Permanent Unfitness to Practise and Ex Parte Confirmation:
Commentary on Medical Council v Kwan [2025] IEHC 742

1. Introduction

This commentary examines the ex tempore judgment of Barniville P in Medical Council v Kwan [2025] IEHC 742, delivered on 8 December 2025.

The case concerns an application by the Irish Medical Council under s.76 of the Medical Practitioners Act 2007 (“the 2007 Act”) to confirm its decision to cancel the registration of Dr Thomas Kwan, a GP registered in the Specialist Division. The cancellation followed Dr Kwan’s conviction in England for two grave offences: attempted murder and administration of poison with intent to endanger life or cause grievous bodily harm.

The judgment is striking in two respects:

Factually, the case is described by the President of the High Court as among “the most unusual and serious” confirmation applications ever to come before the Court.
Legally, it powerfully re‑affirms:
- the operation of the expedited procedure in s.57(6) of the 2007 Act where there is a serious criminal conviction; and
- the High Court’s limited, deferential role under s.76(3) – confirming a decision unless there is “good reason” not to do so – and what that means in practice where cancellation is imposed for egregious criminality.

The core legal questions in the case can be framed as follows:

Did the Medical Council properly invoke the s.57(6) expedited procedure based on a foreign criminal conviction?
Was it lawful and reasonable for the Council to conclude that the respondent had “permanently ceased to be a fit and proper person” to practise medicine and to impose cancellation?
Under s.76(3), was there any “good reason” why the High Court should refuse to confirm the Council’s decision?
Were fair procedures complied with, notwithstanding that the application proceeded in the respondent’s absence and could properly be dealt with ex parte?

Barniville P answers each of these questions in favour of the Medical Council, confirming the cancellation of Dr Kwan’s registration and in doing so sets a powerful benchmark for how Irish courts and regulators should respond to extreme criminal misconduct by health professionals.

2. Factual Background

2.1 Professional and registration history

Dr Thomas Kwan obtained his medical degree from the University of Newcastle‑upon‑Tyne in 1996. He was provisionally registered in the UK in July 1996 and fully registered there in August 1997. He first obtained registration with the Medical Council in Ireland in January 2022, in the Specialist Division of the Register of Medical Practitioners.

2.2 Emergence of allegations and initial regulatory response

In mid‑February 2024 the Medical Council became aware, via media reports, that Dr Kwan had been charged in the United Kingdom with attempted murder. Notably, one report (Sky News, 7 February 2024) carried the headline: “Thomas Kwan: GP in court after being charged with attempted murder over suspected poisoning”.

The Council sought information from:

the General Medical Council in the UK (“GMC”), and
Northumbria Police, the force investigating the offences.

At first, little information was forthcoming. The GMC confirmed only that it had become aware of the charges via press releases and had no further documentation. Northumbria Police declined to provide details at that stage.

Subsequent media reports in early March 2024 suggested that Dr Kwan had also been charged with making or using ricin, a chemical weapon, and that a trial was listed for late July 2024. Those reports later proved partly inaccurate: he was not ultimately charged with using ricin, though his conduct involved extensive engagement with highly toxic substances.

In April 2024, in light of the gravity of what was emerging, the Council’s CEO, Ms Maria O’Kane, made a complaint against Dr Kwan under s.57 of the 2007 Act. This complaint was based on his arrest and charging in the UK and was the start of the formal statutory process that culminated in cancellation.

2.3 Interim suspension in Ireland

Having obtained confirmation in June 2024 from Northumbria Police that:

Dr Kwan had been charged with attempted murder,
he was detained in HMP Hull, and
his trial, initially fixed for July 2024, had been adjourned to October 2024,

the Medical Council decided to apply for interim suspension under s.60 of the 2007 Act.

On 24 June 2024, the High Court (O’Higgins J) granted an order suspending Dr Kwan’s registration until further order. On 15 July 2024, following Dr Kwan’s remote appearance and submissions, further orders were made under s.60 suspending his registration and prohibiting him from practising medicine until further order.

