Dr Touseef Safdar v General Medical Council

On an appeal against sanction under the Medical Act 1983, the court conducts a rehearing and may substitute its own decision, while respecting the tribunal’s advantage in assessing live evidence. Erasure for dishonesty is not automatic. The sanction depends on the seriousness, persistence, motivation, impact, insight, remediation and risk of repetition, assessed against public protection and confidence in the profession. A denial of misconduct is not itself lack of insight, but intentional dishonesty is difficult to remediate without understanding and accepting what occurred, including its triggers and motivations. An abstract acceptance that dishonesty is wrong is insufficient. Where dishonesty is repeated, maintained, malicious, self-serving, harmful to another and involves abuse of professional position, erasure may be the minimum sanction necessary to maintain public confidence.

A Medical Practitioners Tribunal found that Dr Touseef Safdar had committed serious misconduct involving repeated dishonesty and that his fitness to practise was impaired. It directed that his name be erased from the medical register. The findings of misconduct and impairment were not appealed.

Under s 40 of the Medical Act 1983, Dr Safdar appealed against erasure, arguing that the Tribunal had failed to give sufficient weight to unusual personal pressures, had wrongly assessed his insight, and had overstated the risk of repetition. The central issue was whether erasure was appropriate and necessary in the public interest, or excessive and disproportionate.

Appeal dismissed. The Tribunal’s decision to erase the appellant’s name from the medical register was neither wrong nor disproportionate.

1. The appeal under s 40 of the Medical Act 1983 was by way of rehearing. The court could substitute its own decision on sanction and was less dependent on the Tribunal’s expertise where the misconduct was dishonesty. However, it remained slow to interfere with factual findings based on oral evidence, recognising the Tribunal’s advantage in hearing and seeing witnesses.
2. The alleged unusual features did not materially reduce the gravity of the misconduct. Matters occurring after the dishonesty could not explain it. The Tribunal was entitled to reject counsel’s characterisation of the pressures as unusual, particularly where the appellant himself had not given evidence supporting that explanation and the Tribunal had found deliberate and malicious conduct.
3. There was no error in the finding of insufficient insight. Denial of misconduct is not an absolute bar to insight, but intentional and repeated dishonesty is difficult to remediate without identifying and understanding the motivations and triggers and accepting what occurred. A general understanding that dishonesty is wrong does not demonstrate insight into the individual misconduct. The conditional apology, concessions as to misconduct and impairment, and general continuing professional development provided little evidence of insight or remediation.
4. The assessment that the risk of repetition was low but could not be excluded was reasonable. The Tribunal had not ignored the appellant’s previous good character or subsequent conduct.
5. The dishonesty lay towards the most serious end of the spectrum. It was repeated over several months, involved an evolving false narrative and a pattern of fabrication, was intended to benefit the appellant and harm another person, and abused his position as a doctor. The Tribunal was entitled, and correct, to conclude that a lesser sanction would undermine public confidence and fail to uphold proper professional standards. The appeal therefore failed and was dismissed.

High Court (Administrative Court): dismissed the appeal against the Medical Practitioners Tribunal’s sanction of erasure. The Tribunal’s findings of misconduct and impairment were not challenged.