Catherine Ann Lawrance v General Medical Council
| Jurisdiction | England & Wales |
| Judge | Mr Justice Collins |
| Judgment Date | 13 March 2015 |
| Neutral Citation | [2015] EWHC 586 (Admin) |
| Court | Queen's Bench Division (Administrative Court) |
| Date | 13 March 2015 |
| Docket Number | Case No: CO/2461/2014 |
[2015] EWHC 586 (Admin)
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Royal Courts of Justice
Strand, London, WC2A 2LL
Mr Justice Collins
Case No: CO/2461/2014
Ms H F Davies (instructed by Darbys, Oxford) for the Appellant
Mr I Hare (instructed by GMC Legal) for the Respondent
Hearing dates: 11 th February 2015
The appellant appeals against the decision of a Fitness to Practice Panel of what is called the Medical Practitioners Tribunal Service given on 28 April 2014. A finding of misconduct was made which led to a decision that the appellant be erased from the Medical Register. The appeal is brought against the findings of the panel and against the sanction imposed.
The appeal is brought pursuant to Section 40 of the Medical Act 1983. An appeal under s.40 is by way of rehearing and CPR 52 applies: see Practice Direction 52D Paragraph 19(1)(l)(e) and 19(1)(2). The appellant appeared in person before the panel on the first day of the hearing which was 22 April 2014. She had been represented by solicitors via the MPS until December 2013. In circumstances which I shall have to consider in more detail, she indicated that she would not be able to cross-examine the witnesses who were to give evidence against her. She was given overnight to try to obtain representation whether immediate or following a possible adjournment. She attended on 23 April 2014. She had not been able to contact any possible representatives but unfortunately instead of informing the panel of the circumstances she said she considered it unjust and unfair for the hearing to continue and she had nothing further to say. She then left the room and the building. The panel decided to proceed in her absence. The sanction was imposed in her absence.
She claims that the decision to proceed in her absence was unfair. Further, she claims that the panel should not have found the facts against her and in particular should not have found her to have been dishonest, the finding being what had led to the decision that she be erased from the register. Further, she claims that even if the findings of the panel cannot be impugned, the sanction of erasure was too harsh and should not stand.
The dishonesty alleged against the appellant arose from statements she made and evidence she gave in a claim made against her by the partners in the practice in which her husband, Dr. Tarek Moneim, had been a general practitioner. He had become a partner in that practice in April 2003 but had been, as it was put, compulsorily retired from it in February 2007. The appellant had been a partner since January 2002 in a different practice in Reading. She did not do full time work in what I shall call her practice until August 2004. In 2003 and 2004 she did work helping out her husband at his practice. It was her case that she continued to help out, albeit less frequently, after August 2004. There were certainly two occasions in March 2005 when she did what might have been described as locum work. But it was the case against her that she had not worked at all at her husband's practice after the two occasions in March 2005.
Relations between the appellant's husband and Drs Underwood and Pizura, his partners, began to deteriorate. In December 2006 they lodged a complaint against him with the NHS Primary Care Trust. They were concerned, it was said, about his abilities. They complained about him and that led to certain complaints to the GMC in early 2007. The appellant had been drawn into the dispute as Dr Moneim's wife and because she had worked in his practice she knew how his partners operated. She made a complaint to the GMC about Dr Underwood which led to a finding against him in relation to his internet prescribing.
The relationship between Dr Moneim and his partners had broken down by the autumn of 2006. Dr Pizura had referred to Dr Moneim in disparaging terms in e-mails, reflecting adversely on his Egyptian and Muslim background. Complaints were made to the GMC by Dr Moneim against his partners and by them against him. The appellant has said she was concerned about some aspects of Dr Underwood's clinical practice and, since she was unable to deal with her concerns directly with him, she approached the PCT.