3. The Criminal Trial and Sentencing

3.1 Convictions

The criminal trial commenced at Newcastle Crown Court on 2 October 2024. At the outset, Dr Kwan pleaded guilty to:

attempted murder; and
administration of poison with intent to endanger life or to inflict grievous bodily harm.

Sentencing was adjourned and took place on 6 November 2024 before Mrs Justice Lambert, who imposed an extraordinarily severe total sentence of 31 years and 5 months’ imprisonment.

3.2 The offence conduct

The sentencing remarks, extensively recited by Barniville P, provide the factual foundation for understanding the regulatory decision. In summary:

The victim, Patrick O’Hara, was the partner of Dr Kwan’s mother. On 22 January 2024, Dr Kwan attended their home in disguise (hat, tinted glasses, surgical mask) posing as a community nurse conducting a health check and providing a routine Covid‑19 booster.
Using forged NHS‑style letters, fake organisational identities and a fabricated persona (“Raj Patel” of a non‑existent community nursing team), he had carefully groomed the victim’s trust over several months, arranging a home visit for “health monitoring and seasonal vaccinations”.
On the day, he entered the home, conducted apparent health checks, and then injected a toxic substance into Mr O’Hara’s arm under the guise of a Covid booster. When the victim experienced immediate intense pain, he falsely reassured him that it was an allergic reaction and hastened his departure.
Mr O’Hara quickly deteriorated, was hospitalised, and developed necrotising fasciitis requiring multiple surgical debridements and intensive care treatment. He survived but suffered lasting physical and psychological consequences.

The police investigation revealed:

that the poison was iodomethane, a highly toxic fumigant pesticide;
a glass tube containing the poison and a syringe were found at Dr Kwan’s home;
his phone contained 97 internet searches for iodomethane during the relevant period;
he possessed chemicals including mercury, thallium, sulphuric acid and arsenic, and materials sufficient to produce ricin, a scheduled chemical weapon;
he had amassed a “library” of texts on poisons and their effects, including lethal dosages; and
he had contemplated alternative poisoning scenarios (e.g. lacing food or drink) using further forged documents from fictitious organisations.

3.3 Motivation

The sentencing judge found that Dr Kwan’s motive was:

purely financial, linked to his dissatisfaction with what he saw as his entitlements under his late father’s estate; and
aimed at removing Mr O’Hara as an “obstacle” to his anticipated share in a property on his mother’s death.

This finding of cold, financially‑motivated planning, combined with elaborate deception using healthcare imagery and status, is central to the Medical Council’s later conclusion of permanent unfitness to practise.

4. Proceedings Before the Medical Council

4.1 PPC referral and use of s.57(6) expedited process

Following sentencing in November 2024, the Medical Council’s Preliminary Proceedings Committee (“PPC”) considered the matter. Under s.57(5) of the 2007 Act, because this was a complaint grounded in a criminal conviction to which s.57(1)(g) applied, the PPC was obliged to “immediately” refer the complaint to the Council.

The Council decided to consider the complaint under the expedited procedure in s.57(6), which allows immediate action – including cancellation – where:

the nature of the offence or the circumstances in which it was committed render the practitioner permanently unfit to continue to practise medicine; and
it is in the public interest to act immediately.

A meeting was scheduled for 27 June 2025 to decide on the appropriate sanction.

4.2 Notice and opportunity to participate

The Council ensured that:

all material for the meeting was delivered to Dr Kwan in hard copy via prison staff (initially HMP Hull, later HMP Frankland);
prison authorities confirmed on 24 June 2025 that he had been informed of the meeting and that he had “no interest to participate in the meeting in any form”.

He did not attend, did not instruct anyone to attend on his behalf, and did not seek an adjournment.

