General Medical Council v Dr Chitlapalli Sathyanath

An appeal from a professional disciplinary tribunal is by way of review, not rehearing. The intensity of review depends on whether the challenge concerns primary fact, inferential fact or evaluative judgment. A tribunal must address the specific conduct charged; a finding that a general examination was clinically indicated does not answer whether each pleaded intimate act was clinically indicated. Where a finding on sexual motivation materially rests on that mistaken premise, an unsupported account of inadvertence or failure to consider material indicators, the finding is wrong and may require remittal. A specialist tribunal’s impairment assessment otherwise attracts substantial respect. Under the Medical Act 1983, the appeal court may quash the no-impairment decision, substitute a proved allegation and remit unresolved issues.

The General Medical Council appealed under section 40A of the Medical Act 1983 from decisions of the Medical Practitioners Tribunal dated 18, 20 and 23 June 2025. The Tribunal found that the doctor had carried out the alleged intimate conduct and had committed serious professional misconduct, but found that the conduct was clinically indicated, was not sexually motivated and did not currently impair fitness to practise. It issued a warning.

The appeal challenged the findings on clinical indication and sexual motivation, and the conclusion on impairment. The central issues were the proper appellate approach to inferential and evaluative findings, whether the Tribunal addressed the specific acts proved, and whether its reasons and impairment assessment could stand.

Appeal allowed.

1. An appeal under section 40A of the Medical Act 1983 is by way of review, not rehearing. The Court applied the approach in Sastry v General Medical Council [2021] EWCA Civ 623. Review intensity depends on the nature of the finding. Primary facts attract strong deference; an appellate court may more readily reconsider secondary or inferential facts; evaluative judgments attract restraint. Findings on misconduct, impairment and sanction by a specialist tribunal should not be disturbed absent an error of principle or a conclusion outside the proper range. The Court relied on Assicurazioni Generali SpA v Arab Insurance Group [2002] EWCA Civ 1642, General Medical Council v Jagjivan [2017] EWHC 1247 (Admin), General Medical Council v Bawa-Garba [2018] EWCA Civ 1879 and Re Sprintroom [2019] EWCA Civ 832.
2. Sexual motivation is a subjective state of mind proved by inference from primary facts and surrounding circumstances. It is a secondary or inferential finding, although appropriate caution is required where the inference depends materially on credibility assessments. The Court considered GMC v Haris [2020] EWHC 2518 (Admin), GMC v Haris [2021] EWCA Civ 763 and Professional Standards Authority for Health and Social Care v General Dental Council and Danial [2024] EWHC 2610 (Admin).
3. Ground 1 succeeded. The allegation required consideration of the specific actions in allegations 1(a) and 1(b), or at least those actions cumulatively. The Tribunal instead decided only that a groin examination was clinically indicated. It failed to address the accepted sequence of events, material parts of the expert evidence and the doctor’s evidence that there was no clinical reason for the touching. The Court substituted a finding that allegations 1(a) and 1(b) were not clinically indicated, so allegation 3(a) was proved.
4. Ground 2 also succeeded. The Tribunal’s conclusion on sexual motivation materially depended on its erroneous clinical-indication finding. Its description of the brushing as inadvertent did not correspond with the doctor’s evidence, which denied that the accepted conduct occurred. The Tribunal also failed to address material indicators relevant to sexual motivation. The Court did not decide the allegation itself and remitted it.
5. The Court restated the duty to give reasons, drawing on English v Emery Reinbold & Strick Limited [2002] EWCA Civ 605, Phipps v General Medical Council [2006] EWCA Civ 397 and Southall v General Medical Council [2010] EWCA Civ 407, but Ground 2 succeeded on the substantive flaws rather than failure to give reasons alone.
6. Ground 3 did not arise. Had it arisen, the Court would have upheld the Tribunal’s evaluative conclusion on impairment. The no-impairment finding and decision not to make a direction were nevertheless infected by the errors on allegations 3(a) and 3(b).
7. The no-impairment decision was quashed. Allegation 3(a) was substituted as proved in relation to allegations 1(a) and 1(b). Allegation 3(b), misconduct and impairment were remitted to a differently constituted tribunal.

• High Court (Administrative Court): The appeal under section 40A of the Medical Act 1983 was allowed. The findings on allegations 3(a) and 3(b), the no-impairment finding and the decision not to make a direction were quashed in the terms stated above. Allegation 3(a) was substituted as proved and the remaining issues were remitted to a differently constituted tribunal.
• Medical Practitioners Tribunal: On 18, 20 and 23 June 2025, the Tribunal found the relevant conduct proved and amounting to serious misconduct, but found no current impairment of fitness to practise. It issued a warning.