The E-Regulator: Lawrence v General Medical Council [2012] EWHC 464 (Admin)

2 March 2012

Appeal allowed as Fitness to Practise Panel of GMC had relied on its own self-avowed expertise in place of expert evidence and after inadequate reasons were given. 

This was an appeal by Dr Lawrence, a consultant psychiatrist in private practice, under s. 40 of the Medical Act 1983 against certain procedural decisions and factual findings made by the Fitness to Practise Panel (‘the Panel’) of the General Medical Council (GMC) as well as their sanction of erasure. It was alleged that in the course of psychiatric and psychotherapeutic treatment of Patient B, a middle aged married woman, Dr Lawrence acted inappropriately, not in the best interests of his patient and abused his professional position. The allegations included that he attempted to pursue an emotional relationship with Patient B, revealed his sexual fantasies about her, told her she was attractive and told her personal information about himself.

The Panel’s determination was almost entirely against Dr Lawrence. The Panel found that Dr Lawrence encouraged Patient B to believe that he wanted to pursue an emotional relationship with her; that he had told her of a sexual fantasy which he had about her; that he spoke of meeting her socially; and that he continued his psychotherapeutic sessions with Patient B even after he had become emotionally involved with her. The Panel found that this behaviour was sexually motivated, mostly inappropriate, not in Patient B’s best interest and an abuse of his professional position.

Dr Lawrence appealed on four grounds: (1) that Patient B should not have been allowed to give evidence by video link (from Australia where she now lives); (2) in finding that a woman with low self-esteem was unlikely to fantasise that she was attractive to another without encouragement the Panel had relied on expertise it did not have; (3) the Panel’s conclusion that erotic transference alone was unlikely to cause Patient B to believe that Dr Lawrence reciprocated her feelings was unsupported by expert evidence; and (4) the Panel had been wrong to find the allegations against Dr Lawrence proved. 

Dr Lawrence’s appeal was allowed in part.

(1) The court found that the Panel had not been wrong to exercise their discretion and allow Patient B to give evidence by video link. Patient B’s vulnerable mental health, and the public interest argument in allowing these allegations to be investigated, outweighed any arguments that the quality of Patient B’s evidence would be adversely affected or that Dr Lawrence would be prejudiced.

(2) With regards to the Panel’s findings that a woman with low self-esteem was unlikely to fantasise that she was attractive to another without encouragement, the court found that this represented a material procedural irregularity on the Panel’s part. The Panel had made a finding which was not open for it to make as Dr Lawrence had not been given an opportunity to make submissions or to adduce evidence on the matter. The Panel members are not entitled to reach a decision on an issue which has not been the subject of any evidence or arguments. The Panel had also tried to claim relevant experience of this issue as their Chair was a psychiatrist. However, he had no experience of psychotherapy, and therefore this was not ‘expertise’ they could rely on. The reliance of the Panel on its ‘self-avowed expertise’ was found to create precisely the risk which the Court of Appeal in Southall v General Medical Council [2010] EWCA Civ 407 said was to be avoided, ‘namely that a decision was made on the basis of an expert view that had not been the subject of evidence or argument’. 

(3) The only way in which the Panel would have been entitled to find that erotic transference alone was unlikely to cause Patient B to believe that Lawrence reciprocated her feelings would have been expert evidence. However, no expert evidence was heard on this matter and it was unclear as to why the Panel had made these findings. Following established case law, although the degree of detail needed to satisfy the requirement to give reasons depends on the facts of the case, particular detail is required when dealing with expert evidence.

As well as these specified errors, the Panel had made insufficient reference to various issues and given inadequate reasons which meant that in the interests of justice, the Panel’s findings of misconduct were quashed. 

This case shows the importance of the Panel giving full and thorough reasons for their decisions. It also demonstrates the danger of the Panel relying on their own professed expert opinion without hearing specific expert evidence on an issue. 

Julia Hicks

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