Refusal to Engage with Recommended Supports as Ground for Interim Suspension under Section 60 – A Commentary on Medical Council v PQ [2025] IEHC 390

1. Introduction

This commentary analyses the judgment of Mr Justice David Barniville, President of the High Court of Ireland, in Medical Council v PQ (A Medical Practitioner) [2025] IEHC 390. The case concerns an application by the Medical Council (“the Council”) for interim suspension orders under section 60 of the Medical Practitioners Act 2007 pending fitness-to-practise proceedings against a general practitioner (“PQ”).

The core dispute arose from allegations of deteriorating clinical practice, unusual behaviour, and concerns about PQ’s mental health—culminating in a psychiatric opinion that PQ suffers from a persistent delusional disorder of persecutory type. Although the expert opined that PQ could remain in practice subject to therapeutic engagement, PQ resolutely rejected the diagnosis and refused to accept any conditions or undertakings. The Court ultimately suspended PQ’s registration, creating an important precedent on when a practitioner’s non-engagement with recommended supports, rather than the diagnosis alone, justifies interim suspension in the public interest.

2. Factual and Procedural Overview

Parties: The applicant was the Medical Council; the respondent, PQ, is a GP practising in Ireland for ~35 years.
Triggering events: December 2024 communication from the directors of an out-of-hours GP service highlighting a spike in patient complaints, “near-misses”, and fears regarding PQ’s mental health.
Expert assessment: Professor G (consultant psychiatrist) diagnosed a relevant medical disability—persistent persecutory delusional disorder—yet believed PQ could practise if he engaged with Practitioner Health and the Council’s Health Committee.
Legal steps: The Council decided on 12 February 2025 to apply for section 60 orders; application issued 19 February; numerous adjournments during which PQ initially offered voluntary undertakings not to practise.
Positions at hearing: Council offered a detailed suite of conditions/undertakings mirroring Professor G’s recommendations. PQ refused all conditions, claimed a Garda conspiracy, and demanded dismissal of the application.

3. Summary of the Judgment

Justice Barniville granted all suspension orders sought (paras 82-83). Key findings include:

The Court’s paramount consideration under section 60 is public and patient safety.
The three-limb test in O’Ceallaigh v An Bord Altranais is satisfied: (i) seriousness of the allegations; (ii) strong prima facie case of “relevant medical disability”; (iii) likely sanction of significant restriction if allegations proved.
PQ’s absolute refusal to accept Professor G’s diagnosis and to engage with supports/conditions demonstrates a lack of insight that materially heightens risk.
Alternative, less-drastic measures were offered (undertakings/conditions) but rejected, leaving interim suspension as the only practical means of protecting the public.
The balancing exercise between public interest and PQ’s constitutional rights (livelihood, good name) favoured suspension because PQ’s stance nullified any lesser safeguard.
Suspension to remain until further order; liberty to apply for variation if PQ later accepts conditions.

4. Analysis

4.1 Precedents Cited and Their Influence

O’Ceallaigh v An Bord Altranais [2000] 4 IR 54 – Supreme Court authority establishing:
- Interim suspension is exceptional and must prevent immediate danger to the public.
- Three pre-conditions before the professional body seeks suspension: seriousness, strong case, and likelihood of serious sanction.
Barniville P rigorously applied this template (paras 63-74).
Medical Council v Waters [2021] IEHC 252 & Bukhari [2022] – Confirm wide judicial discretion under section 60; emphasis on tailored relief and possibility of protective undertakings.
Medical Council v A Medical Practitioner [2023] IEHC 171 / 679 & Dental Council v A Dentist [2024] – Reinforce the balancing exercise between public safety and constitutional rights, and endorse acceptance of undertakings where adequate.
Medical Council v F.C.M. [2018] IEHC 616 – Commentary (Kelly P) that sanctions such as conditional registration may satisfy the third O’Ceallaigh limb; cited when Barniville P found that likely sanctions short of erasure could satisfy the test (para 74).

Collectively, these authorities shaped a structured framework: identify risk; consider undertakings; impose suspension only if no lesser measure will suffice.

