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You are here: BAILII >> Databases >> England and Wales High Court (Administrative Court) Decisions >> General Medical Council v George [2009] EWHC 1460 (Admin) (24 June 2009) URL: http://www.bailii.org/ew/cases/EWHC/Admin/2009/1460.html Cite as: [2009] EWHC 1460 (Admin) |
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QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Strand, London, WC2A 2LL |
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B e f o r e :
(SITTING AS DEPUTY JUDGE OF THE HIGH COURT)
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GENERAL MEDICAL COUNCIL |
Claimant |
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- and - |
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DR PLAVELIL ABRAHAM GEORGE |
Defendant |
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Mr M Forde QC (instructed by Weightmans, Solicitors) for the Defendant
Hearing dates: 10th and 12th June 2009
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HIS HONOUR JUDGE MOLE (sitting as Deputy Judge of the High Court)
JUDGMENT
(Friday 12th June 2009)
JUDGMENT
"5. When the matter came before the Fitness to Practise Panel in March of this year, that panel decided that it had no jurisdiction to decide the matter before it. The background to the matter was that, following difficulties in relation to the performance assessment, in 2005 the GMC had invited Dr George to undergo a medical examination and he declined to do so. That was a matter which was later pursued before the Fitness to Practise Panel on the basis that he had failed to comply with a reasonable requirement of the assessment team. In fact, as it emerged at the hearing in March 2008, there had been no such requirement made by the assessment team. All that had happened was that there had been an administrative requirement. On that basis the Fitness to Practise Panel concluded it did not have jurisdiction to deal with the matter. Furthermore, the Fitness to Practise Panel came to the conclusion that the allegations made against Dr George in relation to deficient performance had not been properly referred to that Panel, that they were not properly before the Fitness to Practise Panel and, again, it had no jurisdiction to deal with those matters.
6. It is a very unhappy history. It appears on the face of it that there have been many occasions on which Dr George has been uncooperative. It is also a history which does not reflect any great credit on the General Medical Council. The position has now been reached in which the General Medical Council, after a suspension of some five years of Dr George, still has to complete an assessment as to whether Dr George is fit to continue to practise. The point is made by Mr Colman on behalf of the GMC that there has been no substantive finding in respect of his fitness to practise and that the concerns about the defendant's professional performance remain unresolved. He says that it is now proposed to pursue the question of the defendant's fitness to practise by focusing on his health and the unresolved performance issues. In this regard he points to the fact that two of the bases on which fitness to practise may be found impaired under section 35C (2) of the Act are deficient professional performance and adverse physical or mental health.
7. On 18 April 2008, the Interim Orders Panel of the GMC considered the matter of the suspension. It expressed its concern about the defendant's health and performance it also expressed concern about the erosion of his medical knowledge and clinical skills which may have occurred since he last worked. It determined that it was necessary to maintain the order of suspension because the defendant could pose a real risk to patients if allowed to resume unrestricted practise and, it is said, would undermine the confidence that the public is entitled to place in the medical profession. In these circumstances, I am asked to grant a further extension of 12 months within which such further assessments and determinations may be concluded."
After setting out the law the Judge continued:
"10. I am very concerned in this case at the period of time which has passed during which a professional man has been prevented from practising his profession. He has been suspended for a period of five years. I have regard also to the fact that at the start of the suspension he was 60 years old. In the event that the suspension is lifted and he is allowed to practise again, it is going to be increasingly difficult for him to find a permanent post. Ms Bowron in her submissions has made the point that at his age it is most unlikely that he would ever again obtain a substantive post. The effect may be mitigated to some extent by the fact that he has suffered ill-health and may in any event have been unable to practise during parts of this period. Nevertheless, it is a very serious matter to prevent a man from practising his profession. However the GMC considers that there are real concerns as to the fit and as of this doctor to continue to practise and that is a matter of which the court has to give great weight.
11. The question is essentially whether the allegations made against the practitioner justify the prolongation of the suspension. I am satisfied that there is a clear need that the fitness of this doctor to practise should be investigated further by the GMC, both in relation to his previous performance and in relation to his current state of health. This further investigation is to my mind necessary in order for the protection of patients and the protection of the public and necessarily outweighs the prejudice which has been suffered and which will continue to be suffered by Dr George as a result of his suspension. It also outweighs the concerns that I have as to the very considerable delays which have occurred during the proceedings before the General Medical Council.
12. Given the unhappy position which has now been reached, I consider that it is incumbent on the General Medical Council to employ the utmost expedition in pursuing these concerns in carrying out the assessments and referring them to the appropriate panels, if that should be necessary, and in bringing this matter to a speedy conclusion. That is necessary not only in the interests of Dr George but also in the public interest and the public's confidence in the systems which are operated by the General Medical Council.
