Sandon v. General Medical Council (GMC) [2003] UKPC 18 (27 January 2003)
ADVANCE COPY

	Privy Council Appeal No. 47 of 2002

Dr. Peter Henry Gauvain Sandon	Appellant
	v.
The General Medical Council	Respondent

	FROM

	THE PROFESSIONAL CONDUCT COMMITTEE
OF THE GENERAL MEDICAL COUNCIL
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	REASONS FOR REPORT OF THE LORDS OF THE
	JUDICIAL COMMITTEE OF THE PRIVY COUNCIL OF THE
27th January 2003, Delivered the 27th February 2003
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	Present at the hearing:-
			Lord Steyn
			Sir Andrew Leggatt
			Sir Philip Otton
[Delivered by Sir Andrew Leggatt]
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1. 	At the conclusion of the hearing on 27th January 2003 their Lordships agreed humbly to advise Her Majesty that the appeal ought to be dismissed with costs and that they would give their reasons later.  This they now do.

2. 	Dr Sandon appeals to Her Majesty in Council from a decision of the Professional Conduct Committee (“PCC”) of the respondent Council made on 16th May 2002 that his name be erased from the register.

3. 	The appellant admitted all the charges against him without exception.  They may be summarised as follows:

(i)		failing to respond to three letters of complaint from the daughter of an elderly patient dated respectively 7th December 1999, 5th January 2000 and 7th February 2000;
(ii)			sending to the Council what falsely purported to be a copy of a reply dated 23rd December 1999 to the first letter of complaint, though none had been sent;

(iii)			failing to respond to two letters from the Council dated 19th June 2000 and 17th July 2000 asking for copies of a patient’s medical notes;

(iv)			sending to the Council what falsely purported to be a copy of a reply dated 26th July 2000 to the letters from the Council, though none had been sent;

(v)			in 1998 failing to pay to a receptionist an allowance of £560 received from the West Sussex Health Authority for that purpose;

(vi)			in 1998 and 2000 consistently failing to provide promptly information sought by the Child Health Bureau about the immunisation records of children registered with his practice;

(vii)			in that period 1998 to 2000 treating opiate drug users and prescribing drugs to patients not registered with his practice without keeping adequate records of treatment;

(viii)		in the period March to May 2000 suffering his premises to be filthy and unhygienic, and to have fire exits blocked with rubbish, no fire extinguishers, no adequate security at the surgery, and drugs left in accessible places;

(ix)			in 1999 and 2000 failing to send patients’ registration forms to the area health authority, thus being unable to access their medical records and offering services to patients while still registered with another doctor.

4. 	The facts supporting these charges were admitted.  The PCC found them proved and proceeded to find the appellant guilty of serious professional misconduct.  In announcing the PCC’s conclusions the Chairman’s comments included the following:
“You have admitted that, over a period of time your conduct in relation to patients was unprofessional and not in their best interests.  The conditions and standards of your practice were well below that expected of a competent general practitioner and, in allowing this, your conduct was irresponsible, unprofessional and not in the best interests of your patients.  Additionally, your conduct in prescribing drugs to a number of opiate drug users who are not registered with your practice was inappropriate, irresponsible and not in the best interests of your patients.

Very seriously, the dishonest behaviour that you have displayed on a number of occasions and over a period of two years has no place in, and undermines the standing of, the medical profession.  Doctors are under an obligation to act in an honest and trustworthy manner.”

5. 	The PCC considered, but rejected as inappropriate, the imposition of conditions on the appellant’s registration.  They similarly rejected an order of suspension.  They bore in mind the need to balance against his own interest the protection of the public and the maintenance of confidence in the medical profession.  They directed that the appellant’s name be erased from the register.

6. 	Before their Lordships Mr Philip Grey argued on behalf of the appellant that he was unrepresented before the PCC, and that the PCC paid insufficient regard to his explanation why he behaved as he did and to the limited basis on which he asked to remain in practice.  Mr Grey submitted that the appellant’s behaviour in 1999 and 2000 exhibited what counsel styled “classic signs of depressive illness”, and that the dishonesty about letters was consistent with the behaviour of someone who cannot cope.  He invoked a medical report of 28th June 2000 prepared by Dr Fleming, a consultant psychiatrist.  It referred to the appellant’s account of the considerable stress that he had been under for 10 years due to single-handed practice, his poor paperwork management and poor financial management, culminating in bankruptcy in 1993.  He had suffered a “collapse” in 1994 and had become increasingly disenchanted with his work, which he had found increasingly burdensome.  Dr Fleming reported that the appellant “did not show any formal psychiatric diagnosis” but had “long standing work related stresses that is impairing his functioning”.  He recommended that the appellant be retired from his work as a general practitioner on medical grounds.  Thereafter the appellant did retire from general practice.

7. 	Mr Grey asserted upon instructions that the appellant had been wholly changed by giving up his work as a general practitioner.  He relied on letters from several friends and satisfied patients of the appellant testifying to his professional conduct whilst he was in general practice.  Dr Steven Ringer by letter commended the appellant’s work through a company called SchlumbergerSema Medical Services in undertaking disability assessments for the Department for Work and Pensions.  Counsel submitted that, although the appellant is admittedly unfit to return to general practice, he is fit to carry out the work that he has been doing for SEMA, since the risk that he posed to patients did not involve any failing of clinical judgment.  His mortgage exceeds his pension.

8. 	Upon this evidence Mr Grey based his plea that the PCC’s direction should be set aside and replaced by conditions under section 36(1)(iii) of the Medical Act 1983 that for three years the appellant should not act as a general practitioner or carry out work for the National Health Service and should be limited to conducting disability assessments.

9. 	Their Lordships forbear to repeat the divers ways in which over a period of two years the appellant showed himself quite unfit to practice as a doctor, except to recall that they included dishonesty and the inappropriate treatment of opiate drug users and the prescription of drugs to patients not registered with his practice.  The appellant suffered from no psychiatric illness or personality defect, but has attributed his behaviour to stress, while admitting that at the material time his practice was a “shambles” and he was unfit to act as a general practitioner.  The PCC had a professional duty to balance the appellant’s interest in continuing a limited form of medical practice against the public interest in upholding the standing of the medical profession.  Their approach has not been criticised.

10. 	In their Lordships’ judgment the PCC could not credibly have concluded that the appellant’s expectations should prevail over the reputation of the profession.  The direction that his name be erased from the register was in the circumstances inevitable.

11. 	For these reasons their Lordships humbly advised Her Majesty that the appeal ought to be dismissed with costs.