Privy Council Appeal No. 92 of 2001
Dr. Marta Stefan Appellant
The General Medical Council Respondent
THE HEALTH COMMITTEE OF THE
GENERAL MEDICAL COUNCIL
JUDGMENT OF THE LORDS OF THE JUDICIAL
COMMITTEE OF THE PRIVY COUNCIL,
Delivered the 6th March 2002
Present at the hearing:-
Sir Andrew Leggatt
Sir Philip Otton
[Delivered by Lord Steyn]
“The Committee have considered all the information presented to them, and paid attention to your submissions, your answers to their questions and the observations you have made regarding your fitness to practise.
In the light of the evidence considered today, the Committee have again judged your fitness to practise to be seriously impaired, by reason of a condition classified in the ICD-10 Classification of Mental and Behavioural Disorders as F60.0 – paranoid personality disorder. In particular, and bearing in mind advice from the Medical Assessor, the Committee were satisfied that you exhibited the following characteristics of this disorder: excessive sensitivity to setbacks and rebuffs; tendency to bear grudges persistently, e.g. refusal to forgive insults and injuries or slights; suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous; a tendency to experience excessive self-importance, manifest in a persistent self-referential attitude; and a preoccupation with unsubstantiated ‘conspiratorial’ explanations of events both immediate to yourself and in the world at large.Illustrations of the above can be found in the written submission which you presented to the Committee, and your oral evidence.
The Committee have carefully considered whether it would be sufficient to direct that your registration should be subject to conditions, so that you may return to some form of medical practice. In this regard they have noted the view of Dr Turner that you might be fit to practise on a very limited basis. The Committee were satisfied that your problems are too complex and you are now too inflexible to permit even a limited return to practise. With your provisional registration the Committee were satisfied that for practical purposes there was no realistic prospect of obtaining medical employment in the National Health Service.
The Committee note that there has been no change in your medical condition since the last hearing. They remain concerned that your ability to make sound professional judgements continues to be seriously affected by your condition. They feel that the adverse aspects of your condition may present themselves more actively if you were to be under specific emotional or other pressures, such as stress at work. Furthermore the Committee consider that your insight remains limited, that you lack judgment and that you have limited awareness of the nature and realities of clinical practice. The Committee are, therefore, concerned that patients could be placed at risk if you were to be permitted to return to medical practise. They do not feel that your condition is likely to improve within the foreseeable future to an extent that would enable them to allow you to return to medical practise. They have paid particular regard to the issue of proportionality and have weighed your own financial and personal interests against the need for protection of the public. Bearing this balance in mind the Committee have still concluded that they should direct that your registration be suspended indefinitely.
The current period of suspension of your registration will continue until the new direction takes effect. A note explaining your right to appeal against this decision, on a question of law, will be sent to you.
The effect of the direction is that the suspension of your registration will remain in force, and will not be reviewed by the Committee unless you ask the Committee to review it. You will not be entitled to ask the Committee to review the suspension until at least two years after the date on which the indefinite suspension takes effect. If, at that time, the Committee do not lift the suspension, you may ask the Committee to review the suspension again after further interval of at least two years has elapsed, and thereafter at intervals of not less than two years.”
“No appeal under this section shall lie from a decision of the Health Committee except on a question of law.”
The distinction between law and fact is often crucially influenced by the context. Here their Lordships are satisfied that a generous interpretation of “a question of law” is needed so as to ensure that no injustice will remain uncorrected. In the context of section 40(5) it is within the appellate jurisdiction of the Board to consider whether there is any or sufficient evidence to support a material finding. A clearly erroneous finding may disclose an error of law warranting interference. And a material misunderstanding of the evidence may amount to an error of law. And it goes without saying that any unfairness in the hearing and decision making of the Health Committee may invalidate its decision. Without trying to be exhaustive about the circumstances in which they may intervene their Lordships are satisfied that their appellate jurisdiction is wide enough to ensure that justice is done. That is how their Lordships’ have approached the appeal of Dr Stefan.