Public Protection under s.60 of the Medical Practitioners Act 2007: Diminished Weight to Livelihood Rights Where the Practitioner Does Not Practise in Ireland

Introduction

This commentary examines the High Court of Ireland’s ex tempore decision in Medical Council v RS (A Medical Practitioner) [2025] IEHC 542, delivered by Barniville P on 8 October 2025. The Medical Council sought interim orders under section 60 of the Medical Practitioners Act 2007 to suspend the respondent doctor’s registration and to prohibit him from practising medicine in Ireland pending further steps under the Act’s fitness to practise framework.

The application arose against a cross-border regulatory and criminal context. The respondent, registered in Ireland since February 2023 but resident and practising in the United Kingdom, faced serious criminal charges there concerning indecent images of children. The UK’s General Medical Council (GMC) had imposed conditions on his registration in April 2024 and he had no UK licence to practise from early 2025. The Irish Medical Council’s concerns intensified when it learned that, in his 2024 Annual Retention Application Form (ARAF), the respondent answered “No” to questions about being under criminal investigation, despite being arrested and interviewed in January 2024.

The core issue for the High Court was whether, applying the section 60 standards and the classic O’Ceallaigh criteria, an interim suspension was necessary to protect the public. The judgment is particularly significant for clarifying how the balancing exercise treats the constitutional right to earn a livelihood where the practitioner has no current Irish practice and no immediate intention or ability to practise in Ireland; in those circumstances, that right may attract reduced weight.

Summary of the Judgment

The Court granted the Medical Council’s application and made the interim suspension orders sought, including:

• Suspension of the respondent’s registration and prohibition on practising medicine in Ireland.
• Ancillary permissions for the Council to notify relevant bodies (including the Preliminary Proceedings Committee, the Minister for Health, the HSE CEO, and the UK GMC), to reflect the order on the public register, and to respond accurately to queries about the respondent’s registration status.
• Liberty to apply to vary or discharge the orders; costs reserved. Orders to remain in place until further steps under Part 7 and, if applicable, Parts 8 and 9 of the 2007 Act.

Applying the O’Ceallaigh v An Bord Altranais framework, Barniville P held:

• The alleged conduct is exceptionally serious.
• The case appears strong on its face, given digital forensic material said to link the respondent to devices containing indecent images of children.
• If such allegations were ultimately proved in fitness to practise proceedings, the likely sanction would be cancellation of registration.

In the required balancing exercise, the Court recognised the respondent’s constitutional rights to livelihood and good name, and his presumption of innocence. However, it attached limited weight to livelihood rights in Ireland because the respondent had never practised here, had no immediate plans to do so, and was already unable to practise in the UK. The need to protect the public prevailed.

Analysis

Precedents Cited and Their Influence

• O’Ceallaigh v An Bord Altranais [2000] 4 IR 54:
  • Supreme Court authority establishing the centrality of public protection and the “immediate danger to the public” test.
  • Sets out the three preconditions both the regulator and the court must be satisfied of before an interim suspension can be sought or granted:
    1. Seriousness of the complaint.
    2. Apparent strength of the case.
    3. Likelihood that, if the complaint is upheld, the appropriate sanction would be removal (or a sanction at the higher end).
  • Influence: Structured the entire analysis. The Court explicitly tested the facts against each limb and found them satisfied.
• Medical Council v Whelan (Unreported, High Court, 20 February 2001) and Casey v Medical Council [1999] 2 IR 534:
  • Stand for the proposition that interim suspensions are exceptional and should only be made when no lesser measure would protect the public.
  • Influence: The Court’s balancing exercise is framed by the necessity and exceptional nature of suspension; it considered, but noted that no undertakings were offered and none were sought as an alternative.
• Medical Council v FCM [2018] IEHC 616 (Kelly P):
  • Clarifies that “high-end” sanctions short of removal (e.g., conditional registration, cessation from practice pending conditions) can satisfy the O’Ceallaigh third limb.
  • Influence: Reinforces that, even where cancellation is the likely ultimate sanction if proved, the court may consider a spectrum of serious sanctions; however, in this case the Court viewed cancellation as the likely endpoint if allegations were upheld.
• Dental Council v A Dentist [2024] IEHC 731 (Barniville P):
  • Recent synthesis of the section 60 principles, including the treatment of criminal allegations and the importance of not determining contested facts at the interim stage.
  • Influence: Provided a contemporary restatement that the Court applied here, including the role of the presumption of innocence as a factor in, but not a bar to, interim measures.

Legal Reasoning

The Court’s reasoning proceeds through three phases: threshold satisfaction under O’Ceallaigh, consideration of alternatives and undertakings, and a proportionality-based balancing of public protection against the practitioner’s rights.

