The Judicial Committee of the Privy Council Decisions

Manzur v. General Medical Council (GMC) [2001] UKPC 55 (4 December 2001)

Privy Council Appeal No. 24 of 2001

Dr. Khan Mohammad Anis-Uddin Manzur Appellant v.

The General Medical Council Respondent

FROM

THE PROFESSIONAL CONDUCT COMMITTEE

OF THE GENERAL MEDICAL COUNCIL

REASONS FOR REPORT OF THE LORDS OF THE

JUDICIAL COMMITTEE OF THE PRIVY COUNCIL OF THE

17th October 2001, Delivered the 4th December 2001

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Present at the hearing:-

Lord Hope of Craighead

Sir Anthony Evans

Sir Philip Otton

[Delivered by Sir Philip Otton]

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1. The appellant, Dr Khan Mohammed Anis-Uddin Manzur (Dr Manzur) appeals from a direction of the Professional Conduct Committee of the Respondent Council on 2 March 2001 that his name be erased from the Medical Register following the proof of facts relating to his conviction of criminal offences.
2. On 12 May 2000 the appellant appeared before the Bromley Magistrates Court when he pleaded guilty to five charges of false accounting and asked for five further similar offences to be taken into consideration. He was fined £1,500 for each offence and ordered to pay £200 costs.
3. At the hearing before the Council evidence of the convictions was adduced and the appellant admitted the fact which accordingly was formally found proved.
4. At the conclusion of the hearing the Chairman announced the determination and direction of the Committee in the following terms:

"THE CHAIRMAN: Dr Manzur, on 12 May 2000 you were convicted, after pleading guilty, on five charges of false accounting and you asked for five other offences to be taken into consideration. By your dishonesty and deceit, you obtained a not insignificant amount of public money from Bromley Health Authority. That dishonesty and false accounting came to light as a result of an audit which covered the period March 1996 to November 1998.

The Council's 1995 guidance, 'Good Medical Practice', in force at the time of these events, made it clear that doctors must be honest in financial matters relating to their work and must not defraud the service or organisation for which they work.

There is also the important issue of the public interest. The public has a right to expect doctors to be honest and trustworthy. The false accounting perpetrated by you reflects very badly not only on yourself but on the profession as a whole.

The Committee have noted the testimonials and mitigation on your behalf. However, in taking account of all the circumstances in this case and the grave view which must be taken of dishonesty by doctors, the Committee concluded that the appropriate decision is to direct the Registrar to erase your name from the Register.

The effect of the foregoing direction is that unless you exercise your right of appeal, your name will be erased from the Register 28 days from today. That completes the case."

Background

5. Between 1996 and 22 March 1998 the appellant, an Ophthalmic Surgeon, worked as an independent contractor for the Belmont Medical Centre, Bromley carrying out eye tests during domiciliary visits to various nursing homes. The remuneration paid by the Health Service for carrying out such services varies depending on several factors including the number of eye tests carried out at a particular time at the same location. The first two tests attract a fee of £24.94 and thereafter the fee for each examination is £6.94. The appellant altered the dates on claims forms to make it appear that he had carried out fewer tests on particular days and that they had in fact been carried out on other dates – hence claiming a greater fee than that to which he was entitled. This was the method used on each of the five charges and each of the five other offences taken into consideration.
6. Matters came to light as a result of an audit on behalf of the London Borough of Bromley which revealed that over-payments had been made. Three persons were investigated, namely, the dispensing optician, Dr Manzur and another Ophthalmic Surgeon. All three were charged with false accounting. The Optician pleaded guilty and received a sentence of Community Service. The other Ophthalmic Surgeon elected trial by jury in the Crown Court but following the submission of Medical Reports the Crown decided not to proceed with the indictment.