13. It is Dr George's duty as a member of the profession to cooperate fully with his professional body in the necessary further investigations and procedures. In considering the appropriate period of the extension, I proceed on the basis that Dr George will be required to cooperate fully with the General Medical Council. There is no evidence before me to support the view that he is by reason of his medical condition unable to comply with such reasonable requirements as May be made of him by the General Medical Council in that regard.
14. Having regard to all of these matters, I propose to grant an extension of six months. I consider that, on the assumption of cooperation by Dr George, it should be possible for the General Medical Council to complete the necessary procedures within that time. It would, of course, be open to the General Medical Council to make a further application to the court for a further extension should those procedures not have been completed within the period of six months. I express now my view that I very much hope that no such application will be necessary. If such an application is made, of course, it will be a matter for consideration by the judge on that occasion. However, it is my view that the court will on such an occasion need to be persuaded that the General Medical Council has pursued this matter with the greatest expedition. It seems likely that a court on any such future application would consider that any further extension would require compelling justification."
"The GMC accepts that the arrangements for the performance assessment are invalid because it should be carried out under the 1997 Rules and not the 2004 Rules."
The GMC is not required to abandon the performance assessment forever. It is entitled to continue/restart it under the 1997 rules.
However, in the light of the Med 4, it appears that Dr George is (and will probably remain) too ill to take part in the performance assessment until 9th of June 2009 at the earliest. Accordingly, the performance assessment will be put into abeyance although not abandoned.
In the light of all the circumstances, and especially the Med 4, the Registrar is considering the health issues raised under rule 7(3) of the 2004 Rules with a view to directing (that) an assessment of Dr George's health be carried out in accordance with the schedule to those rules.
The GMC will be inviting the High Court to extend the interim suspension order for a further nine months to cover the health assessment, and invites you to consent to such an extension."
"There is information before this Panel which suggests that Dr Abraham George's fitness to practise may be impaired. The concerns in question related to his ill health and the erosion of his medical knowledge and clinical skills which may have occurred since his registration was suspended in March 2003. The Panel has been provided with no information as to any steps the doctor has taken in order to keep his skills and medical knowledge up-to-date.
The panel is of the view that if Dr Abraham George were to be allowed to resume unrestricted practise, he could pose a real risk to patients and could also undermine the trust that the public places in the medical profession and its practitioners. The Panel further considers that it would not be in his own interests to do so, given the unresolved concerns.
The Panel is satisfied that, in all the circumstances, there may be impairment of Dr Abraham George's fitness to practise which poses a real risk to members of the public or may adversely affect the public interest or his own interests. Having balanced his interests and the interests of the public, the Panel considers that an interim order is necessary to guard against such a risk."
SUBMISSIONS
THE LAW
"(1) The court has the power and the duty to consider whether any extension of time beyond the initial period set by the GMC is appropriate. Under the scheme, this exercise in decision making is to be performed by the court as the primary decision-maker.
(2) The court has the power to determine that there should be no extension or that there should be the extension sought by the GMC or some lesser extension. In an appropriate case, the judge also has a power under section 41A (10) to terminate the suspension or to shorten the current period of suspension.
(3) The criteria to be applied are the same as for the original interim order under section 401A (1), namely the protection of the public, the public interest and the practitioner's own interests. The court can take into account such matters as the gravity of the allegation, the nature of the evidence, the seriousness of the risk of harm to patients, the reasons why the case has not been concluded and the prejudice to the practitioner if an interim order is continued.
(4) The onus of satisfying the court that the criteria are met falls on the GMC. The relevant standard is the civil standard.
(5) The judge must reach his decision as to whether to grant an extension on the basis of the evidence on the application, which will have been examined with care.
(6) The power to grant an extension and the power to make the orders set out in section 401A(10) represents the limit of the court's express powers in relation to interim measures. Parliament has not given the court power to determine in the first instance whether an interim suspension order or conditional order should be made. It has clearly taken the view that the GMC is better placed than the courts to decide such matters.
(7) It is not the function of the judge under section 401A(7) to make findings of primary fact nor is there any threshold test to be satisfied before the court can exercise its power of extension.
(8) The evidence on the application will include evidence as to the opinion of the GMC and the IOP or the Fitness to Practise Panel as to the need for an interim order. Appropriate weight will be given to that. All that is required is that the court should give that opinion such weight as in the circumstances of the case it thinks fit.
(9) Finally, the function of the court is to ascertain whether the allegations made against the medical practitioner, rather than their truth or falsity, justify the prolongation of the suspension."
CONCLUSIONS