General Medical Council v Hayat

Factual and Procedural Background

This appeal concerns a decision by the Medical Practitioners Tribunal ("the Tribunal") dated 7 November 2016, which refused to adjourn disciplinary proceedings against the Defendant and proceeded in his absence. The Tribunal found the Defendant guilty of dishonesty and misconduct, and that his fitness to practice was impaired. After a subsequent hearing attended by the Defendant, the sanction of erasure from the medical register was imposed.

The Defendant appealed the Tribunal’s findings. At a hearing on 27 June 2017, Lang J allowed the appeal on the ground that the Tribunal erred by failing to consider relevant medical evidence before continuing the hearing in the Defendant’s absence, and remitted other substantive grounds of appeal for reconsideration by a fresh Tribunal panel. The Appellant ("GMC") then appealed Lang J’s decision, contending that she erred in principle in her analysis of the Tribunal’s refusal to adjourn. Permission to appeal was granted on this basis.

The factual background relevant to the Tribunal’s refusal to adjourn includes the Defendant’s history of admitted deceit, including feigning chest pains in 2003 and making a false insurance claim in 2010. In 2012, the Defendant claimed to have suffered a heart attack in Pakistan and made an insurance claim, which was investigated and declined by the insurer, leading to referral to the GMC and police and subsequent disciplinary proceedings.

The Tribunal scheduled a 15-day hearing starting 31 October 2016. The Defendant made three unsuccessful applications to adjourn the hearing: first for insufficient preparation time, second for lack of funds to pay lawyers, and third based on a handwritten medical note stating he should be off work for seven days due to back pain. The Tribunal refused all adjournment requests, explaining the insufficiency of the medical evidence and emphasizing the public interest in avoiding last-minute adjournments.

On 31 October 2016, during the hearing, the Defendant appeared unconscious but was taken to hospital where medical staff found no evidence of a cardiac event. The hearing was adjourned. Subsequent medical evidence indicated the Defendant was fit to attend upon discharge, but he did not attend the resumed hearing on 7 November 2016. The GMC applied to proceed in his absence. The Tribunal initially refused but ultimately allowed the hearing to proceed in absence on 7 November 2016 after considering additional medical evidence, including a GP-issued sick note stating the Defendant was unfit for work due to dizziness, chest pains, and post-angiography complications.

The hearing proceeded in the Defendant’s absence, lasting until 18 November 2016, when the Tribunal found the central allegations of fraudulent insurance claims established. The disciplinary hearing was adjourned and reconvened in February 2017 with the Defendant attending, after which the Tribunal found impairment and imposed erasure. The Defendant appealed to the Administrative Court.

Legal Issues Presented

1. Whether the Tribunal erred in refusing to adjourn the disciplinary hearing on 7 November 2016 despite medical evidence indicating the Defendant was unfit to attend.
2. The appropriate standard of medical evidence required to justify an adjournment on grounds of ill health in disciplinary proceedings.
3. The extent of deference owed by appellate courts to specialist tribunals’ discretionary decisions regarding adjournments.
4. The threshold for appellate intervention under CPR 52.21(3) in relation to decisions to proceed in a practitioner’s absence.

Arguments of the Parties

Appellant's (GMC) Arguments

• Lang J misdirected herself by holding that medical evidence suggesting unfitness to work "ought generally" result in an adjournment even when such evidence was unparticularised, unreasoned, and disputed.
• The Tribunal was better placed to assess whether the Defendant’s medical condition suggested unfitness to participate in the hearing and deserved appropriate respect.
• The decision to adjourn or not was a case management discretion, subject to appellate interference only if "plainly wrong".
• Lang J failed to consider whether any alleged procedural irregularity caused injustice, noting no evidence that further enquiries would have prevented the hearing continuing in the Defendant’s absence.

Respondent's (Defendant) Arguments

• The GP’s sick note dated 7 November 2016 indicated a medical condition severe enough to justify an adjournment.
• The Tribunal failed to properly investigate the new medical evidence and disregarded the sick note.
• The failure to adjourn resulted in a serious procedural irregularity and unfairness, depriving the Defendant of the opportunity to present his defence.

Table of Precedents Cited

Court's Reasoning and Analysis

The court undertook a detailed analysis of the medical evidence and legal principles governing adjournment decisions in disciplinary proceedings. It emphasized that the Tribunal’s discretion to refuse adjournment must be exercised with regard to fairness, the public interest, and the practitioner's responsibility to engage with the regulator.

The court found that Lang J erred by giving undue weight to the GP’s sick note simply because it post-dated other medical evidence, without properly considering its contents or the broader context. The sick note was found to be a pro-forma document lacking sufficient detail or reasoned medical opinion to establish unfitness to participate in the hearing.

The Tribunal had carefully considered all medical evidence, including the sick note, and concluded that the Defendant had voluntarily absented himself. The Tribunal was entitled to weigh the inadequate sick note against prior evidence and the public interest in avoiding adjournments, especially given repeated unsuccessful adjournment applications by the Defendant.

The court rejected the contention that the Tribunal disregarded the sick note, finding instead that it was properly considered and found insufficient. Further, the Tribunal was not obliged to conduct additional investigations absent evidence that such enquiries would change the outcome.

The court also emphasized the specialist nature of the Tribunal and the limited scope for appellate interference with discretionary decisions such as whether to proceed in the Defendant’s absence. Lang J was found to have failed to apply the correct standard of review by effectively substituting her own judgment for that of the Tribunal.

In sum, the court concluded that the Tribunal’s decision to refuse the adjournment and proceed in the Defendant’s absence was lawful, fair, and within the bounds of reasonable discretion. The appeal was allowed on this basis, overturning Lang J’s decision.

Holding and Implications

ALLOWING THE APPEAL

The court allowed the GMC’s appeal, holding that the Tribunal did not err in refusing to adjourn the disciplinary hearing on 7 November 2016 and proceeding in the Defendant’s absence. The Tribunal’s decision was a lawful exercise of discretion, properly balancing the sufficiency of medical evidence, the Defendant’s responsibility to engage, and the public interest.

The consequence is that the Defendant’s appeal to the Administrative Court was set aside, and the substantive grounds of appeal remain to be reconsidered by a fresh Tribunal panel. No new precedent was established beyond clarifying the application of existing principles regarding medical evidence and adjournment discretion in medical disciplinary proceedings.