Campbell, R (on the application of) v General Medical Council

Factual and Procedural Background

This opinion concerns an appeal by the Appellant against the decision of Judge Silber dated 28 May 2004, which refused the Appellant's application for judicial review of a decision made by the Professional Conduct Committee ("the Committee") of the General Medical Council ("GMC") dated 2 October 2003. The Committee dismissed a charge of serious professional misconduct against the Defendant, a consultant paediatrician employed at Noble's Hospital, Isle of Man.

The disciplinary proceedings were initiated by the Appellant's complaint, which led to a hearing before the Committee under the Professional Conduct Committee (Procedure) Rules 1998. The Committee was required first to determine facts and then to decide if those facts supported a finding of serious professional misconduct.

The Defendant had a long distinguished career running the neonatal unit at Noble's Hospital. The complaint concerned his treatment of two children, referred to as Michael Boyle and Amy Tasker, with allegations of substandard care including failure to maintain proper growth charts, inadequate examinations, delayed referrals, and failure to record head circumferences and arrange timely ultrasounds.

The Committee found that the Defendant's treatment fell below acceptable standards but concluded that the evidence did not support a finding of serious professional misconduct. The Appellant challenged this decision on public law grounds, specifically contending that the Committee erred by considering evidence relevant solely to mitigation when deciding culpability.

Legal Issues Presented

1. Whether the Committee erred in law by taking into account personal mitigation evidence when deciding whether the Defendant was guilty of serious professional misconduct.
2. Whether the decision of the Committee complied with procedural requirements to give adequate reasons for its decision.
3. The correct interpretation and application of Rule 28 and Rule 29 of the Professional Conduct Committee (Procedure) Rules 1998 regarding the distinction between culpability and mitigation.
4. The extent to which the Privy Council decisions in Silver v General Medical Council, Rao v GMC, and Preiss v General Dental Council bind or influence the Committee and the court on these issues.

Arguments of the Parties

Appellant's Arguments

• The Committee wrongly considered evidence exclusively relevant to personal mitigation (such as the Defendant’s unblemished career and testimonials) when deciding whether serious professional misconduct was established.
• The decision in Silver v General Medical Council was incorrectly applied or interpreted by the Committee, leading to a legal error.
• The Committee’s reasons for its decision were insufficient, particularly in relation to the seriousness of the misconduct.
• The appeal should result in quashing the Committee’s decision and ordering a redetermination.

Respondent's Arguments (General Medical Council)

• The Committee followed binding authority from the Privy Council in Silver v General Medical Council and was entitled to consider all relevant evidence, including personal mitigation, when deciding culpability.
• The Committee provided adequate reasons, including specific findings of fact and consideration of the Defendant’s career and testimonials.
• Declaratory relief may be an appropriate remedy instead of ordering a rehearing.

Table of Precedents Cited

Court's Reasoning and Analysis

The court carefully analysed the procedural rules governing the disciplinary process, particularly Rules 27, 28, and 29, which structure the sequential determination of facts, culpability (serious professional misconduct), and mitigation. It emphasized that while some evidence may overlap in relevance to both culpability and mitigation, these remain distinct issues to be addressed separately.

The court found that the Committee misdirected itself by treating personal mitigation evidence—such as the Defendant's unblemished career and testimonials—as relevant to the question of whether serious professional misconduct was proved. This approach conflicted with the clear language of the rules and the proper interpretation of the Privy Council decisions.

The court critically reviewed the Privy Council decisions in Silver, Rao, and Preiss, concluding that the earlier decision in Preiss correctly distinguished between culpability and mitigation, and that the later decisions had been misread or misapplied, leading to confusion. The court agreed with the concerns expressed in the Fifth Report of the Shipman Inquiry that personal mitigation should not influence the determination of serious professional misconduct.

Regarding the sufficiency of reasons, the court agreed with Judge Silber that although terse, the Committee’s reasons adequately explained their decision on the facts and the seriousness of the misconduct.

On the remedy, the court considered whether to order a rehearing or grant declaratory relief. It noted the unusual nature of the proceedings and the potential prejudice to the Defendant if subjected to double jeopardy. The court found no practical benefit to a rehearing and concluded that declaratory relief was appropriate and sufficient to vindicate the Appellant’s position and clarify the legal principles.

Holding and Implications

The court ALLOWED the appeal on the basis that the Committee erred in law by considering personal mitigation evidence when deciding whether serious professional misconduct was established.

The decision of the Committee was quashed, but the court declined to order a rehearing. Instead, declaratory relief was granted, declaring that the Committee erred in law by taking into account personal mitigation evidence—specifically the Defendant’s unblemished medical practice and testimonials—in deciding culpability. Such evidence is relevant only to sanction after a finding of serious professional misconduct.

The effect of the decision is to clarify the proper legal approach for disciplinary committees considering serious professional misconduct allegations, emphasizing the separation between culpability and mitigation. No new precedent was created beyond this clarification, and the ruling directly affects the parties by vindicating the Appellant’s complaint while protecting the Defendant from further proceedings on the same issue.