The Judicial Committee of the Privy Council Decisions

Dr. Alexandra Maria Elizabeth Idenburg Appellant

v.

The General Medical Council Respondent

FROM

THE PROFESSIONAL CONDUCT COMMITTEE

JUDGMENT OF THE LORDS OF THE

JUDICIAL COMMITTEE OF THE PRIVY COUNCIL,

Delivered the 23rd March 2000

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Present at the hearing:-

Lord Clyde

[Delivered by Lord Clyde]

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1. On 1st September 1999 the Professional Conduct Committee of the General Medical Council held that the appellant had been guilty of serious professional misconduct and directed that her registration be suspended for a period of twelve months. The appellant had been contracted to work as a Senior House Officer at the Raigmore Hospital for the period of 7th February to 6th August 1996. After a period of leave from 27th June to 1st July 1996 she was due to return to her duties at the hospital on 2nd July 1996 but did not do so then or later. The Committee found in fact that she did not give any or any adequate prior notice of her intention to leave her post and that she had not subsequently provided any or any adequate explanation of her departure from her post. They also found that certain statements which she had later made to the General Medical Council in letters of 19th February, 7th March and 18th June 1997 were misleading and false. The appellant appeals from the decision of the Committee.

 

2. The letters containing the statements in question followed upon a letter sent on behalf of the Chairman of the Council’s Preliminary Proceedings Committee asking her to give a written explanation for her failure to return to Raigmore and her failure to give any prior notice or later explanation. In the letter of 19th February 1997, sent from Amsterdam, the appellant stated that:-

"… it was for medical reasons that I left the job in Scotland. What turned the scale was that there were complications with my pregnancy, and in order to try to prevent a miscarriage it was necessary to rest. Please excuse me that I find it a bit personal to fax detailed medical information about myself. If necessary my fiancé can ask my GP in Scotland for a medical letter. My fiancé – who is also a doctor – informed the hospital that I was not to attend work anymore."

 

3. In the letter of 7th March 1997, sent from Broadford in Skye, she stated:-

"It was for medical reasons that I left the job in the Raigmore Hospital at the end of June. There were complications with my pregnancy which necessitated me to rest in order to try to prevent a miscarriage. I was seen in Dr. Humphrey’s GP clinic in Broadford and by Mr. Lees (consultant obstetrics and gynaecology) of the Raigmore Hospital. The Raigmore Hospital was informed that I could not attend work any more for medical reasons."

 

4. The preliminary proceedings committee were however not satisfied with the explanations she had offered and by a letter dated 25th April 1997 asked if she could provide reports from Dr. Humphrey and Mr. Lees confirming her statements about her consultations with them or alternatively if she would give permission to the GMC to approach these doctors. The writer continued "I should stress that the GMC does not require medical confirmation, but simply information that the consultations took place". In response to that letter the appellant wrote by letter dated 12th May 1977 "to give you the permission to approach my G.P. and my Gynaecologist for the information that you require". In her letter of 18th June 1997, which followed on further correspondence from the Committee, she stated:-

"In my previous correspondence with you I mentioned that I was physically ill and completely unable to work out of the blue and therefore I was not in a position to give a long notice to the hospital … I did not give any subsequent explanation to the hospital because I presumed that notice of sickness is adequate."

 

5. The appellant did not attend the hearing before the Professional Conduct Committee nor was she represented at it. The Committee were satisfied that she had had due notice of the hearing and decided to proceed in her absence. She had indeed written on 2nd August 1999 to explain that she would not be able to attend "as I am presently with a 6 month old baby". She wrote again on 9th August 1999 making detailed comments upon the statements of the witnesses which had been sent to her. She asked that both of these letters should be presented as her defence. The Committee plainly took the letters into account. The charge originally alleged that due to her failure to give notice of her intention to leave her post the continuity of patient care at the hospital had been jeopardised. In her letter of 2nd August 1999 the appellant sought to counter this allegation and the Committee eventually found that it had not been proved. The appellant also explained in the letter that she did not give prior notice because she did not anticipate she was going to fall ill. On the other hand she claimed that her husband had called the registrar and medical staff and informed them of her ill health. Evidence was led of a brief telephone call received on 2nd July 1996 indicating that she would not be returning but saying nothing of ill health. There was also evidence of a letter dated 10th July 1996 apparently signed by the appellant stating that "due to circumstances beyond my control" she had had to extend her stay, complaining that she had been underpaid and saying that she was very disappointed and disillusioned and would not wish to return to her place of previous work. The committee were not persuaded that any adequate explanation of her departure had been given.

