribunal may prove misconduct through cogent inferences from documentary and circumstantial evidence. Direct evidence of how confidential information was obtained is not essential where the evidence as a whole supports the finding.

An appellate court will not substitute its assessment merely because the tribunal relied on inferences, provided it addressed the central issues, considered the evidence logically and gave clear reasons. Erasure may be proportionate where misconduct is fundamentally incompatible with continued registration and the practitioner lacks sufficient insight.

The appellant, a doctor, appealed under section 40 of the Medical Act 1983 against a Medical Practitioners Tribunal decision directing his erasure from the GMC register under section 35D(2)(a). The Tribunal found that he had been involved in obtaining confidential PLAB2 examination information, creating and distributing teaching materials containing it, and dishonestly representing those materials as original work.

The appeal challenged the Tribunal’s factual findings, procedural fairness, the proportionality of erasure and the refusal of an application to adduce fresh evidence. The central issues were whether the findings were properly supported by circumstantial evidence and whether the sanction and procedure were lawful and proportionate.

1. The appeal was dismissed. The Tribunal’s findings, impairment determination and sanction were upheld.

2. The absence of direct evidence showing precisely how or when the confidential PLAB2 information was procured did not prevent the GMC proving its case. The Tribunal was entitled to draw inferences from the evidence as a whole, including the appellant’s connection with Aspire, his name beside the copyright symbol on the materials, the implausibility of his explanation and inconsistencies in his evidence.

3. The Tribunal had applied the legal advice given by its legally qualified chair. It considered the entirety of the evidence, addressed the central disputed issues, tested oral evidence against objective documentary material, considered the appellant’s good character and avoided deciding credibility solely by demeanour. Its reasons were clear and cogent, and there was no basis for holding its findings wrong or unjust.

4. There was no procedural unfairness in the Tribunal considering the late disclosure of the appellant’s marriage to Aspire’s sole director. The relevant Companies House material had been admitted before cross-examination, the connection had been identified, and the appellant had an opportunity to explain it.

5. Erasure was not disproportionate. On the Tribunal’s findings, the misconduct was fundamentally incompatible with continued registration. Erasure was the only appropriate and proportionate sanction to protect the public, uphold professional standards and maintain confidence in the medical profession, particularly in light of the appellant’s lack of insight.

6. Fresh evidence was refused. The appellant had provided no adequate explanation for not adducing the evidence before the Tribunal, and it was untested evidence which could not properly be introduced on appeal to repair omissions in the original case.

The appellant was ordered to pay the GMC’s agreed costs of £12,961.50, with liberty to apply regarding the payment date.

• Medical Practitioners Tribunal: On 9 December 2022, directed the appellant’s erasure from the GMC register under section 35D(2)(a) of the Medical Act 1983.
• High Court (Administrative Court): The appeal under section 40 of the Medical Act 1983 was dismissed.