4.2 Court’s Legal Reasoning in Depth

Threshold Inquiry – Seriousness & Strength
Barniville P accepted that serial patient complaints and two “near-misses” were inherently serious. Moreover, Professor G’s unchallenged psychiatric diagnosis provided a robust evidential anchor despite PQ’s denials.
Lack of Insight as an Aggravating Factor
The Court repeatedly observed PQ’s “complete lack of insight” (paras 50-53, 71-73). While Professor G did not see immediate functional impairment, the judge held that persistent, unaddressed delusional beliefs and hostility to any oversight substantially magnify risk—particularly because PQ practises in relatively isolated locum settings without systemic safeguards.
Undertakings versus Suspension
Section 60 jurisprudence obliges the Court to explore less intrusive options. The Council’s 12-part undertaking regime was comprehensive, proportionate, and directly mirrored expert advice. PQ’s blanket refusal tipped the balance; suspension became the only modality capable of protecting the public (paras 75-80).
Constitutional Balancing
The Court acknowledged PQ’s right to earn a livelihood and good name. However, it found these rights weighed lightly because (i) PQ had the keys to resume practice by consenting to the conditions; (ii) suspension was interim and reviewable; and (iii) patient safety is paramount (para 80).
Scope and Duration of Orders
Orders mirror the originating motion: suspension of registration; prohibition on practice; ancillary communication permissions; liberty to apply. Duration: “pending further order” – allowing quick modification if circumstances change.

4.3 Likely Impact of the Decision

Regulatory Guidance: Clarifies that refusal to engage with remedial conditions can itself justify interim suspension, even where expert opinion suggests current fitness. This bolsters regulators’ hand when faced with practitioners showing poor insight into diagnosed disorders.
Health-related Cases: Demonstrates that diagnoses of mental health conditions will not automatically lead to suspension; instead, the determinative factor is often insight and co-operation. This nuanced stance may reassure practitioners who seek help early.
Procedural Expectations: Reinforces duty on councils to (a) craft proportionate, evidence-based conditions; (b) document efforts to obtain voluntary undertakings; and (c) place expert material before the Court, even if resisted by the practitioner.
Future Litigation: Sets a pragmatic roadmap for section 60 hearings—expectation that courts will scrutinise refusal of conditions, expressly weigh psychiatric insight, and publish anonymised judgments to balance transparency and privacy under s.60(2).

5. Complex Concepts Simplified

Section 60 Order: An interim (temporary) High Court order suspending a doctor’s registration to protect patients while full fitness-to-practise inquiries proceed.
Relevant Medical Disability: A physical or mental condition capable of impairing a doctor’s ability to practise safely (s.2, 2007 Act).
Persistent Delusional Disorder – Persecutory Type: A psychiatric condition where a person holds fixed false beliefs that they are being harmed or conspired against, despite contrary evidence. Functioning can appear otherwise normal (“encapsulated delusion”).
Undertaking: A solemn promise to the Court or regulator to do (or not do) specified acts. If made to the Court, a breach can constitute contempt.
Balancing Exercise: The Court’s task of weighing public interest in safety against the practitioner’s constitutional rights (livelihood, reputation) before imposing an interim suspension.

6. Conclusion

The High Court’s decision in Medical Council v PQ crystallises an important refinement of Irish interim-suspension jurisprudence: even where expert evidence suggests that a practitioner could continue practising with safeguards, a categorical refusal to accept those safeguards may itself create “immediate danger to the public” warranting suspension. The judgment underscores:

The centrality of insight and co-operation in assessing ongoing risk.
The structured use of the O’Ceallaigh test, coupled with a rigorous constitutional balancing exercise.
The Court’s willingness to provide an “off-ramp” (liberty to apply) enabling practitioners to regain practice rights by later embracing recommended supports.

Regulators, legal practitioners, and medical professionals should view this case as authoritative confirmation that protective conditions—and the practitioner’s attitude towards them—are now pivotal in section 60 risk assessments. Ultimately, the precedent advances patient safety while maintaining procedural fairness and flexibility within Ireland’s fitness-to-practise framework.