R (Singapore Medical Council) v General Medical Council
| Jurisdiction | England & Wales |
| Judge | MR JUSTICE DAVIS,Mr Justice Davis |
| Judgment Date | 21 December 2006 |
| Neutral Citation | [2006] EWHC 3277 (Admin) |
| Docket Number | Case No: CO/10379/2005 |
| Court | Queen's Bench Division (Administrative Court) |
| Date | 21 December 2006 |
[2006] EWHC 3277 (Admin)
IN THE HIGH COURT OF JUSTICE
QUEENS BENCH DIVISION
ADMINISTRATIVE COURT
Mr Justice Davis
Case No: CO/10379/2005
Mr David Pannick QC and Mr Jeremy Hyam (instructed by Leigh Day & Co) for the Claimant
Mr Nigel Pleming QC (instructed by Field Fisher Waterhouse) for the Defendant
Mr Philip Havers QC (instructed by Medical Protection Society) for the Interested Party
Hearing dates: 4 th & 5 th December 2006
Introduction
On any view this is most unfortunate litigation. It involves the Singapore Medical Council ("the SMC") alleging with regard to its counterpart in Britain, the General Medical Council ("the GMC"), that the GMC has reached, through a decision of a Chairman of the Investigation Committee, a decision which is wholly unsustainable and irrational; and that the GMC has also, by failing to consult it, breached a duty of fairness said to be owed to the SMC. In the course of its written submissions the SMC has also stated, among other things, that the GMC has, by its conduct in this case, shown that "the GMC does not respect the findings or integrity of the SMC and its procedure". It is further said that the GMC "should not lightly have ignored the findings or the arguments of their equivalent professional body in Singapore" (thereby implying that it has so ignored them); and, still further, that the Chairman in question "unlawfully usurped" the functions of a Fitness to Practise Panel. These strong allegations, as are the overall grounds advanced by the SMC, are in turn strongly denied by the GMC. For his part, the practitioner the subject of the relevant disciplinary proceedings, Professor Simon Shorvon, has challenged the standing of the SMC to bring these present proceedings: and, indeed, has attributed to the SMC an "improper motive" in doing so.
In a nutshell, the context of the present proceedings is this.
2.1. In 2001 a wide-ranging medical research project was initiated in Singapore. Professor Shorvon was appointed principal lead investigator. Work on the project commenced in about July 2002. Within a few months complaints surfaced about the conduct of the project. There were inquiries and reports.
2.2. Ultimately the SMC conducted its own inquiry. 30 charges were brought against Professor Shorvon. The SMC inquiry was held in Professor Shorvon's absence, he having disputed the SMC's jurisdiction.
2.3. The SMC concluded that Professor Shorvon was guilty of professional misconduct under s.45(1)(d) of the Medical Registration Act (Act 5 of 1997) of Singapore, the SMC announcing its findings on 20 th February 2004. It found all the charges proved. It censured Professor Shorvon, required him to give an undertaking, fined him, and directed that his name be removed from the Register of Medical Practitioners in Singapore. He was also ordered to pay costs.
2.4. The GMC had been aware of such proceedings in Singapore. On 1 st July 2004 a screener referred charges to a Preliminary Proceedings Committee which in due course on 22 nd September 2004 decided that a charge should be formulated and referred the matter to a Fitness to Practise Panel.
2.5. By decision communicated on 23 rd September 2005 the Chairman of the Investigation Committee exercising (or purporting to exercise) his powers under the Rules directed that the referral to the Panel be cancelled.
It is that decision to cancel which is the subject of challenge by the SMC as having been made in circumstances of procedural unfairness and/or as being substantively unsustainable. The Claim Form was issued on 16 th December 2005. Permission was granted on 20 th February 2006.
At the hearing before me the SMC was represented by Mr David Pannick QC (appearing with Mr Jeremy Hyam). The GMC was represented by Mr Nigel Pleming QC. Professor Shorvon was represented by Mr Philip Havers QC.
The factual background
The factual background, in rather more detail, is this.
