The FCA – Transformation to Assertive Supervision
Veeravalli v General Medical Council  EWHC 747 (Admin)
At the material time, the Appellant doctor had been working as a Consultant in Obstetrics and Gynaecology at Tameside and Glossop Integrated Care NHS Foundation Trust (‘the Trust’) since December 2010.
Following a hearing before a Panel of Medical Practitioners Tribunal (MPTS) in September 2021, the Appellant’s fitness to practise was found to be impaired. The Panel imposed an order of conditions on the Appellant’s registration for twelve months.
The Appellant’s denial of the charges was found to be a flawed argument in the face of multiple contradictory statements from colleagues. However, it was the Appellant’s failure to demonstrate insight into his actions which concerned the Panel and ultimately led to the order of conditions.
On 8 March 2017, at 6.50am Patient A was admitted to hospital experiencing strong and regular contractions. When the contractions slowed and it was discovered that the baby (Patient B) was in the breech position, Patient A was given the labour-augmenting drug syntocinon (Oxytocin) at 09.11am. Following a challenging delivery, Patient B was delivered at 10.28am but showed no signs of life and was pronounced dead 30 minutes later.
A number of failings were alleged by the GMC in relation to the Appellant’s care of Patient A. Importantly to note, the GMC did not allege, which is appropriate in fitness to practise proceedings, that the Appellant’s acts or omissions caused Patient B’s death.
After consideration, the allegations that were determined and found proved were that:
In her judgment, the Hon. Ms Justice Lang first dealt with the question of the jurisdiction of the High Court, when dealing with an appeal. In an interesting review of the case law, she began by noting that the right of appeal is given through Section 40 Medical Act 1983 and governed by CPR part 52. The question for the court is whether the Tribunal’s decision was “wrong” or “unjust because of a serious procedural or other irregularity in the proceedings in the lower court”.
The Hon. Ms Justice Lang debated Meadow v General Medical Council where Auld LJ discussed the wealth of expertise found in the tribunals implying that their judgements “deserve respect”. However the subsequent case of Raschid v General Medical Council followed the guidance in Ghosh v General Medical Council where Laws LJ submitted that the approach commended in case law “does not emasculate the High Court’s role in section 40 appeals”. It was pertinent for Laws LJ that the High Court should not shy away from correcting errors in judgement due to fear of over-stepping their jurisdiction.
The Appellant sought to rely on the more recent case of Sastry v General Medical Council where Nicola Davies LJ noted “The Board’s jurisdiction is appellate, not supervisory. The appeal is by way of a rehearing in which the Board is fully entitled to substitute its own decision for that of the committee.” By reviewing possible limitations, the Hon. Ms Justice Lang approved that any dismissal of the Tribunal’s decision was likely within the High Court’s authority.
The Appellant’s case relied on denying multiple allegations and disputing his role in the events of the morning. On appeal, he sought to show that the allegations were ‘wrong and irrational’:
It was noted by the Hon. Ms Justice Lang that the Tribunal undertook “a detailed and careful analysis of the facts, and evaluated them against the legal test of serious misconduct”. They assessed the Appellant’s actions against the GMC’s Consent Guidance and Good Medical Practice. They agreed with the principle that “where there have been serious departures from expected standards of conduct and behaviour, this can constitute misconduct”. Failing to obtain consent from Patient A was a particular point that highlighted poor communication between doctor and patient and substantially contributed to the poor management of Patient A.
The Tribunal acknowledged that the Appellant’s denial of the allegations did not preclude him from developing insight into his actions. However further reflections submitted by the Appellant failed to convince the Tribunal, and the appellant court, that he had provided any “sufficient meaningful evidence that he has accepted any personal responsibility.” Indeed, they commented that instead “he had reflected on the failings of the system and the failings of his colleagues.”
Given the otherwise unblemished career of the Appellant, the Tribunal felt that an order for suspension was disproportionate. However the failure to show insight into any deficiencies which caused the incident and instead to highlight failings elsewhere meant that practising conditions, including a Personal Development Plan, for twelve months were justified.
Given the backlog in hospitals after the COVID-19 pandemic, it is understandable that hospitals will be short-staffed and that medics will be stretched. Medical professionals will inevitably have to step in, often at short notice, to help out colleagues. This may result in confusion over responsibilities and duties, but at all costs, should not result in poor patient management.
There is strong evidence from this case that taking responsibility for one’s actions is looked on far more favourably than blanket denial of misconduct and apportioning blame elsewhere.
If you have any questions about the issues raised in this blog, please contact a member of our family and divorce team.
Felicity Yule is a trainee solicitor at Kingsley Napley and is currently in her first seat in the Family team. Felicity joined Kingsley Napley in August 2017 as a paralegal in the Immigration team. She was promoted to senior immigration advisor and recently offered a training contract with the firm.
Felicity graduated in French and History from King’s College London in 2016, and spent her third year in Martinique. She completed her Graduate Diploma in Law at BPP in June 2017 and her Legal Practice Course in June 2020.
Shannett is a Partner in the Regulatory Team having trained in the NHS and commenced her career exclusively defending doctors. She provides regulatory advice predominantly in the health and social care and education sectors.
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