Walker-Smith v General Medical Council

Factual and Procedural Background

On 15th October 2004, charges of serious professional misconduct were brought by the General Medical Council (GMC) against three medical practitioners, referred to here as Practitioner A, Practitioner B, and Practitioner C, and referred to a Fitness to Practise Panel under the procedural rules requiring criminal standard proof in a two-stage process. The hearing began in July 2007 and after extensive submissions and evidence, the panel found Practitioner A and Practitioner B guilty of serious professional misconduct and ordered their names erased from the medical register, while Practitioner C was not found guilty. Practitioner B appealed the findings against him, challenging both stages and the sanction imposed.

Practitioner A was Senior Lecturer and Director of Research at a hospital from 1992 to 1997 and had developed a hypothesis linking inflammatory bowel disease and measles virus or vaccine. Practitioner B was a Consultant Paediatric Gastroenterologist who, with his team including Practitioner C, transferred to the hospital in 1995 and sought ethics approval for research involving additional biopsies on children with developmental and gastrointestinal symptoms.

A research project ("Project 172-96") was submitted for ethics approval in 1996, aiming to investigate a syndrome involving enteritis and disintegrative disorder following measles/rubella vaccination. The project was approved subject to conditions in late 1996 and early 1997. Between July 1996 and February 1997, eleven children were admitted for investigation under Practitioner B and his team. The results were published in a paper in the Lancet in 1998, which Practitioner B was the senior clinical investigator. The publication and its public health implications caused controversy.

The GMC alleged that Practitioner B conducted research without ethics approval and subjected children to clinically inappropriate investigations, while Practitioner B contended that the investigations were clinically justified medical practice aimed at diagnosing and treating individual patients. The central issue was the distinction between medical practice and research, and the intention behind the investigations.

The panel made findings adverse to Practitioner B in relation to the investigations of the children, the publication of the Lancet paper, and other aspects of clinical conduct, concluding serious professional misconduct. Practitioner B appealed these findings.

Legal Issues Presented

1. Whether the investigations undertaken by Practitioner B on the children were research requiring ethics approval or clinically indicated medical practice.
2. The relevance of the practitioner's intention in distinguishing medical practice from research.
3. The appropriateness and clinical indication for specific invasive investigations (e.g., colonoscopy, barium meal, lumbar puncture) on the children.
4. The accuracy and propriety of Practitioner B's role and statements in the publication of the Lancet paper.
5. Whether Practitioner B's conduct amounted to serious professional misconduct justifying erasure from the medical register.

Arguments of the Parties

The opinion does not contain a detailed account of the parties' legal arguments.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The court undertook a detailed examination of the factual matrix, focusing on the distinction between medical practice and research. It emphasized that the intention of the practitioner is a critical factor, supported by guidance from the Royal College of Physicians, which distinguishes medical practice as solely intended to benefit the individual patient, while research aims primarily to advance general knowledge.

The court found that the panel failed to make an explicit finding on Practitioner B's intention, which was a fundamental error. The panel also did not adequately address or weigh conflicting expert evidence on the clinical indication for invasive investigations, nor did it properly evaluate the honesty and truthfulness of Practitioner B in his dealings with the Ethics Committee and colleagues.

In relation to the individual children investigated, the court noted significant inadequacies in the panel's reasoning, including failure to explain preference for expert opinions that supported the GMC's case over those supporting Practitioner B. The panel's conclusions that many investigations were not clinically indicated were often based on incomplete or incorrect summaries of evidence.

The court also analyzed the Lancet paper, concluding that the panel misinterpreted its language and failed to justify findings that Practitioner B was irresponsible or misleading in describing the patient population and referral process. The panel's finding that Practitioner B caused administration of an unapproved drug was inconsistent and unsupported.

Overall, the court found the panel's determination was flawed by inadequate reasoning, factual errors, and failure to address critical issues, including Practitioner B's intention and the clinical justification for investigations.

Holding and Implications

The court QUASHED the panel's determination that Practitioner B was guilty of serious professional misconduct and the sanction of erasure from the medical register.

The decision directly affects the parties by overturning the findings and sanctions against Practitioner B. The court did not set new precedent but emphasized the necessity for panels to carefully distinguish between research and medical practice, to properly assess practitioner intention, and to rigorously evaluate expert evidence in disciplinary proceedings.