A v General Medical Council

Factual and Procedural Background

This opinion concerns an application for judicial review brought by the Applicant, a young adult acting through her litigation friend and father, challenging a decision made by the Professional Conduct Committee (PCC) of the General Medical Council (GMC) on 22 September 2002. The PCC had determined that a medical practitioner, referred to as the Defendant, was not guilty of serious professional misconduct. The proceedings before the PCC arose from a complaint made by the Applicant's parents, who actively participated in formulating the charge and presenting submissions, albeit formally represented by the GMC as prosecutor.

The Defendant initially participated in the judicial review proceedings but withdrew after permission was granted, based on correspondence indicating no request for remittance of the case back to the GMC. The Applicant initially sought an order quashing the PCC decision but later withdrew this request, instead seeking a declaration that the PCC had erred in law. The court was invited to consider whether the PCC had properly addressed issues relating to the Defendant's conduct, including the effect of the Applicant's parents' wishes and duties of confidence.

The background involves the Applicant's serious illness from approximately 1996 to 1999, diagnosed as myalgic encephalomyelitis (ME), during which she was bedridden. There was significant disagreement between the Applicant's parents and the Defendant regarding the appropriate treatment and management of the Applicant's condition. The local authority was involved in child protection considerations, including child protection conferences and the decision not to register the Applicant on the Child Protection Register, reflecting the complexity of the case and divergent medical opinions.

The Defendant's conduct included attempts to influence the clinical management of the Applicant after the parents had explicitly requested no further involvement by him. The charge alleged that such conduct was without consent, contrary to the parents' wishes, involved unauthorized access to confidential information, and included inaccurate assertions. The PCC found the Defendant not guilty of serious professional misconduct, concluding that he had reasonable cause to suspect significant harm to the Applicant and thus was justified in his actions.

Legal Issues Presented

1. Whether the PCC erred in law by failing to consider that the Defendant's conduct constituted serious professional misconduct on the basis that it was a disproportionate breach of duties of confidence owed to the Applicant and her parents ("Breach of Confidence Argument").
2. Whether the PCC correctly applied the legal standard relating to reasonable cause to suspect significant harm under the Children Act 1989 when determining justification for the Defendant's conduct.
3. Whether the Defendant's actions after the parents' expressed wishes to exclude him from involvement were justified in the public interest and proportionate.
4. Whether a declaration should be made regarding the proper legal principles governing the balance between doctor/patient confidentiality and child welfare interests.

Arguments of the Parties

Applicant's Arguments

• The charge and issues before the PCC included allegations of breach of confidence that could independently found a finding of serious professional misconduct.
• Even if the PCC did not consider the breach of confidence argument, it should have done so as a relevant legal issue in determining the charge.
• The Defendant's conduct after 11 June 1997 was not justified, was disproportionate, and breached confidentiality and parental rights.
• The decision of the local authority and child protection conferences negated any justification for the Defendant's interventions.
• The PCC's failure to consider these points amounted to an error of law warranting relief.

Respondent's (GMC) Arguments

• The PCC was concerned with a charge of serious professional misconduct focused on whether the Defendant had reasonable cause to intervene, not on detailed proportionality or breach of confidence issues.
• The charge did not include a separate breach of confidence allegation as a basis for misconduct.
• The PCC correctly applied the legal test derived from the Children Act 1989 concerning reasonable cause to suspect significant harm.
• The Defendant's conduct was justified as a proportionate response to concerns about the Applicant's welfare.
• It was not necessary and would have been inappropriate for the PCC to consider alternative bases for misconduct not properly put before it.

Table of Precedents Cited

Court's Reasoning and Analysis

The court carefully examined the nature of the charge before the PCC, the factual background concerning the Applicant's serious illness and the conflicting medical opinions regarding her treatment. It noted the significant role played by the Applicant's parents in formulating the charge and pursuing the case.

The court found that the PCC's focus was on whether the Defendant had reasonable cause to suspect that the Applicant was suffering or likely to suffer significant harm, justifying his intervention under the Children Act 1989. The PCC was not tasked with, nor did it consider, whether the Defendant's actions constituted a disproportionate breach of duties of confidence. The so-called "Breach of Confidence Argument" was not put to the PCC and, accordingly, the court held that the PCC did not err in law by failing to consider it.

The court further reasoned that even if the breach of confidence argument had been before the PCC, it would likely have failed because the Defendant acted in good faith, without improper motive, and in a manner proportionate to his concerns for the Applicant's welfare. The court emphasized the importance of respecting parental views but recognized that parents of a child do not have absolute autonomy over medical treatment decisions, given the court's inherent jurisdiction and statutory powers.

The court acknowledged the difficulties and tensions arising from the differing medical opinions and the lack of a clear system for monitoring and reviewing the Applicant's treatment. It found that the Defendant's conduct in raising concerns and seeking to influence management was a justified, proportionate response in the overall public interest of promoting the welfare of the child.

Regarding duties of confidence, the court explained that the relationship between doctor and patient carries a strong public interest in confidentiality but that this interest must be balanced against the public interest in protecting children from harm. The court outlined relevant factors to consider in this balancing exercise, including the roles of parents, local authorities, and medical professionals, and the nature of disclosures involved.

The court declined to make a general declaratory judgment on the legal principles, finding that the PCC did not err in law and that such a declaration could lead to an overly rigid or inappropriate application of principles that are inherently fact-sensitive and judgmental.

Holding and Implications

The court's final decision was to dismiss the Applicant's challenge to the PCC's determination.

DISMISSED

The court held that the PCC did not err in law in concluding that the Defendant was not guilty of serious professional misconduct. The Defendant was justified in his conduct by reasonable cause to suspect that the Applicant was suffering or likely to suffer significant harm, and his actions were proportionate and in the overall public interest.

The decision means that the Defendant's professional conduct as found by the PCC stands, and no further hearing or quashing of the PCC decision is warranted. The court did not establish any new precedent beyond affirming the applicability of existing legal principles concerning child welfare, duties of confidence, and professional conduct in the context of disputed medical treatment of a child.