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R (on application of AW) v St George’s, University of London  EWHC 1647 (Admin)
A medical student, AW, began a graduate entry course in medicine at St George’s University, University of London (SGUL) in 2012. After passing her first two years of medical school, AW was diagnosed with renal cancer in July 2015, which was the same month that she was due to take her third year exams. She failed these exams narrowly. Although she retook them in August 2015, she again failed the exams and so began retaking the year in September 2015.
Unfortunately AW continued to experience problems with her health over the following months. She interrupted her studies in April 2016 to undertake ten weeks of treatment and recovery. In correspondence to AW, SGUL set out that their interpretation of the Interruption of Studies (IOS) policy meant that she would be able to resume her course in February 2017. She attended occupational health appointments in February 2017 and August 2017, the second of which deemed her ‘currently fit for training’ providing she was given required adjustments and support. AW had to take further time out of University due to health reasons. AW began a further IOS in April 2018, and therefore missed more than six weeks of her clinical experience - this IOS was to last until February 2019. As health grounds had been the reason for interruption, AW would again need to undergo an occupational health assessment before returning to study.
On 12 March 2019, SGUL decided to terminate AW’s student registration on the SGUL medical course. In a letter sent to AW on 3 April 2019, SGUL set out their reasoning for this. First, SGUL considered that AW had failed to meet the agreed conditions required for her return from an IOS. This was a reference to the expectation that AW would return to study at a set time and undergo an occupational health assessment to confirm that she was fit to do so. Indeed, an appointment was scheduled between AW and occupational health which was subsequently cancelled by AW. SGUL viewed her failure to rearrange this appointment as meaning that AW could not return to the course. The second reason cited for AW’s registration being terminated, was that she had failed to attend her first allocated placement in paediatrics following her term of absence and had not informed her placement coordinator of the absence.
AW asked SGUL about her right of appeal on 4 April 2019. SGUL took the view on 17 April 2019 it was no longer prepared to consider a complaint from AW. On 24 May 2019 AW served SGUL with a pre-action letter ahead of lodging a claim for Judicial Review.
On 19 June 2019 AW served her Judicial Review claim challenging the decision SGUL had reached on 12 March 2019.
The High Court recognised that SGUL was concerned about AW’s ability to maintain her current knowledge to a level such that she could practice safely. However, the Court considered that the problem in fact stemmed from SGUL not explaining to AW that a failure to attend an occupational health assessment before February 2019 could lead to her registration being terminated. In the Court’s view, SGUL failed to make it clear that if AW did not attend an occupational health referral by a certain date or re-enrol by a certain date, her registration would be terminated. Significantly, this failure to communicate such a vital piece of information occurred despite the frequent communication taking place between AW and SGUL during the relevant period. The Court was critical of SGUL’s failure to communicate this information and it was on this point that their decision to terminate AW’s registration was found to be unlawful.
It is also of note that during the Court proceedings, SGUL submitted additional reasons as to why AW’s registration should be terminated. The High Court made short shrift of these additional points and criticised SGUL for failing to advance the arguments at the time of termination, which would have given AW a chance to respond and address the concerns.
The Court invited AW and SGUL to determine whether it would be possible for her to resume her studies to complete the final two years of her medical degree.
We often advise students about fitness to practise and disciplinary matters at University level. Whilst each institution has its own processes, this decision makes clear that Universities have to ensure that communication with students is clear, directly sets out what is expected of them and the potential outcomes should they not meet those expectations. Decisions such as terminating studies can have a significant impact on the individual concerned, and therefore it is imperative that Universities follow due process.
Shannett Thompson is a Senior Associate in the Regulatory team. She is a highly experienced lawyer taking the lead in defending health professionals before their regulatory bodies including the GMC. She has substantial experience in advising individuals in relation to their regulatory obligations in the wider context.
Sian Marie Jones is a Legal Assistant in the Regulatory team. Sian investigates and prepares fitness to practise cases relating to professional misconduct, ill-health, and lack of competence on behalf of the Health and Care Professions Council (HCPC). She also investigates fitness to practise cases on behalf of the Education Workforce Council (EWC) and General Optical Council (GOC).
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