4.3 The Council’s decision to cancel registration

At its 27 June 2025 meeting, the Council decided to impose the sanction of cancellation of registration, relying on its powers under s.71 of the 2007 Act as invoked via s.57(6). The key elements of its reasoning were:

It noted the guilty pleas to attempted murder and to the administration of poison with intent to endanger life or cause grievous bodily harm.
It was satisfied that the UK convictions related to conduct which, if committed in Ireland, would constitute offences triable on indictment, thereby falling squarely within s.57(1)(g).
It regarded the offences and their circumstances as “most serious”, specifically finding that:
- Dr Kwan used his status as a doctor to plan and execute the crime;
- the acts were premeditated and carefully planned;
- his motive was financial gain;
- the offences involved trickery and exploitation of the victim’s vulnerability, in the context of the Covid‑19 pandemic and public trust in healthcare services;
- he left his victim knowing he had suffered an adverse reaction to the poison; and
- the offences caused permanent physical and psychological harm to the victim.
Based on these findings, the Council concluded that the offences rendered Dr Kwan a person who had permanently ceased to be a fit and proper person to practise medicine.
It considered that it was in the public interest to act immediately under s.57(6), both:
- to prevent any further deception or misuse of his status as a registered doctor; and
- to protect public confidence in the profession and in its regulation.
It regarded delay (e.g. by remitting the matter to the CEO for investigation and a full inquiry) as unnecessary, wasteful, and contrary to the objective of efficient and expeditious regulation.

The Council concluded that cancellation was the only appropriate sanction, given:

the extreme gravity and nature of the conduct;
the need to protect the public; and
the imperative to maintain trust and confidence in the profession.

It also regarded the severity of the criminal sentence (31 years 5 months) as significant and noted the guilty plea, but the latter obviously did not displace the need for cancellation.

4.4 The respondent’s limited correspondence

The only substantive engagement from Dr Kwan came in a letter dated 24 June 2025 (received 30 June 2025), in which he corrected one aspect of the Council’s earlier letter: he noted that he had not been convicted of “the production and use of a chemical weapon”, describing that as “absolutely incorrect”.

While factually correct, Barniville P considered this clarification irrelevant to the issue before the Court, given the uncontested and extremely serious actual convictions.

4.5 Notice of the decision and absence of appeal

The Council’s decision was notified to Dr Kwan by email (15 July 2025) and by post (16 July 2025. He was informed that he had 21 days to appeal to the High Court or to seek to set aside the Council’s decision. He did not do so.

His non‑engagement was consistent with earlier indications that he did not wish to participate in the regulatory process.

5. Summary of the High Court Judgment

The High Court was asked, under s.76 of the 2007 Act, to confirm the Council’s decision to cancel Dr Kwan’s registration.

The key conclusions of Barniville P were:

Jurisdiction and procedure: The Court was satisfied that the respondent had been properly served with the papers and that the application could lawfully proceed, including on an ex parte basis if necessary under s.76.
Compliance with s.57: The Court found that all statutory preconditions in s.57 were met:
- The complaint fell within s.57(1)(g) – a conviction outside the State for offences that would be indictable if committed in Ireland.
- The PPC correctly referred the complaint to the Council under s.57(5).
- The Council lawfully availed of s.57(6), concluding that the offences rendered the respondent permanently unfit to practise and that immediate action in the public interest was required.
Fair procedures: There was no breach of fair procedures. The respondent had been:
- given notice of the Council meeting and the supporting material;
- offered the opportunity to participate; and
- informed of his right to appeal the Council’s decision.
His refusal to engage could not be used to undermine the validity of the process.
Reasonableness of the sanction: The Court accepted that cancellation was not only within the range of reasonable sanctions but that any more lenient sanction would have been “manifestly unreasonable”. On the “shocking and macabre” facts, cancellation was effectively the only tenable outcome.
“Good reason” test in s.76(3): Under s.76(3), the Court “shall” confirm the Council’s decision unless there is “good reason” not to. Applying the principles (recently summarised by the same judge in Nursing and Midwifery Board v Burke [2025] IEHC 557), the President held that:
- there was no procedural defect;
- no breach of fair procedures; and
- no manifest unreasonableness in the Council’s reasoning or choice of sanction.
Accordingly, there was no “good reason” to refuse confirmation.
Order and costs: The Court confirmed the cancellation decision as sought in the originating motion and made no order as to costs, noting that the Council did not seek costs in light of the respondent’s long‑term imprisonment in the UK.

