Medical Council v B (Approved)

Factual and Procedural Background

This opinion concerns an application made by the Medical Council (the "Council") pursuant to section 60 of the Medical Practitioners Act 2007 (the "2007 Act") seeking orders to suspend the registration of a registered medical practitioner (the "Respondent") and prohibit him from practicing medicine pending further proceedings under Parts 7, 8, and 9 of the 2007 Act. The Council initiated the application following concerns about the Respondent’s conduct, including multiple driving convictions and breaches of undertakings previously given to the Court. The Respondent was formerly employed as a surgical registrar at a named General Hospital until his contract ended in July 2022 and was not renewed.

The Council’s complaint arose from the Respondent’s disclosures in his 2020 Annual Retention Application Form (ARAF) and subsequent investigations by the Preliminary Proceedings Committee (PPC) regarding criminal convictions, including offences related to driving under the influence, driving while disqualified, and possession of cannabis. The Council received a letter from a Superintendent expressing serious concerns about the Respondent’s fitness to practice due to his pattern of behaviour, including driving offences and substance misuse, which raised patient safety concerns.

The application was first brought on 25 November 2021 and heard by Irvine P. on 20 December 2021, when undertakings were agreed between the parties in lieu of suspension orders. However, subsequent breaches of these undertakings by the Respondent, including convictions for driving while disqualified and uninsured, prompted the Council to renew its application for suspension orders. The matter was adjourned and heard before the President of the High Court on 27 July 2022, with further affidavits exchanged and submissions made.

Legal Issues Presented

1. Whether the Court should grant an order suspending the registration of the Respondent under section 60 of the Medical Practitioners Act 2007 pending the outcome of disciplinary proceedings.
2. Whether the suspension of registration and prohibition from practicing medicine is necessary to protect the public.
3. How to balance the public interest in protection against the Respondent’s constitutional rights to practice medicine and earn a livelihood.
4. The appropriateness and sufficiency of undertakings offered by the Respondent as an alternative to suspension orders.

Arguments of the Parties

Applicant's Arguments (Medical Council)

• The Council contended that suspension was necessary to protect the public due to the Respondent’s serious and escalating pattern of behaviour involving driving offences, substance misuse, and breaches of court undertakings.
• The Respondent had a history of alcohol and substance abuse issues spanning several years, with a lack of insight into the seriousness of his conduct.
• At least one undertaking given to the Court was breached, undermining confidence in the Respondent’s compliance.
• The Council expressed concern about the difficulty of monitoring voluntary undertakings, especially if the Respondent sought locum work.
• The Council emphasized the risk profile of the Respondent’s medical role and the need for public protection pending disciplinary proceedings which could take twelve months or more.
• As a fallback, the Council offered a set of new undertakings that the Respondent agreed to, but maintained that suspension orders remained the primary objective.

Respondent's Arguments

• The Respondent acknowledged past issues with alcohol and substance abuse but denied ever compromising patient safety or attending work under the influence.
• He disputed some factual allegations, including that he was traveling to or from work while under the influence on a key occasion.
• He provided multiple positive references from consultants and clinical nurse managers attesting to his professionalism and fitness to practice.
• The Respondent accepted he breached one undertaking but explained the circumstances and expressed remorse.
• He asserted he had not consumed alcohol or illegal substances since August 2021 and was actively seeking help through support groups.
• The Respondent emphasized that his medical profession was his sole income and expressed willingness to comply with undertakings.
• He argued there was no evidence of actual risk to patient health or safety to justify suspension.

Table of Precedents Cited

Court's Reasoning and Analysis

The Court commenced by acknowledging the wide jurisdiction under section 60 of the 2007 Act, which permits the Court to make any order it deems appropriate, including suspension of registration. It noted the serious consequences of suspension orders for a medical practitioner’s livelihood and reputation, thus emphasizing that such orders should only be issued when necessary to protect the public and when no other order suffices.

The Court applied established principles requiring a balancing exercise between the public interest in protection from potential harm and the constitutional rights of the Respondent to practice medicine and earn a living. The Court carefully considered the seriousness of the Respondent’s conduct, including multiple criminal convictions related to driving offences and substance misuse, and the Respondent’s breaches of undertakings given to the Court.

However, the Court found that there was no evidence before it demonstrating any threat to the health, safety, or welfare of the Respondent’s patients. The numerous positive professional references, including from consultants and clinical nurse managers, weighed heavily in favour of allowing the Respondent to continue practicing under strict conditions rather than suspension.

The Court noted the Council’s loss of trust and confidence in the Respondent’s compliance due to breaches of undertakings and failure to provide requested information promptly. Despite this, the Court was persuaded by the absence of direct patient safety risk and the Respondent’s representations regarding his efforts to address his substance abuse issues.

Consequently, the Court concluded that the balance of interests, albeit finely poised, favoured accepting a set of new undertakings agreed by the Respondent rather than imposing immediate suspension. The Court emphasized that these undertakings must be complied with strictly and that any breach would likely lead to suspension orders being granted.

The Court also imposed a timetable for the Respondent to provide outstanding information to the Council’s Health Committee and PPC, warning that failure to do so would have serious consequences.

Holding and Implications

The Court’s final ruling was to ACCEPT THE NEW UNDERTAKINGS offered by the Respondent and agreed with the Council, in place of granting the suspension orders sought under section 60 of the Medical Practitioners Act 2007.

This decision means that the Respondent’s registration is not suspended at this stage, and he is permitted to continue practicing medicine subject to strict undertakings and oversight by the Council. The Court made clear that this is a last chance for the Respondent, and any breach of the undertakings or failure to provide requested information will likely result in suspension orders being granted.

No new legal precedent was established by this ruling; rather, it reflects the application of established legal principles balancing public protection with the rights of medical practitioners pending disciplinary proceedings.