General Medical Council v Varaha Vijaya Nageswara Appala Naidu Konathala

An appellate court reviewing a professional disciplinary sanction must respect the tribunal’s evaluative judgment, but may intervene where the decision contains an error of principle or falls outside the range of decisions reasonably open to it.

Where misconduct involves serious sexually motivated abuse of a patient, the assessment of public protection includes patient safety, public confidence and proper professional standards. A tribunal cannot treat limited insight as satisfying a guidance requirement for insight, or treat a low but real risk of repetition as insignificant where the misconduct is very serious.

Such conduct may be fundamentally incompatible with continued registration, making erasure the appropriate sanction.

The General Medical Council appealed under section 40A of the Medical Act 1983 against a Medical Practitioners Tribunal decision suspending Dr Konathala’s registration for 12 months with a review.

The appeal challenged both the validity of the appellant’s notice and the substantive sanction. The GMC alleged that the Tribunal had erred in assessing future risk, treated limited insight as mitigation, misapplied paragraph 97(g) of the Sanctions Guidance, and failed properly to explain its decision to impose suspension rather than erasure.

The central issues were whether the appeal had been validly commenced and whether suspension was within the range of sanctions reasonably open to the Tribunal.

1. Validity of appeal. The unsigned section 14 of Form N161 was a significant omission. However, the court’s seal indicated that the appellant’s notice had been issued and the appeal proceedings had begun. The court therefore had power under CPR 3.10 to remedy the omission. The appeal was commenced within the statutory period. [18]-[25]

2. Appellate approach. A sanction decision is evaluative and appellate intervention is limited. The court may nevertheless intervene for an error of principle or where the decision falls outside the bounds of what the specialist tribunal could properly and reasonably decide. [62]-[65]

3. Impairment. The Tribunal had fairly read its findings as addressing both past misconduct and future risk. Ground 1 therefore failed. [72]-[75]

4. Insight and paragraph 97(g). Limited insight may be a mitigating factor, although it carries reduced weight. But paragraph 97(g) required the Tribunal to be satisfied that the doctor had insight into the misconduct and did not pose a significant risk of repetition. On the Tribunal’s own findings, the Respondent had not shown sufficient insight. The possibility of developing insight during suspension could not satisfy the requirement. [76]-[94]

5. A low but real risk of repetition may be significant when the underlying misconduct is serious. The Tribunal therefore could not properly conclude that paragraph 97(g) was present. [91]-[94]

6. Sanction. The Tribunal’s findings established sexually motivated, gratuitous and non-consensual conduct undertaken for the doctor’s sexual gratification, involving an abuse of professional trust. The public-protection assessment had to include public confidence and proper professional standards, not merely physical safety. The Tribunal’s reliance on the conduct being opportunistic and isolated, and its narrow view of public protection, were errors of principle. The conduct was fundamentally incompatible with continued registration, and erasure was the only proper and reasonable sanction. [95]-[103]

7. The appeal was allowed and the Tribunal’s decision was quashed. The court provisionally considered that it should substitute erasure under section 40A(6)(c), but adjourned the decision hearing for 14 days to receive submissions on whether to exercise the substitution or remittal powers under section 40A(6)(c) and (d). [104]-[105]

• High Court (Administrative Court): Appeal allowed and the Tribunal’s sanction decision quashed. The court provisionally indicated erasure but adjourned the decision on substitution or remittal.
• Medical Practitioners Tribunal: The Tribunal found misconduct and impaired fitness to practise, then imposed 12 months’ suspension with a review. [2025] EWHC 1550 (Admin)