1. Threshold satisfaction under O’Ceallaigh:
   • Seriousness: The alleged conduct—possession and making of Category A and B indecent images of children and extreme pornography—is among the gravest forms of misconduct alleged against a medical practitioner. The Court stressed that these remain allegations, but the nature of the subject matter is intrinsically serious.
   • Strength of the case: While refusing to resolve factual disputes, the Court considered the materials from UK police and the GMC, including digital forensic results said to link the respondent to the devices and associated email account. On their face, these materials make the case appear strong.
   • Likely sanction if proved: The Court stated that, were such allegations proved in an Irish fitness to practise process, cancellation would likely be appropriate, describing it as “hard to imagine anything more serious.”
2. Consideration of alternatives and undertakings:
   • Suspension is an exceptional remedy. Courts look to whether undertakings or conditions could adequately protect the public. Here, none were offered by the respondent and none were sought by the Council; the Court therefore proceeded on the basis that lesser measures were not realistic.
   • The Council’s own Guidance Note on Immediate Suspension Orders, particularly for sexual misconduct and child pornography, was noted as shaping the Council’s approach. The Court was satisfied the Council considered the necessary factors.
3. Balancing exercise: public protection versus constitutional rights:
   • Good name and livelihood: The Court recognised the respondent’s constitutional rights but attached limited weight to the right to earn a livelihood in Ireland because:
     • He has never practised in Ireland.
     • He has no immediate plans to practise here.
     • He is already unable to practise in the UK due to licensing status.
     This is a key refinement: in the s.60 balance, the weight afforded to livelihood rights may be significantly reduced where the practitioner is not currently practising (or intending to practise) in the State.
   • Good name: The Court acknowledged reputational rights but held that, in the particular circumstances, public protection had to prevail, particularly as criminal proceedings will run their course elsewhere.
   • Presumption of innocence: The Court emphasised the presumption remains intact and that nothing in its decision undermines it. Nonetheless, the presumption is not a jurisdictional bar to interim suspension where the O’Ceallaigh thresholds are met and the public interest demands action.

The Court also addressed procedural fairness: ensuring the respondent, who appeared remotely, could be heard despite initial audio issues; verifying service of materials; and noting his unrepresented status and distress. The Court concluded the hearing could fairly proceed.

Impact and Significance

This judgment consolidates and refines several strands of s.60 jurisprudence with practical consequences for regulators and practitioners:

• Weight of livelihood rights when the registrant does not practise in Ireland:
  • A notable clarification is that the constitutional right to earn a livelihood in Ireland may carry reduced weight where the registrant has no current Irish practice, no imminent intention to practise here, and is already unable to practise elsewhere. This can tip the balance towards interim suspension in cross-border cases involving grave allegations.
• Cross-border information and cooperation:
  • The Court readily received and acted upon information from UK regulators and police, including digital forensics and interview materials, at the interim stage. The ancillary orders expressly facilitating communication with the GMC and public register updates reinforce the priority given to cross-border public protection.
• Role of non-disclosure on retention forms:
  • The respondent’s failure to disclose a live criminal investigation on the ARAF was recorded as a serious concern by the Council. While not a determinative factor on its own, such non-disclosure can legitimately inform risk assessment at the s.60 stage because it goes to candour, integrity, and regulatory trust.
• Presumption of innocence remains, but is not a bar:
  • The decision reaffirms that interim public protection orders may be made notwithstanding ongoing criminal proceedings, provided the statutory test is met and the court remains scrupulous not to determine facts or prejudge criminal matters.
• Undertakings as an alternative:
  • Even in very serious cases, the court expects consideration of whether undertakings or stringent conditions might suffice. However, where none are offered and the allegations are grave, outright suspension will more readily be viewed as necessary.
• Procedural fairness in urgent, remote hearings:
  • The Court’s handling of remote participation difficulties and self-representation illustrates practical fairness safeguards: verifying service, summarising submissions for the respondent, and ensuring he was heard before proceeding.

Complex Concepts Simplified

• Section 60 orders (Medical Practitioners Act 2007): Interim, protective measures (such as suspension) made by the High Court to protect the public while the statutory fitness to practise process runs its course. They are not findings of misconduct.
• O’Ceallaigh test: Before seeking or granting an interim suspension, three things must appear: the complaint is very serious, the case appears strong on the face of the materials, and if proved, the likely sanction is at the higher end (often removal).
• “Exceptional measure” and “no lesser order suffices”: Because suspension severely impacts livelihood and reputation, it should be used only when necessary and when lesser measures (like undertakings or conditions) would not adequately protect the public.
• Balancing exercise: The court weighs the public’s need for protection against the practitioner’s constitutional rights (livelihood, good name). The balance is fact-sensitive and can vary depending on factors like current practice location and immediacy of public risk.
• Presumption of innocence: Even where criminal charges are pending, the practitioner is presumed innocent. The court does not decide the truth of allegations at the interim stage. However, if the allegations are grave and the case appears strong, interim protection orders can still be justified.
• Parts 7, 8, and 9 of the 2007 Act: These broadly cover the statutory fitness to practise process and any ensuing measures and appeals. Section 60 orders operate “in the meantime” until those processes progress or conclude.
• Ancillary regulatory orders: Permissions to notify other bodies, update the public register, and share transcripts ensure transparency, inter-agency cooperation, and public awareness of the practitioner’s interim status.

Conclusion

Medical Council v RS reinforces the established s.60 framework while making an important practical clarification: when a practitioner does not practise in Ireland and has no immediate prospect of doing so, the constitutional right to earn a livelihood in the State carries reduced weight in the interim suspension balance. In the presence of exceptionally serious allegations, apparently strong supporting material, and likely severe sanctions if proved, public protection justifies interim suspension notwithstanding the presumption of innocence and reputational concerns.

The decision underscores the High Court’s willingness to act swiftly in the public interest, to facilitate cross-border regulatory cooperation, and to preserve fairness in urgent, remote hearings. It offers a clear roadmap for future s.60 applications involving overseas criminal charges, non-disclosure concerns, and practitioners whose primary practice lies outside Ireland.

Key takeaways:

• Section 60 remains a robust public protection tool; the O’Ceallaigh criteria, coupled with a careful balance of rights, govern its use.
• Livelihood rights may attract less weight where the registrant does not practise in Ireland and is unable or unwilling to do so imminently.
• Non-disclosure of criminal investigations to the regulator can legitimately heighten risk concerns at the interim stage.
• Presumption of innocence is preserved but does not block interim measures where the case appears strong and the risk to the public is high.
• Ancillary orders enabling information-sharing and public register updates are integral to effective, transparent interim protection.