Dr Nithya Santhanalakshmi Shunmugavel Pandian v The General Medical Council

An appellate court reviewing a professional disciplinary tribunal must respect the tribunal’s role as primary fact-finder. It should be slow to interfere with primary factual findings, but may do so where the findings are plainly wrong, unsupported by evidence, or cannot reasonably be explained by the tribunal’s advantages in seeing and hearing witnesses.

Where objective contemporaneous evidence exists, it should ordinarily be considered first and oral evidence tested against it. Where the only documents are alleged to be falsified, witness credibility and reliability may assume greater importance, including demeanour where appropriate. A regulator is not required to call every potentially relevant witness, and a tribunal need not address every argument expressly.

Dr Pandian appealed against a Medical Practitioners Tribunal decision suspending her for two months after findings of misconduct, dishonesty and impaired fitness to practise. The Tribunal found that she recorded cardiac, respiratory and abdominal examinations of Patient A although those examinations had not occurred.

The appeal challenged the Tribunal’s factual assessment, including its reliance on Patient A’s evidence and demeanour, the absence of evidence from a supervising consultant, and the admission of evidence about Patient A’s employment. The appeal was also lodged out of time because the Tribunal administration gave an incorrect deadline. The central issues were whether time should be extended and whether the Tribunal’s decision was wrong or unjust because of serious procedural or other irregularity.

The court extended time for the appeal. The delay resulted from misleading information in the Tribunal administration’s notification letter, and those circumstances justified extending the statutory period.

1. Ground 1 dismissed. The usual approach is to consider objective contemporaneous evidence first and test oral evidence against it, reflecting the unreliability of memory. That approach did not require interference here because the records of both examinations were alleged to have been falsified and therefore were not objective evidence of what occurred.
2. In the absence of reliable objective evidence, the Tribunal was entitled to focus on oral evidence and to consider demeanour as one factor. Its conclusion did not rest on demeanour alone. Patient A’s recollection that Dr Khan had underlined anxiety was supported by the records, her complaint was made relatively quickly, and Mr B corroborated her evidence on the central issue. Minor inconsistencies did not make the finding unreasonable.
3. The Tribunal was not required to make a separate finding on Dr Pandian’s credibility because she had no direct recollection of Patient A. The apparent illogicality of recording an examination that had not occurred did not outweigh the Tribunal’s assessment of Patient A’s reliability. The burden of proof was not reversed.
4. Ground 2 dismissed. It was for the parties to decide which witnesses to call. The GMC’s failure to call Dr Khan was not treated by the Tribunal as adverse to either party and did not create an error of principle.
5. Ground 3 dismissed. Evidence about Patient A’s employment had potential relevance when admitted. The Tribunal ultimately attached little weight to it, and that evaluation was not wrong.

The appeal was dismissed.

The appeal was brought from a Medical Practitioners Tribunal decision of the General Medical Council imposing a two-month suspension for misconduct, dishonesty and impaired fitness to practise. The High Court extended time and dismissed the appeal.