Toth & Anor, R (On The Application Of) v General Medical Council

Factual and Procedural Background

The Applicant ("Plaintiff") made a complaint ("the Complaint") to the Respondent ("the General Medical Council" or "GMC") against his general practitioner ("the Interested Party" or "Doctor") relating to the care provided to the Plaintiff's son, who suffered from glycogen storage disease and died following an alleged failure to provide appropriate treatment. The Plaintiff contended that the Doctor failed to promptly administer intravenous glucose, instead treating with sedatives, which the Doctor denied.

Following the son's death, the Plaintiff pursued various proceedings, including complaints to the Family Health Services Authority (FHSA), County Court damages claims under the Fatal Accidents Acts, and High Court claims for pathological grief reaction, some of which were struck out or settled. The Complaint to the GMC was made on 25 July 1997, but the GMC only notified the Doctor on 22 December 1997.

Under the GMC disciplinary procedure, complaints pass through a screener and then the Preliminary Proceedings Committee ("PPC") before potentially reaching the Professional Conduct Committee ("PCC"). The screener decided on 23 March 1998 ("First Decision") and again on 23 July 1998 ("Second Decision") not to refer the Complaint for further inquiry. The Plaintiff sought judicial review of these Decisions, contending they were unlawful.

The GMC acknowledged the Decisions were legally flawed and consented to quashing them. However, the Doctor, as an interested party, opposed quashing on grounds of potential injustice to him. The Court was tasked with deciding whether to quash the Decisions and providing guidance on the construction of the Rules governing the screener's role and the GMC's power to impose confidentiality obligations on the Plaintiff regarding disclosure of documents.

Legal Issues Presented

1. Whether the Decisions of the screener not to refer the Complaint to the PPC were lawful.
2. Whether the Court should exercise its discretion to quash the Decisions despite acknowledged legal flaws.
3. The proper construction of the Rules regarding the role and powers of the screener in disciplinary proceedings.
4. Whether the GMC can impose confidentiality obligations on the Plaintiff as a condition for disclosure of certain medical evidence.

Arguments of the Parties

Applicant's Arguments

• The Decisions were legally flawed and should be quashed to allow a proper investigation of the Complaint.
• The Plaintiff has a substantial and continuing interest in pursuing the Complaint despite delays and prior proceedings.
• The GMC failed to follow correct procedures, particularly in the screener's role and disclosure practices.
• The Plaintiff should be entitled to receive relevant documents subject to reasonable confidentiality conditions.

Respondent's Arguments (GMC)

• The GMC accepted the Decisions were legally flawed and consented to quashing them.
• The GMC proposed new procedural practices to increase transparency, including limited disclosure of material to complainants.
• The GMC contended it could properly impose confidentiality undertakings on the Plaintiff regarding sensitive medical material.
• On costs, the GMC did not resist paying the Plaintiff's costs but argued for a fair apportionment given the involvement of other parties.

Interested Party's Arguments (Doctor)

• Although accepting the Decisions were legally flawed, the Doctor argued the Court should exercise discretion not to quash them to avoid injustice to him.
• The Doctor highlighted the prior proceedings and judgments obtained by the Plaintiff and the delay in making the Complaint.
• The Doctor emphasized the stress and adverse impact on his health and professional reputation caused by the GMC’s procedural failures.
• The Doctor submitted that at worst his conduct amounted to excusable clinical misjudgment or negligence, not serious professional misconduct.
• The Doctor opposed any order requiring him to pay the Plaintiff’s costs, citing his status as a victim of the GMC’s errors.

Table of Precedents Cited

Court's Reasoning and Analysis

The Court analysed the statutory scheme under the Medical Act 1983 and the GMC Rules, focusing on the distinct roles of the Registrar, screener, PPC, and PCC in filtering and investigating complaints.

The Registrar’s role is ministerial, ensuring formal compliance before referring complaints to the screener. The screener’s role is narrow: to filter out complaints that need not proceed further because there is no practical reason for further investigation. The screener must be satisfied of a negative—namely, that the usual course to the PPC is unnecessary. This excludes assessing the merits or weighing conflicting evidence, which are matters for the PPC and PCC.

The Court rejected the argument that the screener’s role includes deciding whether a complaint ought to proceed or assessing evidence strength. Instead, the screener must respect the PPC’s investigative role and only stop complaints where there is a substantial and sufficient reason.

The PPC’s role is to decide whether a complaint ought to be referred for inquiry, with a more substantive filtering function and investigative powers, but still with caution due to the one-sided nature of the procedure at that stage. The PPC must balance the interests of the practitioner, complainant, and public, resolving doubts in favor of proceeding.

The Court found that the Decisions were made in error, as the screener improperly resolved conflicts of evidence and reconsidered the Complaint beyond his jurisdiction. The Court also addressed the GMC’s power to impose confidentiality undertakings on the Plaintiff as a condition for voluntary disclosure of confidential medical material, holding that such conditions are lawful and proper to protect the interests of practitioners submitting sensitive evidence.

Balancing the interests of the Plaintiff and the Doctor, the Court acknowledged the hardship and stress caused to the Doctor by the GMC’s procedural failures but concluded that the public interest and the Plaintiff’s legitimate expectation for a proper investigation outweigh these concerns. The Decisions were therefore quashed, and the Complaint was remitted to a different screener with guidance to observe the proper statutory role.

Holding and Implications

The Court QUASHED the Decisions of the screener dated 23 March 1998 and 23 July 1998.

The Complaint is to be reconsidered by a different screener who must exercise his duties in accordance with the statutory scheme and the guidance provided in the judgment. The GMC is entitled to require the Plaintiff to give a confidentiality undertaking in respect of confidential medical evidence relating to the Doctor’s health as a condition of disclosure.

The Court directed that the GMC pay the costs of the Plaintiff. No order was made for the Doctor to pay costs, recognizing him as a victim of the GMC’s procedural failures. The decision does not establish new legal precedent but clarifies the proper roles of the screener and PPC under the GMC Rules and confirms the propriety of confidentiality undertakings in appropriate circumstances.