Prendiville & Anor v The Medical Council & Ors

Factual and Procedural Background

This opinion concerns two applicants, referred to as Professor Prendiville and Dr. Murphy, both medical practitioners specializing in obstetrics and gynaecology, who sought to quash decisions of the Medical Council confirming findings of professional misconduct against them by the Council's Fitness to Practise Committee (FPC). The applicants also, if necessary, sought declarations regarding the constitutionality and compatibility of certain provisions of the Medical Practitioners Act, 1978 with the European Convention on Human Rights. These constitutional questions were deferred pending the outcome of the certiorari applications.

The background events relate to reports prepared in November 1998 by the applicants and a third consultant concerning the obstetric practice of Dr. Neary at Our Lady of Lourdes Hospital in Drogheda, specifically addressing his rate of caesarean hysterectomies. These reports were prepared urgently at the request of the Irish Hospital Consultants Association (IHCA) to assist in an industrial relations dispute involving Dr. Neary's suspension by the North Eastern Health Board. The reports supported Dr. Neary's continuation in practice pending a peer review by the Institute of Obstetrics and Gynaecology.

The Health Board commissioned an independent review by Dr. Maresh, who reached different conclusions and recommended suspension of Dr. Neary, which occurred in December 1998. Dr. Neary was subsequently struck off the medical register in 2003 following a lengthy FPC hearing.

Following a government-initiated private inquiry into the events at the hospital, a complaint was made against the three consultants who prepared the initial reports, leading the Medical Council to initiate proceedings against Professor Prendiville and Dr. Murphy. The FPC held a hearing in late 2006, finding certain allegations of professional misconduct against both applicants. The Council, in February 2007, confirmed the FPC findings but imposed no sanctions. The applicants sought to appeal the Council’s decision but were informed no appeal lay except in cases involving erasure, suspension, or conditions on registration. Consequently, they applied for judicial review.

Legal Issues Presented

1. Whether the Medical Council acted ultra vires by considering itself bound to confirm the FPC’s findings of professional misconduct and confining its role to the question of sanction only.
2. Whether the participation of FPC members in the Council meeting considering the FPC’s findings constituted a breach of natural justice.
3. Whether the procedure followed by the Council in receiving and acting on legal advice was fair and in accordance with natural justice.
4. Whether the FPC and Council applied the correct legal standard in defining professional misconduct.
5. Whether the FPC’s report was deficient due to lack of adequate reasons for its findings.
6. Whether the decisions of the FPC and Council were unreasonable or irrational on the evidence.

Arguments of the Parties

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

Table of Precedents Cited

Court's Reasoning and Analysis

The court undertook a detailed examination of the statutory framework governing the Medical Council and its Fitness to Practise Committee (FPC), focusing on the interpretation of section 13(7) of the Medical Practitioners Act, 1978, which states that acts of committees are subject to confirmation by the Council unless dispensed with. The court found that the FPC is such a committee and that the Council had not dispensed with the necessity for confirmation.

The applicants contended that this meant the Council must exercise an independent judgment to either confirm or refuse confirmation of the FPC’s findings, considering submissions on why the FPC’s findings might be flawed. The Council argued it was bound by the FPC’s decision on guilt and could only decide on sanction. The court rejected the Council’s narrow interpretation, reasoning that a construction which renders the Council powerless to reconsider FPC findings except on sanction would be constitutionally problematic, especially as no appeal on merits lies to the court in cases without erasure or suspension. The court preferred the applicants’ construction, allowing the Council a meaningful role in reconsidering the FPC’s findings.

Regarding natural justice, the court found it inappropriate that members of the FPC who made the findings sat on the Council to consider confirmation, as this breached the nemo iudex in causa sua rule. The court also found fault with the Council’s procedure of receiving legal advice exclusively by the President and Vice President, without disclosure to the applicants or their counsel, amounting to a denial of audi alteram partem. The court cited domestic and English authorities requiring parties be given opportunity to comment on legal advice before decisions are made.

On the substantive issue of professional misconduct, the court examined the standard applied by the FPC, which followed the “expected standards of conduct” test derived from O’Laoire v. The Medical Council. The court noted that this test was modified by the Council’s ethical guide, which until 2004 defined professional misconduct as conduct considered disgraceful or dishonourable by doctors of experience and good repute (the moral turpitude standard). The court held that applying the expected standards test before it was promulgated was unfair and unreasonable.

The court also found the FPC report deficient for lack of adequate reasons explaining the basis for its findings of professional misconduct, which is necessary to enable proper consideration by the Council and judicial review. It rejected the Council’s contention that no duty to give reasons existed, relying on constitutional and natural justice principles and relevant case law.

On the question of remittal, the court exercised its discretion not to remit the case for reconsideration due to the significant passage of time, the damage already suffered by the applicants, and the quashing of both the Council’s and FPC’s decisions.

Holding and Implications

The court held that the decisions of both the Fitness to Practise Committee and the Medical Council must be quashed.

The court declared that the Medical Council acted ultra vires by regarding itself as bound to confirm the FPC’s findings without exercising independent judgment and by confining its role solely to sanction. The procedure followed by the Council in receiving legal advice was unfair and breached natural justice. The FPC applied an incorrect standard of professional misconduct and failed to provide adequate reasons for its findings.

The direct effect of this decision is to nullify the findings of professional misconduct against the applicants and the Council’s confirmation of those findings. The court declined to remit the matter for reconsideration, noting the prejudice to the applicants and the length of time since the original events and proceedings.

No new precedent was established beyond clarifying the Council’s role under s. 13(7) and the procedural requirements for fairness in disciplinary proceedings under the Act.