Dr Siong Lee v General Medical Council

An appellate court reviewing a Medical Practitioners Tribunal decision must respect primary findings, particularly credibility findings. Intervention is justified where a finding is materially wrong or outside the generous ambit of reasonable disagreement.

Under rule 34(1) of the General Medical Council (Fitness to Practise) Rules Order of Council 2004, hearsay may be admitted where it is fair and relevant. Fairness requires a careful assessment of the issues, the other evidence, the reason for the witness’s absence, the potential prejudice and the means of testing reliability. A preliminary tribunal may consider the registrant’s position when identifying the issues and assessing admissibility.

Dr Siong Lee appealed against decisions of a Medical Practitioners Tribunal. The tribunal found that he had dishonestly altered a patient’s medical records and suspended his registration for 12 months.

The preliminary tribunal admitted a deceased patient’s witness statement and complaint letter as hearsay. The substantive tribunal then found that the alleged telephone consultation, examination recommendation and referral had not occurred, and that the retrospective amendments and a subsequent complaint response were dishonest.

The appeal challenged both the admission of the hearsay evidence and the substantive tribunal’s assessment of the evidence and reasons.

1. Appeal dismissed. The decisions of the preliminary and substantive tribunals were neither wrong nor unjust.

2. The appeal jurisdiction under section 40 of the Medical Act 1983 is appellate rather than supervisory and proceeds by way of rehearing, although witnesses are not recalled. Appropriate weight must be given to the tribunal’s findings, especially findings based on credibility. The court may intervene where a primary finding is materially wrong, including where it is against the evidence, but the relevant test is whether it exceeds the generous ambit within which reasonable disagreement is possible: Yassin v the General Medical Council [2015] EWHC 2955 (Admin).

3. Hearsay admission under rule 34(1) requires a robust assessment of fairness. The factors identified in Thorneycroft v Nursing and Midwifery Council [2014] EWHC 1565 include the witness’s absence, any good reason for it, whether the evidence is sole or decisive, the other evidence, the issues and the available means of testing reliability.

4. The preliminary tribunal was entitled to consider the appellant’s statement and submissions to identify the issues. His concessions narrowed the central question to whether the events described in the amended records had occurred or were dishonest inventions. Considering his evidence did not reverse the burden of proof. The tribunal was also entitled to take apparently reliable supporting material at face value at the admissibility stage. This approach was consistent with R v BOB [2024] EWCA Crim 1494.

5. The substantive tribunal gave adequate reasons. It was entitled to use the earlier complaint letter to show that the complaint was recorded nearer to the events, rather than as independent corroboration. Its conclusion rested on a wider body of evidence, including the sequence of amendments, inconsistencies in the appellant’s evidence and the absence of contemporaneous records. The finding of dishonesty was therefore supported by the evidence.

• Medical Practitioners Tribunal: On 16 January 2025, allegations of dishonest retrospective amendments to a patient’s records were found proved. On 2 May 2025, the tribunal found impairment of fitness to practise and suspended the appellant for 12 months.
• High Court (Administrative Court): The appeal was dismissed. The tribunal decisions were held neither wrong nor unjust.