Dr Waney Marian Valerie Squier v General Medical Council

JurisdictionEngland & Wales
JudgeMr Justice Mitting
Judgment Date03 November 2016
Neutral Citation[2016] EWHC 2739 (Admin)
CourtQueen's Bench Division (Administrative Court)
Docket NumberCO/2061/2016
Date03 November 2016

[2016] EWHC 2739 (Admin)

IN THE HIGH COURT OF JUSTICE

QUEEN'S BENCH DIVISION

THE ADMINISTRATIVE COURT

Royal Courts of Justice

Strand

London WC2A 2LL

Before:

Mr Justice Mitting

CO/2061/2016

Between:
Squier
Appellant
and
General Medical Council
Respondent

Sir Robert Francis QC and Miss C Bradley QC (instructed by Radcliffes Le Brasseur) appeared on behalf of the Appellant

Mr R Kark QC (instructed by GMC) appeared on behalf of the Respondent

JUDGMENT ON SANCTION TO BE APPLIED

Mr Justice Mitting
1

Under section 35C(2) of the Medical Act 1983, a registrant's fitness to practise is to be treated as impaired by reason of misconduct. The remaining circumstances in which practise may be treated as impaired are not relevant for present purposes.

2

Although the statute refers only to misconduct and not to serious misconduct or serious professional misconduct, the parties agree, on the basis of Auld LJ's observations in Meadows, that it means the same as serious misconduct or serious professional misconduct and does not signify any lowering of the threshold before a finding of impairment of fitness to practise could be made: see paragraph 198 of his judgment.

3

Mr Kark on behalf of the GMC and on instructions has conceded that, in the light of the length of these proceedings, the circumstances in which Dr Squier finds herself and in the public interest, I should determine impairment, and if I find impairment, sanction, rather than remit the case to another tribunal, to decide impairment and sanction afresh on the basis of my findings on the factual issues, which I have handed down today. I have the power to do so under section 47C of the 1983 Act and also under CPR 52.1(a)(i) and I accede to the suggestion of the parties that I should exercise it.

4

The first question, therefore, to be decided is whether the conduct in respect of which I have upheld the findings of the MPT amounts to serious misconduct or serious professional misconduct. It does. It is serious professional misconduct for a medical practitioner when giving evidence before a court as an expert witness repeatedly to break the obligations laid down by the courts on expert witnesses. Those obligations are correctly summarised in the GMC's guidance to the profession about the giving of expert evidence.

5

The reason why it amounts to serious professional misconduct was explained succinctly by Eleanor King J in S at paragraph 247 of her judgment:

i. "These Courts rely on the professionalism and rigor of the experts who come before them."

6

In Dr Squier's case, on account of the findings of the MPT which I have upheld, she did repeatedly breach the obligations of an expert medical witness in a number of cases. Further, and this is an aggravating feature, that misconduct was compounded by the deliberate miscitation of research papers in two of the cases. Her misconduct in those respects demonstrates to my satisfaction that her fitness to practise is impaired.

7

It is then necessary to go to consider what sanction should be imposed. I take as my starting point the GMC guidance on sanctions, which in the version current at the time of Dr Squier's hearing stated in paragraph 13:

i. "The main reason for imposing sanctions is to protect the public. This is the statutory overarching objective, which includes…

ii. (b) maintaining public confidence in the profession.

iii. (c) promoting and maintaining the proper professional standards and conduct of the members of the profession."

8

Paragraph 19 was also relevant:

i. "In deciding what sanction, if any, to impose the panel should consider the sanctions available starting with the least restrictive. It should also have regard to the principle of proportionality weighing the interests of the public with those of the practitioner…"

9

In this case, as in all others, it is the public interest which is paramount. Principally, to promote and maintain proper professional standards and conduct by members of the profession — those doctors who do give expert evidence before the courts — it is necessary that a finding of misconduct should be visited by a sanction. Three are available; the imposition of conditions for up to three years, suspension and erasure. On the facts of this case and in reality, only the imposition of conditions and erasure are viable sanctions.