(a) The inquiries in Singapore
In August 2001 an application was made for a research project to be carried out in Singapore under the auspices of the National Neuroscience Institute ("NNI"), a medical institution with a particular focus on neurological research and having access to public funding. The NNI is a subsidiary of the National Healthcare Group.
The main purpose of the project was to identify major genes influencing disease in Singapore's three principal ethnic population groups with regard to disease susceptibility and drug responsiveness in four conditions in particular: epilepsy, Parkinson's Disease, stroke and neuroleptic induced tardive dyskinesia. There were also secondary research objectives, which included contributions to international efforts to define genome-wide patterns of Levo-Dopa in multiple populations. In the grant application to the Biomedical Research Council of Singapore the project was stated to have important functions in terms of training, commercial opportunities, planning of healthcare provision and raising the reputation of Singaporean neuroscience and genomic research.
Professor Shorvon is a highly accredited and world-renowned researcher in this field. He had applied to come to Singapore as Director of the NNI in December 2000; and in due course he was also appointed principal lead investigator of the project. It is said that the project was at the time one of the largest research projects undertaken in Singapore; and a grant of SGD 10 million (around £3.3 million) had been made by the Biomedical Research Council. A team of scientists and doctors was assembled, including local medical practitioners and also including co-principal investigators. One of the team was a Doctor Ramachandran, who had been a research student of Professor Shorvon at London University. Professor Shorvon himself took the position of Director of the NNI on secondment from University College, London where he was then (as he is now) a Professor of Clinical Neurology. Work started on the project shortly after approval was granted on 17 th July 2002.
Towards the end of November 2002 (that is to say, only a few months after work had started) complaints began to surface. In essence the complaints were of three kinds:
9.1. that Professor Shorvon and his researchers had obtained confidential information relating to epileptic and Parkinson's Disease patients without the knowledge or consent of such patients or their treating physicians.
9.2. that such patients had been recruited to take part in the project without the knowledge or consent of the patients' treating physicians and without the patients' fully informed consent.
9.3. that Professor Shorvon or his researchers under his supervision had prescribed or altered the Levo-Dopa medication of these patients without their knowledge or the consent of their treating physicians.
In his written submissions in the proceedings before me Professor Shorvon chooses to regard it as very suspicious that the allegations in part were made by a Singaporean co-principal investigator in the project who in due course was made Director in his place.
On 24 th January 2003 the NNI was directed to hold an inquiry and a panel of four doctors was appointed to report. Members of the project team, including Professor Shorvon, were interviewed, as were various doctors from the two relevant hospitals and various patients.
The NNI Inquiry panel reported on 21 st March 2003. In its summary the Panel concluded, among other things, that "the research was carried out in serious breach of ethical guidelines which are applicable in Singapore as well as internationally. The PD [Parkinson's Disease] patients' rights were disregarded and their safety and well-being were compromised in the course of the research." The panel decided that Professor Shorvon and Dr Ramachandran (the Project Manager) "decided to bypass the then PD patients' treating neurologists" in order to obtain blood samples from patients. In addition, the panel concluded that it was decided to undertake Levo-Dopa testing, and to request certain patients to alter their prescribed Levo-Dopa medication, without the patients being fully informed and without their treating neurologists being told. Various other findings were made. Overall, the essential conclusions, among others, were:
12.1. Patient records were disclosed to the project team without patients' consent; and it was deliberately decided not to seek ethics approval for accessing patients' records.
12.2. No ethics approval had been obtained for the Levo-Dopa testing (in contrast to the obtaining of blood samples): this was a breach of proper professional practice and ethical guidelines.
12.3. The well-being and safety of the PD patients had been compromised by reason of the alteration to or omission of their prescribed dosages. The Panel found it "quite unacceptable and unethical" that the patients' treating neurologists were not consulted; and that the Levo-Dopa testing and omission of medication was not done under clinical observation. The Panel stated that: "The patients were treated like experimental subjects without any rights… the patients' welfare was disregarded… the way the testing was done compromised patients' well-being and safety. Such a procedure of testing on human subjects would not be acceptable in any civilised society."
12.4. The Panel further concluded that patients were not told clearly about the Levo-Dopa testing: some...
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