Controlling and Coercive Behaviour: Widening the Net
High Court gives guidance on extension of interim suspension orders with regard to health allegations.
Judgment date: 11 February 2014
The claimant General Medical Council (the Council) applied to extend the period of suspension imposed by the Interim Orders Panel of the Council for 18 months on 14 August 2012 under s41A(6) and (7). Reviews had taken place on 17 January 2013, 10 July 2013 and 9 December 2013. The 17 January 2013 review was itself subject to an appeal.
The defendant doctor (D) is 69 years old and practises as a General Practitioner. In the summer of 2012 D was the subject of two separate patient complaints. The gravamen of these complaints was that D had become abusive and indeed physically violent toward two couples who had attended his surgery for advice and treatment. A police investigation was embarked upon in respect of these incidents but no further action was taken.
It was in respect of the above two incidents that the interim suspension order was imposed on 14 August 2012.
The Council embarked on its investigation of the above allegations however whilst these investigations were on-going the Council received a letter from Dr Alison Conway on 17 October 2012 raising concerns about D’s health, namely that he was suffering with cognitive impairment and in light of this should not be seeing patients on his own. These concerns were in the period from 17 October 2012 until the date of the Council’s application to extend the period of suspension and a number of medical reports were provided by both sides as to the nature and impact of D’s cognitive impairment.
At the time of the Council’s application they had written to D outlining the proposed matters which were alleged against D and he had been invited to respond within 28 days. The Council further made clear in their application that they would not be seeking further medical evidence, beyond updating medical assessments currently in their possession, or be making a work place assessment. It was on this basis the Council requested a 9 month extension of D’s suspension.
In objecting to the Council’s application, D made reference to a number of expert reports indicating that his ability to practise was not impaired. Particular reference was made to a report by Dr Kemp, a clinical neuropsychologist, concluded there was no evidence to support a diagnosis of dementia or Alzheimer’s Disease and that D likely supper with anomia, something which Dr Kemp state he did not think would have any significant impact on D’s ability to work in general practice.
In determining whether to extend the period of suspension the Court stated that, in respect of the summer 2012 allegations which initially brought D to the Council’s attention, an extension would not be justified.
However, the Court noted that the nature of the case had changed since those allegations were first made and that the central issue was now whether D was be suffering with Alzheimer/dementia or some other form of cognitive impairment. The Court noted reports obtained by the Council indicted that D’s cognitive function was impaired such that his continued practice posed a risk to the public whilst reports obtained by D indicated otherwise.
The Court reminded itself that it was not its function to determine the substantive issues and held that it was clear from the medical evidence on both sides that D did suffer from some cognitive impairment. In view of this cognitive impairment the Court further opined that the real question was ‘whether or not that [the cognitive impairment] amongst other matters sufficiently effects the defendant’s ability to practise…so as to disqualify him from practice’ .
The Court further held that ‘it is of the essence of being a medical practitioner… that he has sufficient mental acuity in order to carry out that task appropriately and safely ‘ .
The Court noted the conflict between the experts in these matters and ultimately held that, should the opinion of the Council’s experts ultimately be accepted, that D’s continued practise may well be a risk that does go to override the prejudice that would result to D and an extension was thus ordered.
In making this order the Court was mindful of the need for the Council to proceed expeditiously and only granted the order for 3 months as opposed to the 9 months originally sought.
A useful case which serves as a reminder that, where there is a conflict of expert evidence and on one reading of that evidence there is a risk to the public, an extension to an interim order is likely to be granted.
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