The Appeal

7. In the Petition and the Case in writing on his behalf the appellant seeks to set aside the direction to erase his name from the Register on a number of grounds. Ms Sheilagh Davies who appeared before the Board concentrated on a broad submission that the sanction imposed was unduly harsh and disproportionate to the gravity of the offences. She contended that erasure is the most severe in a wide range of sanctions and should only be invoked in the most serious cases. The amount involved was at worst £728. Dr Manzur had acknowledged from the outset a civil liability of £689 which sum he had re-paid to the Health Authority (and may be more) at an early stage. The record of the proceedings did not on its face make it clear that the Committee had appreciated the fact that the appellant had always denied that his criminal liability exceeded his civil liability and there was no suggestion to the contrary. Accordingly the Committee fell into error. Moreover the Committee did not ventilate or explore the other sanctions which were open to them. Counsel acknowledged that an admonition would have been too lenient, and that a conditional registration with supervision was unrealistic as there was no lingering doubt about the appellant's capability as a doctor. It was open to the Committee to postpone the hearing pending further investigation or developments. The most realistic alternative was a period of suspension from practice up to the statutory maximum of 12 months. Ms Davies submitted that having regard to the appellant's age of 64 years this conduct, although dishonest, was an "isolated fall from grace" during a long and distinguished career (which she helpfully outlined) and that the public interest did not require the ultimate sanction of erasure.
8. Their Lordships came to the conclusion that they should accede to counsel's submission and that they should humbly advise Her Majesty to allow the appeal, set aside the direction of erasure and substitute a period of suspension for three months. Their Lordships announced their decision at the conclusion of the hearing and indicated that they would deliver their reasons in writing at a later date.
9. Although there is some ambiguity as to the precise basis of overpayment upon which the Committee proceeded, their Lordships do not consider this of much significance in the light of the more potent factors in his favour. However arrived at, the amount attributed to the appellant was not great and substantially less than that attributed to the optician (in excess of £4,000) and the other doctor (in excess of £1,400). Although the optician was made subject to a Community Service Order she was not exposed to any form of disciplinary proceedings by a professional body. The criminal proceedings against the other doctor were abandoned (no doubt for good reason) and he has not been brought before the Professional Conduct Committee, nor, apparently, will he ever be. By contrast the appellant was ordered to pay a substantial fine of £7,500 and was the subject of these disciplinary proceedings. He has had a long career practising in the United Kingdom and in his native Bangladesh. His ability as a doctor has never been questioned. Moreover he has given service to others which has gone well beyond what is normally expected of a doctor to his patients. He has spent substantial periods of his own time in Bangladesh working in the Islamic Eye Centre in Dhaka alleviating the suffering of the disadvantaged in that deprived country where specialist eye care is often hard to come by. Their Lordships were told that he has raised money and frequently provided from his own resources to purchase spectacles for patients too poor to acquire them. His work in the Centre has received formal recognition by the authorities. In addition he set up the Mozaharuddin Multi-Craft Centre in honour of his father providing basic socio-cultural activities for the poor and illiterate. We considered that these are matters standing for his credit and upon which he (and the Board) can properly draw. He will shortly be retiring from the National Health Service and if the present direction were to stand he would be approaching 69 before he could apply to be restored to the register. In the light of all these matters their Lordships considered that the direction to erase was unduly harsh and disproportionate, that it was not necessary in the public interest and that they should invoke their rarely-exercised power to set aside a direction of the Professional Conduct Committee.
10. Their Lordships considered alternative forms of disposal. They recognised that this was a case of blatant dishonesty, which undermined the integrity of doctors in the public's perception. A mere admonition would be far too lenient. A conditional registration would be both too lenient and inappropriate. They considered the possibility of postponement but were satisfied that this would also be inappropriate. They concluded that the appropriate order was one of suspension of his registration for a period of three months to run from 17 October 2001, the date of the determination of the appeal.
11. Accordingly their Lordships have humbly advised Her Majesty that the appeal should be allowed, that the direction of the Professional Conduct Committee of the respondent Council that the appellant's name should be erased from the Medical Register be set aside and in substitution that his name should be restored to the Register but that his registration should be suspended during a period of three months (pursuant to s.36(1)(a)(ii) Medical Act 1983) – such period to commence and run from 17 October 2001.