6. The Legal Framework

6.1 Section 57: Complaints based on criminal convictions

Section 57 of the 2007 Act sets out the statutory pathway for dealing with complaints, including those arising from criminal convictions.

Section 57(1)(g) provides that a complaint may be made (including by the Council itself) on the ground of:

“a conviction in the State for an offence triable on indictment or a conviction outside the State for an offence consisting of acts or omissions that, if done or made in the State, would constitute an offence triable on indictment.”

This provision is central here: it allows the Irish regulator to respond to serious offending outside the State, using the foreign conviction as the trigger, provided that the conduct would amount to an indictable offence if committed in Ireland. Attempted murder and serious poisoning offences plainly meet this test.

Section 57(5) dictates that where a complaint falls within s.57(1)(g):

“the Preliminary Proceedings Committee shall immediately refer the complaint to the Council.”

This removes any discretion from the PPC once it is satisfied that the complaint is grounded in such a conviction.

Section 57(6)(a) then creates an expedited route for cases of serious conviction:

“(6) The Council shall consider a complaint referred to it under subsection (5) and—
(a) if it is of the opinion that—
(i) the nature of the offence that is the subject of the complaint or the circumstances in which the offence was committed render the practitioner permanently unfit to continue to practise medicine, and
(ii) it is in the public interest that it take action immediately under this paragraph,
the Council shall decide under section 71 to impose on the practitioner the sanction referred to in section 71(f) as if the complaint were a report referred to in section 69(1) of the Fitness to Practise Committee in relation to the complaint, and the other provisions of Part 9 (except section 72(2)) shall apply to that decision accordingly…”

The “sanction referred to in s.71(f)” is cancellation of registration – effectively erasure or striking off.

The combined effect is that, in a qualifying conviction case, the Council may:

bypass a full Fitness to Practise Committee inquiry; and
proceed directly to cancellation, provided it is satisfied as to:
- permanent unfitness arising from the offence or its circumstances; and
- the need to act immediately in the public interest.

6.2 Section 60: Interim suspension

Section 60 allows the Council to apply to the High Court for interim suspension of a doctor’s registration where it is necessary to protect the public pending the final outcome of disciplinary proceedings. This power was used early in the process, with O’Higgins J making such orders in June and July 2024.

While not the focus of this judgment, the use of s.60 is important context: it underscores that, even before conviction, the regulatory system can act protectively where serious allegations exist.

6.3 Sections 71 and 76: Sanctions and High Court confirmation

Section 71 lists possible sanctions available to the Council, including:

advice, admonishment or censure;
attachment of conditions to registration;
suspension; and
cancellation (erasure) under s.71(f).

Section 76 deals with confirmation by the High Court of a s.71 decision. Crucially, s.76(3) provides:

“The Court shall, on the hearing of an application under subsection (1), confirm the decision under section 71 the subject of the application unless the Court sees good reason not to do so.”

This wording establishes:

a statutory presumption in favour of confirmation; and
a limited supervisory role for the High Court – it does not rehear the case de novo or substitute its own view of the appropriate sanction unless there is “good reason” not to confirm.

7. Precedents and Authorities Cited

7.1 Nursing and Midwifery Board v Burke [2025] IEHC 557

Barniville P notes that the legal principles governing confirmation applications under provisions analogous to s.76 were recently summarised by him in Nursing and Midwifery Board v Burke [2025] IEHC 557, para. 51.

Although the detailed text of Burke is not reproduced in this judgment, the reference makes clear that:

there is an established body of case law outlining the High Court’s role when asked to confirm decisions of professional regulators; and
Kwan is intended to be read as an application of those already settled principles, not as a radical re‑statement of them.

