Shah Ali v The General Medical Council
[2024] EWHC 2272 (Admin)
Patricia Rogers, R (on the application of) v The General Medical Council
12 March 2024
[2024] EWHC 567 (Admin)
High Court
A doctor changed a patient's medical notes after the patient got a cancer diagnosis. The medical council didn't think this was serious enough to investigate further. The court disagreed, saying the council didn't properly consider whether the doctor was dishonest, even if the changes were factually correct. The court ordered the council to review its decision.
Key Facts
- •Dr. Faisal Patel retrospectively amended patient Mr. Loder's medical notes without indicating the alterations.
- •Ms. Patricia Rogers, Mr. Loder's former partner, challenged the General Medical Council's (GMC) decision not to refer the allegations to the Medical Practitioners Tribunal (Tribunal).
- •The GMC's Case Examiners decided not to refer the allegations, a decision later upheld on review.
- •The amendments were made after Dr. Patel learned of Mr. Loder's cancer diagnosis.
- •An independent expert report criticized Dr. Patel's actions as misleading and below professional standards.
- •The court considered whether the presumption of impaired fitness to practice was engaged and whether the Case Examiners' decision was adequately reasoned.
Legal Principles
Case Examiners must have due regard to the Guidance for the Investigation Committee and case examiners and not depart from it without cogent reasons.
Guidance for the Investigation Committee and case examiners
The realistic prospect test applies to both factual allegations and whether the facts demonstrate impaired fitness to practice.
Guidance for the Investigation Committee and case examiners, Annex B
Allegations of dishonesty create a presumption of impaired fitness to practice, which must be rebutted to avoid referral to the Tribunal.
Guidance for the Investigation Committee and case examiners, paragraphs 24-28
A decision of the Case Examiners not to refer an allegation to the Tribunal may be reviewed on limited grounds (material flaw or new information).
General Medical Council (Fitness to Practise) Rules Order of Council 2004, Rule 12
The court considers whether the GMC review decision was reasonably open to the review decision-maker, even if the court might have reached a different conclusion.
Judicial Review principles
Outcomes
The claim succeeded on Grounds 3 and 4.
The Case Examiners failed to properly consider Allegation 5 (intention to avoid criticism) and provided insufficient reasoning for their decision on Allegations 1 and 2 (inappropriate amendments). The court found that an accurate retrospective entry can still be dishonestly motivated and that the Case Examiners did not adequately consider the independent expert's strong criticism of Dr. Patel's actions.
The decisions of 6 September 2022 and 9 February 2023 were quashed in relation to Allegations 1, 2, and 5.
These allegations must be reconsidered by the Case Examiners due to material flaws in the original decision-making process.