10

Mr Kark submits on behalf of the GMC that to promote and maintain proper professional standards, but above all to maintain public confidence in the profession, it is necessary that a registrant such as Dr Squier who has transgressed in the respects which I have upheld should receive the sanction of erasure. He rightfully points out that the judiciary is a section of the public whose confidence must be maintained. Dr Squier, in the evidence that she gave, unhappily undermined that confidence, as the judgments of the three Family Division judges to which I have been referred have demonstrated.

11

It is easy to conceive of circumstances in which only erasure could be an appropriate sanction. In this case, the circumstances are, however, more finely balanced. Dr Squier is an internationally renowned paediatric neuropathologist, both as a practitioner and as a scientist publishing her own views about matters within her expertise.

12

The area of her practice which has been criticised is a specific area of her practice. In those circumstances, paragraphs 62 and 63 of the GMC's guidance on sanctions becomes relevant. 62 provides:

i. "Conditions might be most appropriate in cases…

ii. (c) where there is evidence of shortcomings in a specific area or areas of the doctor's practice."

13

That applies here.

14

Paragraph 63 deals with the circumstances in which conditions are likely to be appropriate and workable. They include:

i. "(a) the doctor has insight into the concerns."

15

When giving evidence before the MPT and when submissions were made on her behalf at the conclusion of the fact-finding exercise, the MPT were entitled to conclude that Dr Squier had shown little or no insight into the concerns raised by the charges against her even when they had been found to have been proved.

16

It is a significant fact that her insight has now changed. I am going to quote a passage which Sir Robert Francis on her behalf read out:

i. "She has found the hearing in this court to have had a striking impact on her. She recognises that careful and fair consideration has been given to her case and she has found it a matter for serious regret that this court has found it necessary to uphold some of the criticisms made of her practice as an expert witness. Having reflected on the judgment, she accepts that in certain respects her practice has fallen short of the standards which she agrees are rightly expected of expert medical witnesses. Dr Squier wishes to apologise for this conduct. In particular, she accepts that there is a need for greater accuracy in her citation of literature and of the need to make clear where authors of papers she relies on for one purpose have expressed views of their own which are inconsistent with hers. She understands that she is not obliged to agree with such conclusions, but she must make clear why she disagrees with them."

17

Sir Robert has also made it clear that she has no intention of accepting instructions to appear in the Family Courts. I will return to the extent of conditions to be imposed if that is the appropriate outcome.

18

Another factor to be borne in mind, not only in the interests of Dr Squier but also in the public interest, is what the public would lose if she were to be erased from the register. I have been provided with an extensive bundle of testimonials. Sir Robert has drawn my attention to some of them in the course of his submissions today. I have read them, but I need do no more than cite three to demonstrate the continued value to the public of her continuation in what I have described as her "ordinary" practice.

19

Dr Robin Kennett, a consultant in clinical neurophysiology at the John Radcliffe Hospital, in a letter dated 28 September 2015;

i. "From my role as an appraiser, I know that she is considered nationally as an expert in the neuropathology of brain development and she provided a national expert reporting service in this field."

20

Mr Alexander Green, a consultant neurosurgeon, in a letter of 14 March 2016;

i. "The very high quality of her work, the shortage of qualified neuropathologists and the excellent service that she has provided over her career are very strong reasons why she should be allowed to continue in her clinical work. If she were to be stopped, it would be a great loss to the patients that are being treated at Oxford and the NHS as a whole. Her vast experience and her enthusiasm for teaching adult pathology should be kept going as long as possible."

21

Finally, Professor Sewry, a consultant pathologist at the Institute of Child Health in Great Ormond Street, in her letter dated 15 March 2015;

i. "If Dr Squier is suspended or erased from the medical register, this would be a severe loss to the patients and to the NHS. There is currently a shortage of trained neuropathologists, particularly with skills in both muscle and the nervous system… It is important that the neuropathology knowledge and skills that Dr Squier has acquired over many years are passed on to trainees who will be her successors in a highly specialised area where there are few candidates to fill posts."

22

Dr Squier is 68. Until her suspension seven and a half months ago, she was the consultant paediatric neuropathologist at the John Radcliffe Hospital,...

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