Based on the approach taken in this judgment, the principles from Burke (and earlier confirmation jurisprudence) evidently include:

The Court’s function is supervisory, not appellate in the broad sense: it does not reconsider the merits from scratch.
The Court examines:
- whether the regulator complied with its statutory powers and procedures;
- whether fair procedures were followed; and
- whether the decision (particularly as to sanction) falls within the range of reasonableness open to a rational decision‑maker.
If these criteria are met, the Court is obliged to confirm the decision – absent “good reason” to the contrary.

Kwan confirms that this deferential approach applies with full force to cancellation decisions under the Medical Practitioners Act.

7.2 Established but unstated jurisprudence

Beyond Burke, the judgment does not expressly cite other authorities. That said, it sits comfortably within the broader Irish case law on:

the limited role of the courts in reviewing decisions of expert professional regulators; and
the high threshold for judicial interference with sanctions imposed to protect the public and the reputation of a profession.

Barniville P’s reasoning – especially his statement that any lesser sanction would have been manifestly unreasonable – underscores the strong judicial deference typically afforded to the sanctioning choices of such bodies, provided statutory and procedural requirements are satisfied.

8. The Court’s Legal Reasoning

8.1 Jurisdiction and ex parte nature of the application

At the outset, Barniville P confirms that:

the respondent had been properly served and was fully aware of the application; and
the Court was entitled, in any event, to deal with applications of this kind on an ex parte basis under s.76.

The seriousness of the matter – cancellation following very grave convictions – is emphasized as further justification for proceeding without delay, particularly where the respondent had repeatedly indicated his wish not to participate.

8.2 Application of s.57(1)(g): foreign conviction for an indictable offence

The President has no difficulty holding that the facts fall “clearly” within s.57(1)(g). He describes the facts as “shocking and macabre” and notes that:

attempted murder is plainly an offence triable on indictment in Ireland; and
the offence of administering poison with intent to endanger life or to cause serious harm would likewise be triable on indictment if committed here.

The UK conviction therefore triggers the s.57(1)(g) mechanism and empowers (indeed, obliges) the PPC to refer the complaint immediately to the Council under s.57(5).

8.3 Operation of s.57(5) and (6): expedited cancellation

Having identified that s.57(1)(g) applies, the Court then examines whether the Council correctly used the s.57(6)(a) expedited route.

Barniville P accepts that the Council:

properly considered the nature of the offences and the circumstances of their commission; and
was entitled to conclude that these rendered the respondent permanently unfit to practise medicine.

The extensively quoted sentencing remarks provide the evidential backbone for this conclusion. They show:

advanced and meticulous planning;
the use and abuse of medical knowledge and professional status to deceive;
a “calculated and callous” method of gaining entry to the victim’s home, “under the guise of a trusted healthcare professional”, thereby striking “at the heart of public confidence in the healthcare profession”;
a financial motive tied to anticipated inheritance; and
significant, lasting harm to the victim, as well as broader psychological effects on public trust.

On any view, a doctor who has used sophisticated medical deception and knowledge of the health system to attempt a financially‑motivated murder by poisoning is difficult to reconcile with the concept of someone fit to be trusted as a medical practitioner.

The Court also endorses the Council’s assessment that it was in the public interest to act immediately, noting:

the risk of ongoing deception by reliance on his status as a doctor, even while imprisoned (e.g. in written or online contexts); and
the importance of the reputation of the professional regulatory system – the public needs to see prompt and decisive action when confronted with such conduct.

8.4 High Court’s role under s.76(3): the “good reason” test

The crux of the judicial function lies in s.76(3). The Court must:

“…confirm the decision under section 71 … unless the Court sees good reason not to do so.”

Barniville P structures his analysis around three questions:

Were the relevant statutory provisions (particularly s.57) complied with?
Were there any breaches of fair procedures?
Was the decision manifestly unreasonable?