Dr Moneim's complaint against his partners was rejected by the GMC as not being within the scope of its Fitness to Practice procedures. Dr Moneim was found to have made numerous retrospective amendments to patients' records, some dishonestly, and on 27 April 2010 he was suspended from practice for 12 months. On appeal, the decision (save as to one finding of dishonesty) was upheld. The appellant's allegations against Dr Underwood were not established in relation to his professional performance save that he accepted a period of professional monitoring of his record keeping and was given a formal warning in relation to his practice of internet prescribing. The internet prescribing had been considered by the police and they together with the appellant referred it to the GMC.
The PCT in an e-mail of 5 March 2007 had sought access to the visit and message books for the two surgeries operated by the appellant's husband's practice between 2003 and 2006. Those books showed records of home visits and messages received and would contain the doctors' notes of actions taken as a result. Following their collection by the PCT on 12 March 2007, they were handed to the appellant by the PCT on 14 March 2007 to be returned to the practice. She said she received them to give to her husband to enable him to prepare his response to the allegations which had been made against him. Some eight weeks later she made her complaint about Dr Underwood to the GMC.
Despite requests both by Dr Moneim's partners and the PCT that the books should be returned to the practice, they were not. They were being kept, it was said securely, at the appellant's surgery. The failure to return them led to a claim in the Reading County Court for their return and damages said to have been incurred because of their absence and time spent in seeking their return. The claim as lodged was for damages amounting to £24,650. The books were returned in February 2008 but the claim for damages and costs continued.
It was alleged against the appellant that she had used the books to try to support her complaint against Dr Underwood in particular. This she denied saying that she had continued to do locum sessions and act as a second 'on-call' doctor from time to time to help out her husband. She also, she said, carried out administrative work, such as collection and sorting of post, and was involved in the provision of contraceptive services. All this she did after August 2004 until her husband was compulsorily retired. That she had done any such work, save for the two occasions in March 2005, for which, although her husband's name was recorded on the EMIS system used, she was paid, she received no other payment. That she had done any work as she alleged was denied by her partners and by Ms Charlton, the practice manager.
The circuit judge's findings are important since they were relied on to support the case against the appellant. He found Ms Charlton to have demonstrated her loyalty to Drs Underwood and Pizura and to have overstated her case in that respect. But otherwise her evidence was supported by the practice records. Dr Underwood he found to have been a poor witness. He had had to modify his evidence in a number of particulars thus having to accept that what he had put in his statement was inaccurate. Some of his evidence the judge found unacceptable. But on the key issue the judge was not prepared to accept the appellant's evidence. The judge's finding was in these terms:-
"On the balance of probabilities, I am persuaded by the evidence of Ms Charlton and, so far as it goes, Dr Pizura that, apart from the two occasions in March 2005, Dr Lawrance was not engaged to work for the claimant's practice after she became a partner to her own practice in August 2004. I cannot exclude the possibility that she occasionally deputised for her husband in making a home visit or some other task but, if that happened, any record of her work she had done was made by him in his own name."
The reference to her becoming a partner in August 2004 is wrong, but the error is immaterial since that was the date when she commenced to be a full time partner. It is to be noted that the judge did not rely on Dr Underwood's evidence in his conclusion nor did he rule out the possibility that the appellant had done some work such as she had stated. Nevertheless, he had clearly rejected significant parts of her evidence which either lacked any documentary support or were not credible explanations of some important matters.
I have dealt in some detail with the County Court decision since the appellant's statements for and evidence given in the hearing resulted in the complaint to and findings of the Fitness to Practice Panel. I shall refer to the decision as that of the FTP. The allegations as amended at the hearing that the appellant faced were as follows:-
"That being registered under the Medical Act 1983 (as amended):-
1. On 7 March 2005, whilst working as a part time General Practitioner at the Chancellor House Surgery and Tilehurst Village Surgery, Reading ('The Practice'), you recorded consultations you had undertaken at the practice in the name of your husband, Dr Moneim, a GP partner at the practice;
2. On or about 4 December 2009 you provided a statement to...
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