Dr N Karwal v General Medical Council [2011] EWHC 826 (Admin)

1 June 2011

The appellant doctor, K, appealed her twelve month suspension by the General Medical Council (GMC) after the Panel found her fitness to practise was impaired by reason of her misconduct.  In 2008, K was convicted on three out of twenty-six allegations of dishonesty when the Panel decided she had knowingly made false representations to a colleague, defrauding him of £188,000.

Finding that K’s conduct was dishonest, the Panel were not satisfied that she had insight into her conduct, imposed a 12 month suspension and directed a review, held in December 2009 and March 2010.  The review Panel concluded that K continued to demonstrate a lack of insight and she was further suspended for nine months.

On appeal K contended that the Panel had erred on the grounds that:

  1. it had permitted the GMC, without warning or notice, to present a case of lack of insight;
  2. it was not on the facts entitled to find lack of insight; and
  3. the finding of impairment was not open to the Panel; alternatively, it was not a proper finding and/or against the weight of the evidence.

Dismissing K’s appeal, the High Court held that the Panel had not erred. In particular, the Court held that the review Panel was obliged to consider the appellant’s dishonesty and her lack of insight, both of which were explicitly highlighted as concerns in the conclusions of the 2008 hearing. Further, K and her legal advisers would, or should have been aware of paragraph 116 of the GMC’s Indicative Sanctions Guidance and the need of the review panel “to satisfy itself that the doctor has fully appreciated the gravity of the offence”. 

Insight, in the sense of determining whether the doctor has appreciated the gravity of the offence, was inevitably going to be an issue at the review in respect of the question of current impairment.  Dishonesty by a doctor, albeit unconnected with the practice of medicine, undermined the profession’s reputation and public confidence in it. Such conduct provided a clear and proper basis for finding that K’s fitness to practise was impaired.

The Court firmly rejected K’s submission that the Panel had erred by equating maintenance of innocence with lack of insight. The Court held that the Panel was entitled to take into account K’s lack of appreciation of the gravity of her offence along with her continued dishonesty when reaching its conclusions on impairment.

The court reached a logical, somewhat unsurprising conclusion. For those representing clients in such proceedings, it is worth remembering the impact that a lack of insight will have on the panel’s determination of the appropriate sanction.

Sian Jones

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