Haris v General Medical Council

Factual and Procedural Background

The appellant, a medical doctor qualified since 2008 and a GP since 2014, faced complaints in 2017 from two female patients alleging non-clinically indicated intimate examinations without informed consent or gloves. These incidents occurred in separate locations within weeks of each other: one at an out-of-hours service in a town in Lancashire and the other at a hospital Minor Injuries Unit in Yorkshire. The Medical Practitioners Tribunal (MPT) accepted the patients' accounts and rejected the appellant's denials. Although the MPT found the acts could be perceived as overtly sexual, it did not find sexual motivation, influenced by the appellant's diagnosis of Asperger's syndrome and associated evidence. The MPT imposed conditions on the appellant's registration for 12 months.

The General Medical Council (GMC) appealed under section 40A of the Medical Act 1983. The High Court judge allowed the appeal, concluding the only rational inference was that the appellant's motivation was sexual, substituting the MPT's finding accordingly. The judge also found the appellant lacked insight into the gravity of his actions and quashed the MPT's findings on remediation, risk, and sanction, remitting sanction to the MPT. The appellant was permitted to appeal the judge's finding on sexual motivation, which is the sole ground of the current appeal. The sanction hearing was stayed pending this appeal.

Legal Issues Presented

1. Whether the High Court judge was correct in finding that the only rational conclusion from the facts was that the appellant's conduct was sexually motivated.
2. Whether the MPT's original finding of no sexual motivation was irrational or outside the bounds of reasonable decision-making.

Arguments of the Parties

Appellant's Arguments

• The judge failed to properly apply the principles requiring deference to the MPT's advantage in seeing and hearing witnesses, particularly regarding the appellant's professed lack of sexual interest supported by family and expert evidence.
• The MPT's finding of no sexual motivation was a primary fact finding and should not have been overturned without clear error.
• The pleadings left open the possibility that the touching was clinically motivated, if not clinically indicated, and the judge erred in dismissing this.
• There was no direct evidence of sexual motivation, and the clinical setting and other contextual factors were relevant to the inferences to be drawn.

Respondent's (GMC) Arguments

• The acts of intimate touching without clinical justification, consent, or gloves, and false record keeping overwhelmingly supported a finding of sexual motivation.
• The MPT's acceptance of the appellant's denials and the expert evidence did not provide a plausible innocent explanation for the conduct.
• The judge correctly identified the MPT's approach as fundamentally flawed and irrational in finding no sexual motivation.
• The absence of sexual motivation was not reasonably open on the evidence, and the judge was entitled to substitute her own finding.

Table of Precedents Cited

Court's Reasoning and Analysis

The court carefully analysed the factual findings made by the MPT, which accepted the complainants' credible and consistent accounts of intimate, non-consensual touching without clinical justification, consent, or gloves, and found the appellant's denials and contemporaneous records to be unreliable and inaccurate. The court emphasized that the state of a person's mind, including sexual motivation, is inferred from conduct and surrounding evidence.

The court found that the MPT's acceptance of evidence from the appellant's family and an expert psychiatrist, while credible, did not provide a plausible alternative explanation to the overtly sexual conduct. The MPT failed to properly consider the implications of the appellant's false denials and inaccurate records on the question of motive. The court held that the MPT's conclusion that the touching was not sexually motivated was irrational and not reasonably open on the evidence.

The court rejected the appellant's argument that the judge failed to afford proper deference to the MPT, finding that the judge was entitled to substitute her own conclusion on the issue of sexual motivation given the flawed approach by the MPT. The clinical setting did not provide a clinical motivation for the conduct but merely the opportunity for it. The court agreed with the judge that the only rational inference was sexual motivation, and that the judge's substitution of that finding was justified.

Holding and Implications

The court DISMISSED the appellant's appeal, upholding the High Court judge's finding that the appellant's conduct was sexually motivated.

This decision confirms that appellate courts may overturn tribunal findings of fact on sexual motivation where the tribunal's reasoning is flawed and the evidence overwhelmingly supports a contrary inference. The ruling emphasizes the importance of proper inference drawing in regulatory appeals and the limited scope for deferring to tribunals when their approach is fundamentally flawed. The sanction hearing will proceed in light of the upheld finding of sexual motivation. No new legal precedent was established beyond the application of established principles to the facts of this case.