Privy Council Appeal No. 3 of 2001

Dr. John Harding Price	Appellant
	v.
The General Medical Council	Respondent

	FROM

	THE PROFESSIONAL CONDUCT COMMITTEE
OF THE GENERAL MEDICAL COUNCIL
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	JUDGMENT OF THE LORDS OF THE JUDICIAL
	COMMITTEE OF THE PRIVY COUNCIL,
	Delivered the 7th November 2001
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	Present at the hearing:-
			Lord Hobhouse of Woodborough
			Lord Mackay of Clashfern
			Sir Andrew Leggatt
		  	[Delivered by Sir Andrew Leggatt]
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1. 	Dr John Harding Price appeals to Her Majesty in Council from a determination of the Professional Conduct Committee of the General Medical Council made on 16th December 2000 that he had been guilty of serious professional misconduct, and from its direction that his name be erased from the Register and his registration suspended with immediate effect.  

2. 	The charge against Dr Harding Price concerned three different patients, Miss X, Mrs Y and Miss Z.  The Committee found the charge proved in all respects except for allegations, which were abandoned, that he had removed Miss X’s bra without consent and slapped her bottom, and except for an allegation that his actions in asking Miss Z questions regarding her sex life and financial position were “inappropriate”.  At the hearing before the Committee Dr Harding Price was represented by counsel, and each of the complainants was examined and cross-examined, as he was himself.    

3. 	Because the Committee fully explained their findings, it is sufficient to set out their decision without separately recapitulating the details of the charge or the evidence supporting it.  The decision was announced by the Chairman in the following terms:-
“Dr Harding Price, Miss X attended you on 22 August 1998 and stated, at the outset, that she did not know why she was there.  It was clearly your responsibility to explain fully, and to satisfy yourself that she understood, the nature and purpose of the consultation and of any examination.  This you failed to do.  Further, during the physical examination you moved her knickers without telling her what you intended to do and without seeking and obtaining her consent and kept her undressed unnecessarily.  You thereby failed to respect her privacy and dignity. 

In relation to Mrs Y you pursued detailed and intimate questioning without explaining why this might be relevant. This questioning related to Mr and Mrs Y’s sex life and other sexual matters.  You persisted despite her request to stop and consequent distress.  The Committee have found that you did not seek or obtain Mrs Y’s consent to convey details of the consultation to her general practitioner or to her husband.  Given the circumstances of the case you should have obtained such consents.  

These matters reveal a serious deficiency in both your communication skills and your attitude towards patients.  

At an early stage of a consultation, and before undertaking any examination, their nature and purpose should be fully explained by the doctor.  Patients’ consent should be properly obtained.  Patients are entitled to be treated with consideration and to have their privacy and dignity respected. 

Further, in relation to Miss Z you did not obtain a proper history and you failed to perform an adequate physical examination when she attended you on 6 September 1999. This represented a failure on your part to provide good clinical care.  

Your conduct displays an approach to practice which has no place in medicine.  Your evidence has demonstrated to the Committee that you have no insight into why your patients have understandably found your conduct to be upsetting. Your previous appearance before this Committee, although in relation to matters of a different kind and which occurred a number of years ago, should have left you in no doubt as to the need to follow proper standards of professional conduct and the potential consequence of failing to do so.  

Taking all these considerations into account, the Committee have judged you to have been guilty of serious professional misconduct in relation to the facts found proved in the charge against you.”

4. 	Before their Lordships’ Board Dr Harding Price conducted his own appeal.  In very full written submissions, to which he added orally, he emphasised that he had not physically harmed any of the three women referred to in the charge, and he attacked the competence of the Committee, the nature of the evidence and the fairness of the Council’s approach as being insufficient to justify an order for striking off.  

5. 	Dr Harding Price challenged the composition of the Committee, which during the hearing consisted of four doctors and four lay people.  One of the lay members was a nurse, who acted as Chairman.  He complained that all of them were inexperienced as members of the Committee.  After their findings had been announced one of the doctors withdrew on the ground that he could not be available at the adjourned hearing.  This left the lay members in a majority on the Committee.  

6. 	The General Medical Council (Constitution of Fitness to Practise Committees) Rules Order in Council 1996 (SI 2125 of 1996) requires a quorum of five for meetings of the Professional Conduct Committee, including at least one lay member.  In recent years the number of lay members has been considerably increased, no doubt in order to meet the criticism that doctors against whom complaints are made are being judged too much by members of their own profession.  The composition of the Committee on this occasion was unexceptionable having regard to the issue which the Committee had to consider.