He answers each in turn:

Statutory compliance: The Council “complied fully” with s.57. The PPC referred under s.57(5) as required and the Council correctly applied s.57(6)(a) in imposing cancellation as the sanction envisaged by s.71(f).
Fair procedures: There was no procedural unfairness. The respondent’s non‑engagement was his own choice, despite clear opportunities to participate and to appeal.
Reasonableness: The decision was “so far from being unreasonable” that:
“…it is impossible to envisage any other sanction other than cancellation which would be appropriate in the circumstances here. In fact, a decision to impose a more lenient sanction would have been manifestly unreasonable…”

Once these points are established, there is no “good reason” to decline confirmation. The Court is therefore bound to confirm the decision.

8.5 Weight given to the sentencing remarks

The judgment’s detailed recitation of the sentencing remarks serves a dual purpose:

It illustrates the extraordinary gravity of the case and the extent to which the respondent’s conduct undermined trust in healthcare.
It provides a solid evidential basis for the Council’s and the Court’s assessments of permanent unfitness and the necessity for cancellation.

Reliance on such remarks is legally orthodox in conviction‑based disciplinary proceedings: the conviction is not being re‑litigated; instead, the sentencing judge’s factual findings are used to inform the regulatory assessment of fitness to practise.

8.6 The respondent’s correction of a misdescription

The one point raised by the respondent – that he had not been convicted of a chemical weapons offence – is acknowledged. Barniville P considers this “irrelevant” to the matter before him, given:

the actual convictions (attempted murder; administration of poison) remain of the utmost gravity; and
the Council’s reasoning is founded on those convictions and the underlying conduct, not on any erroneous belief that he had been convicted of ricin‑related offences.

8.7 Fair procedures and the respondent’s non‑participation

The Court takes careful note of the steps taken to ensure fairness:

the respondent received material in prison via official channels;
he explicitly declined to participate in the Council hearing;
he was notified of the outcome and of his right to appeal; and
he chose not to appeal or otherwise engage with the High Court process.

In these circumstances, the absence of the respondent at the confirmation hearing does not invalidate the process. The Court is satisfied that:

natural justice was respected; and
the procedural framework of s.57 and s.76 was “impeccably” followed by the Council.

9. Simplifying Key Legal Concepts

9.1 Ex tempore judgment

An ex tempore judgment is one delivered orally at the end of a hearing, rather than reserved and delivered later in written form. It is subsequently transcribed and approved, as in this case. The fact that it is ex tempore does not diminish its authority; it is simply a reflection of judicial efficiency where the issues are clear.

9.2 Ex parte application

An ex parte application is one made to the court without the other side being present or represented. Section 76 allows such applications in confirmation proceedings. In Kwan, the judge notes that the application could, in any event, be dealt with ex parte, but here the key point is that the respondent:

was notified;
knew about the proceedings; and
chose not to attend.

Thus, although the hearing proceeded without him, it was not strictly “ex parte” in the sense of ignorance; it was more accurately uncontested.

9.3 Offence “triable on indictment”

An offence “triable on indictment” is a serious criminal offence which, under Irish law, must or may be tried before a judge and jury in a higher court, rather than summarily before a District Court judge without a jury. Examples include:

murder and attempted murder;
serious assaults; and
serious drug or firearms offences.

Section 57(1)(g) uses this concept as the threshold for when a criminal conviction, in Ireland or abroad, can ground a professional complaint leading to cancellation.

9.4 “Fitness to practise” and “fit and proper person”

The idea of a fit and proper person in professional regulation is broader than clinical competence. It encompasses:

integrity and honesty;
respect for patient autonomy and safety;
adherence to ethical and professional norms; and
a character that justifies the high level of trust placed in doctors.

A doctor who has used their professional status and knowledge to attempt to murder someone, particularly using healthcare imagery and deception, is fundamentally at odds with this concept. That is why the Council concluded that he had “permanently ceased to be a fit and proper person” to practise.

9.5 Cancellation vs suspension

Suspension (under s.60 or as a sanction under s.71) is typically temporary. It removes the right to practise for a period, but leaves open the possibility of return, often under conditions.
Cancellation (s.71(f)) removes a practitioner’s name from the register – commonly referred to as “erasure” or “being struck off”. It is the most severe sanction and is generally reserved for the gravest cases, where the practitioner’s conduct is fundamentally incompatible with continued membership of the profession.

