High Court Challenges GMC Decision in Patel Case: Focus on Realistic Prospect Test and Adequacy of Reasons

Citation: [2024] EWHC 567 (Admin)
Judgment on

Introduction

In the notable case of Patricia Rogers, R (on the application of) v The General Medical Council, the High Court of Justice delved into judicial review proceedings challenging the General Medical Council’s (GMC) decision not to refer certain allegations against Dr. Faisal Patel to the Medical Practitioners Tribunal. The court considered the application of the realistic prospect test, the presumption of impaired fitness to practise, the weight and evaluation of expert evidence, and the adequacy of the reasons provided by the GMC in reaching its determination.

Key Facts

Patricia Rogers sought judicial review regarding GMC’s decision not to refer allegations involving Dr. Patel’s retroactive amendments to the medical notes of Mr. Victor Loder. Mr. Loder passed away due to mesothelioma, and Ms. Rogers contended that Dr. Patel retrospectively altered medical records without indicating such changes. Despite Dr. Patel admitting to the retrospective alterations, the GMC’s Case Examiners concluded there was no realistic prospect of a Tribunal finding these amendments to be untrue or dishonestly motivated.

Ms. Rogers raised various grounds challenging the Case Examiners’ decision not to refer the matter to the Tribunal and sought a review on these bases. The High Court examined the alleged legal errors in the decision-making process, considering the evidence, the Guidance for the Investigation Committee and case examiners, and applicable legal standards.

The court focused on several key legal principles:

  1. Realistic Prospect Test: This test comprises two limbs: whether there is a realistic prospect of the facts being proven and, if so, whether the doctor’s fitness to practise is implicated to justify action on registration. The presumption of impairment applies to the second limb and is triggered by serious allegations if proven.

  2. Presumption of Impaired Fitness to Practise: For allegations like dishonesty, a presumption arises that the doctor’s fitness to practise is impaired. This presumption requires rebuttal evidence showing that the conduct in question is at the lower end of the spectrum of seriousness or that exceptional circumstances justify not referring the allegations to the Tribunal.

  3. Weight and Assessment of Evidence: Case Examiners are entitled to assess the weight of evidence but ought not to resolve substantial conflicts. Expert opinions, particularly regarding professional standards, must be taken seriously, and failure to sufficiently reason disagreements, if any, with expert evidence may constitute a flaw in the decision-making process.

  4. Adequacy of Reasoning: Decisions must be sufficiently rationalised, especially when dealing with matters impacting public confidence in the medical profession. Material flaws in reasoning or failure to consider comprehensive expert evidence may lead to the quashing of the decision under review.

Outcomes

The court found two main grounds on which the initial GMC decisions were flawed:

  1. Allegations 1 and 2 (Inappropriate Record Keeping): The court determined that the Case Examiners did not adequately reason their decision not to refer the case to the Tribunal, despite recognizing that Dr. Patel’s actions were “inappropriate” and fell “seriously below the standard expected.”

  2. Allegation 5 (Dishonest Motivation): The court ruled that it was an error to allege misconduct could not be proven dishonest simply because the retrospective entries may have been factually correct. An accurate entry might still be motivated by dishonest intentions, and the Case Examiners failed to adequately assess this possibility.

The High Court quashed the applicable parts of the decisions, and the matters of Allegations 1, 2, and 5 were remanded to the Case Examiners for reconsideration.

Conclusion

The judgment in Patricia Rogers, R (on the application of) v The General Medical Council underscores the intricacies involved in judicial review of professional regulatory decisions. It cements the notion that decisions to not proceed with allegations of professional misconduct must be substantiated with robust reasoning and due consideration of expert testimony, especially when questions of honesty and integrity arise. The High Court’s decision showcases the careful scrutiny applied to review proceedings and the importance of adherence to established guidelines and processes by regulatory bodies like the GMC.