The Judicial Committee of the Privy Council Decisions

Privy Council Appeal No. 47 of 1997

Dr. Roland Graf Appellant

v.

The General Medical Council Respondent

FROM

THE HEALTH COMMITTEE OF THE

GENERAL MEDICAL COUNCIL

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JUDGMENT OF THE LORDS OF THE JUDICIAL

COMMITTEE OF THE PRIVY COUNCIL,

Delivered the 10th December 1997

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Present at the hearing:-

Lord Slynn of Hadley

Lord Steyn

Lord Hope of Craighead

  ·[Delivered by Lord Slynn of Hadley]

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1. On 24th June 1996 the Health Committee of the General Medical Council constituted under Schedule I Part III paragraph 22 of the Medical Act 1983 directed that Dr. Roland E. Graf's registration as a medical practitioner be suspended for a period of twelve months.  The reason for that direction was that the Committee judged Dr. Graf's fitness to practise to be seriously impaired by reason of his mental condition.  He did not appeal against that decision within the twenty eight days provided by section 40(3) of the 1983 Act.  On 25th June 1997 the Health Committee at a resumed hearing under Part IV of the General Medical Council Health Committee (Procedure) Rules Order of Council 1987 were deeply concerned about his mental condition, again judged his fitness to practise to be seriously impaired and directed that his registration be suspended for a further period of twelve months.

 By petition dated 21st July 1997 Dr. Graf appealed against that direction.

2. Before their Lordships Dr. Graf appeared in person.  It was explained to him that an appeal from a decision of the Health Committee lay only on a question of law by reason of section 40(5) of the Act of 1983.  He nevertheless wished to explain, and their Lordships listened to, a number of grievances about which he feels deeply.

3. The background can be stated shortly.  Dr. Graf qualified as a doctor in 1969.  He has not practised since 1974 when he gave up practice, largely it seems through problems with his eye sight.  He does not now wish to practise as a doctor.

4. In 1981 he asked to be exempted from paying the annual registration fee because of illness and subsequently because of financial problems.  He was advised by the General Medical Council to apply for his name to be removed from the Register.  He did not wish to do that.  By letter dated 7th December 1981 he was told that the Council would need to consider whether he was fit to practise.  He was eventually interviewed by two consultant psychiatrists on 5th March 1982 who, by reports each dated 18th March 1982, found that he was not suffering from a mental illness but that he was suffering from a personality disturbance which was likely to affect his ability to practise as a doctor.  By letter dated 20th April 1983 the General Medical Council agreed that his case would not be referred to the Health Committee if he undertook to continue to refrain from practice and to agree that the Health Screener appointed by the Medical Council might request periodic reports from Dr. Graf's general practitioner.  The General Medical Council considering that those undertakings had been given, he was told that no further action would be taken in his case. 

5. In 1995 the General Medical Council received information appearing to come from the Fosse Health Trust that Dr. Graf had applied for a post as a clerical officer with the Trust.  Having considered the application the Health Screener took the view that Dr. Graf should be re-examined to see whether he was fit to practise.  In the light of that and subsequent correspondence his case was referred to the Health Committee under rule 9(3) of the Rules.  Further correspondence took place leading to the meeting of the Health Committee on 24th June 1996 when his registration was suspended. He has taken a number of points which, whether or not they are technically open to him on this appeal, can shortly be dealt with.

6. In the first place he objected to the Health Committee sitting in private.  That they were plainly bound to do by virtue of rule 17(1) of the Rules.

7. He said next that there was no information raising a question as to whether his fitness to practise was seriously impaired by reason of his physical or mental condition.  If his case had begun under rule 6 of the Rules, the application for the post of clerical officer and the letters from Dr. Graf were capable of constituting such information.  The proceedings, however, were under rule 9 where, undertakings having been given, if thereafter as a result of a report from a medical supervisor or from other information it appears to the President that the doctor's "physical or mental condition has otherwise deteriorated he may then refer the case to the [Health] Committee".  Here it seems to their Lordships that in the correspondence and in the application form there was information on which the President could properly refer the case to the Health Committee.

8. He then complained that neither the Registrar under rule 12(1) nor the Committee indicated "the physical or mental condition by reason of which it is alleged that his fitness to practise is seriously impaired".  It is accepted, he said, that he was not suffering from a mental illness, and mental disorder is not specific enough to be, and is not in any case, a mental condition within the meaning of the rule.  Since Dr. Graf was unwilling in 1996 to undergo a medical examination and in the light of the earlier reports of his personality disturbance or disorder it was obviously difficult for a precise diagnosis to be made.

In Crompton v. The General Medical Council (No. 2) [1985] 1 WLR 885 their Lordships' Board accepted that an indication of "mental disorder" could, if a more precise clinical diagnosis was difficult, be a sufficient notice of the mental condition relied on.  Whilst it is desirable that as precise a notification as is possible of the mental condition relied on should be given, their Lordships consider, as did the Board in Crompton, that in the present case a sufficient indication of the "mental condition" was given as to enable the appellant to deal with it.  Finally as to the hearing he alleges that the notification of the Health Committee's decision was prepared before the meeting of the Committee.  There is nothing to support that.  The Chairman of the tribunal told him that the determination was "written and approved by us immediately before you came in the room".  That clearly meant that it had been prepared after the parties had withdrawn and before he was re-admitted to the hearing following the Committee's deliberation in camera.

9. His overriding submission, however, is that he is not suffering from a mental condition such as seriously to impair his fitness to practise within the meaning of section 37 of the 1983 Act.  This is essentially a question for the Health Committee and not one of law for their Lordships.  No issue of law or procedure, apart from those to which reference has been made, has been raised by Dr. Graf upon which their Lordships could possibly interfere with the decision of the Health Committee.  Without referring to the voluminous bundle of letters from Dr. Graf which was produced to the Health Committee and to their Lordships it is sufficient to say that there was clearly material before the Committee upon which they could conclude as they did.

10. Their Lordships will humbly advise Her Majesty that the appeal should be dismissed.

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