In Kwan, the Court considers cancellation to be not only appropriate but inevitable on the facts.

9.6 The “public interest” and professional reputation

In regulatory law, the public interest has at least two key dimensions:

Protection of the public – ensuring that patients and the public are not exposed to avoidable harm from unfit practitioners.
Maintenance of confidence – ensuring that the public continues to trust the profession and its regulatory system.

The Council (and the Court) explicitly rely on both dimensions:

Even though the respondent is imprisoned, acting decisively prevents misuse of his status as a registered doctor.
Equally, taking no action – or delaying action – in the face of such egregious conduct could damage public confidence in the medical profession and its regulator.

9.7 “Good reason” not to confirm under s.76(3)

The phrase “good reason” in s.76(3) is not defined, but in context it is clear that it covers situations such as:

breach of statutory procedures;
denial of fair procedures / natural justice;
decisions that are irrational or grossly disproportionate; or
jurisdictional errors.

Kwan illustrates that:

once the regulator has acted within its powers and afforded fair procedures; and
the sanction is rationally connected to the seriousness of the conduct,

the High Court will not interfere. Confirmation will follow almost as of course.

10. Impact and Significance

10.1 A benchmark for cancellation following grave criminality

This decision stands as a clear statement that:

Where a doctor engages in highly premeditated, violent criminal conduct involving deception that exploits their professional status, cancellation of registration is not only permissible but effectively inevitable.
In such extreme cases, any lesser sanction may itself be regarded as manifestly unreasonable.

The emphasis that a more lenient sanction would be irrational is significant. It provides a strong precedent for future regulatory decisions and confirmation applications involving similarly egregious conduct.

10.2 Robust use of the s.57(6) expedited procedure

The case confirms that the expedited pathway in s.57(6) is not a dead letter. Where its conditions are met, the Council is:

entitled to; and
expected to

proceed directly to cancellation without a full Fitness to Practise Committee hearing.

Importantly, Kwan illustrates how a regulator should:

carefully map its reasoning onto the statutory language (permanent unfitness; public interest; immediate action); and
document its consideration of the factual matrix (offence nature, planning, motive, harm, impact on trust).

It provides a model for future use of s.57(6) by professional regulators in Ireland.

10.3 Public confidence and reputational considerations

Both the Council and the Court stress the impact on:

public confidence in healthcare professionals; and
confidence in the system that regulates them.

This case makes clear that:

regulatory action is not purely about punishing wrongdoing (that is the function of the criminal law), but about protecting the public and the profession’s reputation; and
inaction or delay in the face of extreme misconduct can itself damage that reputation and thus harm the public interest.

10.4 Treatment of foreign convictions and cross‑border regulation

Kwan underlines that:

Serious convictions abroad will promptly and decisively affect an Irish registration once the statutory s.57(1)(g) threshold is met.
The regulator may rely on the conviction and sentencing remarks as a sufficient evidential foundation, even if direct cooperation from foreign police or regulators is limited.

This is critical in a modern, mobile professional environment, ensuring that doctors cannot escape regulatory consequences by crossing borders.

10.5 Deference to specialist regulators in sanctioning

The judgment strongly reinforces the principle that:

The choice of sanction is primarily for the specialised regulator, not the court; and
The court intervenes only where:
- the regulator has misdirected itself in law;
- breached fair procedures; or
- imposed a sanction that no reasonable decision‑maker could impose (i.e. is “manifestly unreasonable” or disproportionate).

Here, the Court goes further, indicating that any departure from cancellation would, on these facts, have been unreasonable. That is a strong signal of deference combined with clear expectations of sanction severity in the most serious cases.

10.6 Practical implications for practitioners and regulators

For medical practitioners:

Serious criminal offending – particularly involving violence, deception, and exploitation of professional status – will almost inevitably lead to cancellation of registration, in Ireland as elsewhere.
Non‑engagement with the regulatory process does not protect against such outcomes and may only deprive a practitioner of any chance to present mitigating factors.

