Privy Council Appeal No. 69 of 2000
Dr. Purabi Ghosh Appellant v.
The General Medical Council Respondent
THE PROFESSIONAL CONDUCT COMMITTEE
OF THE GENERAL MEDICAL COUNCIL
JUDGMENT OF THE LORDS OF THE JUDICIAL
COMMITTEE OF THE PRIVY COUNCIL,
Delivered the 18th June 2001
Present at the hearing:-
Lord Bingham of Cornhill
Lord Cooke of Thorndon
[Delivered by Lord Millett]
(i) on 7th February 1994 she twice failed to visit David Neil when requested to do so;
(ii) she prescribed Klaricid for him without having put herself in a position to make an adequate assessment of his condition and treatment needs;
(iii) she did not make any, or any adequate, arrangements for David's condition to be assessed in hospital;
(iv) by her actions and omissions she failed to ensure that David received adequate medical assessment and treatment, and failed to make an adequate record of the events of 7th February in David's medical records.
(v) she failed to visit Mr Lea on 4th March 1996;
(vi) she did not take sufficient care in filling in Mr Lea's cremation form.
(1) She was to seek and follow the advice of a Director of Postgraduate General Practice Education in undertaking supervised re-training in general practice designed to remedy the deficiencies in her clinical knowledge and skills revealed during the course of the proceedings with particular reference to clinical assessment, record keeping and communication skills;
(2) Before the next hearing of her case by the Committee she was to supply the Council with objective evidence of the satisfactory completion of this programme of retraining;
(3) She was not to engage in locum posts in any capacity;
(4) She was not to engage in any unsupervised practice or in single-handed practice;
(5) She was to advise any prospective employer and any agency with which she was registered, or whom she approached concerning medical employment, of the conditions imposed on her registration.
"Dr Ghosh, in April 1998 the Professional Conduct Committee found you guilty of serious professional misconduct in relation to the standard of care you provided, which fell short of the standard expected of a registered medical practitioner. They directed that for a period of two years your registration be subject to conditions requiring you to undertake supervised retraining in general practice to remedy deficiencies in your clinical knowledge and skills, with particular reference to clinical assessment, record keeping and communication skills. You were directed to supply the Committee with objective evidence of the satisfactory completion of such a programme.
In considering whether you have complied with the conditions imposed on your registration in April 1998, the Committee have carefully considered all the evidence before them today. They have noted that you sought advice initially, and were offered considerable help by the Office of the Postgraduate Dean and others in meeting the conditions.
You failed to comply with the arrangements for retraining agreed with the Postgraduate Dean and to co-operate with the programme of retraining which he and your general practice colleagues had instituted for your benefit. Moreover, there was a formal complaint from a patient about your professional conduct which led to your dismissal from the practice to which you had been attached for retraining.
No objective evidence of the satisfactory completion of any programme for retraining has been presented to the Committee. You have clearly broken conditions 1 and 2 which were imposed by the Professional Conduct Committee in April 1998 despite having had nearly two years in which to comply with them.
The Committee have taken note of the submissions made on your behalf. However, your failure personally to give evidence today either to explain your breaches of the conditions or to give assurances as to your future conduct have made it difficult for the Committee to be satisfied that the imposition of further conditions would provide sufficient protection for the public.
The Committee have concluded, on the evidence before them, that the protection of the public requires that your name be erased from the Register.
The Committee have further determined that it is necessary for the protection of members of the public that your registration in the Register should be suspended with immediate effect and they have accordingly ordered that your registration be suspended forthwith."
"The principles upon which this Board acts in reviewing sentences passed by the Professional Conduct Committee are well settled. It has been said time and again that a disciplinary committee are the best possible people for weighing the seriousness of professional misconduct, and that the Board will be very slow to interfere with the exercise of the discretion of such a committee. … The Committee are familiar with the whole gradation of seriousness of the cases of various types which come before them, and are peculiarly well qualified to say at what point on that gradation erasure becomes the appropriate sentence. This Board does not have that advantage nor can it have the same capacity for judging what measures are from time to time required for the purpose of maintaining professional standards."
For these reasons the Board will accord an appropriate measure of respect to the judgment of the Committee whether the practitioner's failings amount to serious professional misconduct and on the measures necessary to maintain professional standards and provide adequate protection to the public. But the Board will not defer to the Committee's judgment more than is warranted by the circumstances. The Council conceded, and their Lordships accept, that it is open to them to consider all the matters raised by Dr Ghosh in her appeal; to decide whether the sanction of erasure was appropriate and necessary in the public interest or was excessive and disproportionate; and in the latter event either to substitute some other penalty or to remit the case to the Committee for reconsideration.
"When the committee have … judged that a practitioner has been guilty of serious professional misconduct the effect of rr 30 and 31 is to require them, in deciding what, if any, direction to give, to consider each possible course of action open to them in sequence. The steps in the sequence are (1) to give no direction, (2) to direct that the practitioner's registration shall be subject to conditions, (3) to direct suspension, (4) to direct erasure. At each step the committee are to determine 'whether it shall be sufficient' to take that step. Only if they determine that it will not be sufficient are they to proceed to consider the next step."