7. 	The withdrawal of one of the doctors from the Committee was discussed with counsel, and no objection was made on behalf of either party.  The course followed was sensible and fair.  The decision in this case to continue the hearing without the member who withdrew cannot be criticised.

8. 	Dr Harding Price submitted that it was essential for an independent psychiatrist to be called.  It appeared to be his view that only with the assistance of an expert witness could the complexities of psychiatric practice and the way in which he conducted his consultations be properly appreciated.  It would always have been open to him to call an independent psychiatrist to give evidence on his behalf, if his counsel had taken the view that it would assist him, but none was called.  In any event none of the elements of the charge against him depended on a familiarity with psychiatry or its practices. 

9. 	The unfairness that Dr Harding Price imputed to the Council appeared to consist of the imposition of an interim suspension order.  It is to be borne in mind that the fairness of the procedure prescribed by the Medical Act 1983 was upheld by the European Commission of Human Rights in Wickramsinghe v United Kingdom (unreported) 9th December 1997.

10. 	Dr Harding Price reiterated that there was no evidence that he had harmed any of his patients.  That was so; and it was unsurprising, since, so far from charging physical harm, the allegations were of a failure to explain the purpose of his examinations, and of objectionable behaviour towards his patients. 

11. 	Their Lordships are not persuaded that there is merit in any of Dr Harding Price’s grounds for challenging the Committee’s determination of serious professional misconduct.  Of more moment is his challenge to their direction for the erasure of his name from the Register.  

12. 	After revoking the interim suspension of Dr Harding Price’s registration the Chairman announced the direction as to penalty in these terms:
“In deciding whether it is necessary to affect your registration, the Committee have taken into account all the matters urged in mitigation on your behalf including the testimonials and evidence from a character witness.  

Your conduct has fallen seriously below the standard which patients are entitled to expect of registered medical practitioners.  In all the circumstances the Committee have decided to direct the Registrar to erase your name from the Register. 

The Committee have further determined, that as your failings demonstrate a standard of practice which presents a risk to the public, it is necessary for the protection of members of the public that your registration should be suspended with immediate effect and have accordingly ordered that your registration be suspended forthwith.”

13. 	Fifty years of service to generations of patients as a general practitioner, and 40 years as a consultant, did not bode such an ignominious end.  For this result Dr Harding Price blamed a Committee which he said was relatively untrained and inexperienced in assessing evidence.  He did not accept that he had failed to explain the purpose of his examinations, or that the standard of his conduct presented a risk to the public.  He asserted that he had conducted himself in the consultations the subject of the charge honestly, honourably and correctly; and he was able to tender several letters of support and to call a witness as to character.  He submitted that he therefore ought not to have been struck off.

14. 	The Committee were satisfied that the substance of Miss X’s complaint was true, and it is significant that Dr Harding Price misconducted his consultation with her despite the presence of a chaperone.  After distressing Mrs Y by persisting in intrusive questioning about sexual matters, Dr Harding Price further exceeded what was permissible by telling her husband details of the consultation without her consent.  In relation to Miss Z he failed to provide good clinical care because he did not conduct a sufficiently full examination.  Since three patients complained, independently of each other, about widely diverse forms of misconduct, it is evident that no form of condition attached to continuance in practice would be apt to protect the public.  

15. 	The incidents involving Miss X and Mrs Y were bad examples of different kinds of misconduct, and in respect of them Dr Harding Price showed not only a lack of consideration for the patients concerned but a remarkable lack of insight into why they had found his conduct upsetting.  The conclusion was irresistible that, given the opportunity, he would be likely to continue to put at risk the dignity and privacy of patients in the future.   When the Committee alluded to a serious deficiency in Dr Harding Price’s “communication skills”, they must be taken, in the light of the way in which he conducted his appeal before the Board, to have been referring to an unwillingness, rather than an inability, to vouchsafe his patients the explanations to which they were entitled.  His previous appearance before the Committee was rightly treated as material only for the warning that it had afforded him about the consequence of failure to observe the standards to be expected of him. 

16. 	Although Dr Harding Price is now too old to practise as a general practitioner, their Lordships are satisfied that, if he were permitted to resume his practice as a consultant psychiatrist, he would be liable to behave in a similar way.  Suspension would therefore give the public insufficient protection.  Their Lordships consider that the Committee were entitled to conclude that Dr Harding Price had shown an approach to practice and an attitude to patients which have no place in medicine.  The direction that his name be erased from the Register was necessary, and is not amenable to challenge.  Their Lordships will humbly advise Her Majesty that the appeal ought to be dismissed.  The Appellant must pay the Council’s costs before the Board.