For the Medical Council and other regulators:

The judgment vindicates careful, statute‑led reasoning and shows that well‑documented, principled decisions will be robustly upheld.
It encourages frank consideration of the reputational dimension of the public interest and confirms that acting to maintain confidence is not only legitimate but important.
It demonstrates good practice in liaising with foreign prison and regulatory authorities to ensure notice and fairness.

10.7 Costs and pragmatic justice

The Council did not seek costs, and the Court made no order as to costs. This reflects:

recognition of the respondent’s long‑term incarceration and practical inability to meet an adverse costs order; and
a pragmatic approach that focuses on the protective and regulatory aims rather than financial retribution.

11. Critical Reflections

While the outcome in Kwan is unsurprising given the facts, several broader reflections arise.

11.1 The meaning of “permanent” unfitness

The Council concluded that the respondent had “permanently ceased” to be a fit and proper person. In practice:

This reflects a present assessment based on current information and the extreme nature of the offences, rather than an absolute prediction about human change decades into the future.
Nonetheless, the combination of extreme violence, betrayal of professional trust, and utilitarian financial motive makes it difficult to imagine future circumstances in which public confidence could be adequately restored.

The case thus helps to illustrate what Parliament likely had in mind when allowing regulators to find “permanent” unfitness.

11.2 Fairness in expedited proceedings where the practitioner is incarcerated abroad

Expedited processes inevitably compress procedural steps. A potential concern is whether an imprisoned practitioner, especially abroad, can realistically mount a defence or present mitigation.

In Kwan, those concerns are to a large extent neutralised because:

the respondent was plainly aware of the proceedings;
prison authorities confirmed his decision not to participate; and
the case hinges on convictions following guilty pleas, so the factual foundation is not in dispute.

However, in less clear‑cut cases, regulators will need to ensure that incarceration does not inadvertently undermine access to legal advice or effective participation. Thorough documentation of the opportunities afforded, as was done here, will be essential.

11.3 “Double punishment” concerns

Some might question whether cancellation amounts to a form of double punishment for the same conduct already sanctioned by the criminal court. The established answer in regulatory law – implicit in this judgment – is that:

criminal sentencing and professional sanctions serve different purposes: deterrence, retribution and public order on the one hand; public protection and professional standards on the other;
regulatory sanctions are protective, not punitive, even if they have severe consequences for the practitioner.

Kwan serves as a stark illustration of this distinction: the 31‑year sentence addresses the criminal wrong; the cancellation ensures the profession is not tainted by association with someone whose conduct is fundamentally incompatible with being a doctor.

12. Conclusion

Medical Council v Kwan [2025] IEHC 742 is a powerful reaffirmation of the robustness of Ireland’s regulatory regime for medical practitioners when confronted with the most extreme forms of professional betrayal and criminal misconduct.

The judgment establishes or reinforces several key propositions:

Foreign convictions for offences that would be indictable in Ireland (s.57(1)(g)) fully justify disciplinary proceedings and, in appropriate cases, immediate cancellation of registration.
The expedited procedure in s.57(6) is properly used where the nature and circumstances of the offence render a practitioner permanently unfit and where immediate action is in the public interest.
The High Court’s role under s.76(3) is tightly constrained: it must confirm the regulator’s decision unless there is a demonstrable “good reason” not to – typically, procedural illegality, unfairness, or manifest unreasonableness.
In cases of planned, financially‑motivated attempted murder involving exploitation of medical status and healthcare trust, cancellation is the only rational sanction. Anything less would be manifestly unreasonable.
The judgment underscores the twin pillars of the public interest in regulation: protecting individuals from harm and maintaining public confidence in the profession and its oversight mechanisms.

In short, Kwan stands as a paradigmatic case of “permanent unfitness” to practise medicine. It demonstrates the willingness of both the Medical Council and the High Court to act swiftly and decisively when the integrity of the profession and the safety of the public demand it.

Permanent Unfitness to Practise and Ex Parte Confirmation: Commentary on Medical Council v Kwan [2025] IEHC 742