 

6. In the letter of 9th August 1999 the appellant took strong objection to statements by Dr. Ravangave and Dr. Lees disclosing without her permission detailed medical information which she claimed was confidential. She pointed out that in the letter of 25th April 1997 it had been stressed that the only information which the GMC would require was that consultations took place. At an early stage in Dr. Ravangave’s evidence, after he had stated that the first time that the appellant had attended the general practitioner practice was on 3rd September 1996, the chairman raised the point that the evidence would go beyond what had been covered in the letter. It was then decided that any such evidence led would be heard in camera and that course was adopted. The same course was taken with Dr. Lees. He stated that the appellant had been seen at the Raigmore Hospital early in September 1996 but when his evidence advanced to personal detail the public were excluded.

 

7. The appellant appeared in person before their Lordships and presented her case with great clarity and economy. The burden of her complaint was that the determination of the Committee was based upon information illegally obtained. She pointed out that the provisions of the consent which she had given had been overstepped and that the information which the medical witnesses had given should not have been admitted because it was obtained illegally. She argued that if the Committee were able to extend the scope of the consent there would be no value in giving a consent. She commented that it was odd that where professional confidence had been breached by the witnesses she should be charged with a lack of honesty.

 

8. The substance of the evidence from Dr. Ravangave and from Dr. Lees was not only directed to the point that it was only in early September 1996 that the appellant had first consulted the doctors, but also indicated that at that time her pregnancy was relatively recent. The latter point was obviously relevant to the truth of the assertion that she had had a problem with a pregnancy in early July, but it is difficult to accept that it did not go to some extent beyond the strict scope of the permission. But, however that may be, their Lordships are satisfied that the admissibility of the evidence does not depend upon its having been legally obtained. That principle is well established in the criminal law, as has recently been affirmed in Reg. v. Khan (Sultan) [1997] AC 558. The appellant argued that the principle was applicable only to criminal cases, but their Lordships are persuaded that it is not so restricted. It certainly applies to disciplinary proceedings such as that with which the present appeal is concerned. Indeed Rule 50 of the General Medical Council Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules Order of Council 1988 (S.I. 1988 No. 2255) enables an even wider scope to admissibility than would be permitted under criminal proceedings in England. What is essential is that it be relevant to the issue to be determined, and that was very plainly the case here. That the appellant had not seen the doctors until September 1996, which was within the scope of the permitted evidence, pointed strongly to the conclusion that she had not been unable to return to her work in July due to some problematic pregnancy. Further detail as to the stage of the pregnancy in September merely served to confirm that conclusion. In so far as the appellant was concerned at the publication of medical details personal to herself the Committee were careful to have the public excluded from the hearing during the brief passages of the evidence which related to the stage of her pregnancy and there should be no reason to fear that any material which she would regard as confidential would receive any wider publicity than was necessary for the purposes of the hearing. The whole hearing appears to have been conducted with every consideration for the fairness of the process and their Lordships find no ground for interfering with the conclusion reached by the Committee.

 

9. The appellant has also in her letter of appeal expressed disappointment at what she describes as the lack of integrity and trust shown by the Raigmore hospital staff in not believing her assertion that her absence over the final month had been due to ill health and in prying into her medical affairs. But in a situation where she has been found to have given no sufficient explanation for her unexpected absence and to have belatedly given a false account of her condition, the staff might well have ground for some lack of confidence in her; and indeed she does recognise in her letter of appeal, unfortunately too late, that she "should have reported it to the medical staffing more professionally".

 

10. Their Lordships will humbly advise Her Majesty that the appeal should be dismissed. The appellant must pay the costs of the appeal.