Sheela Jogula Ramaswamy v General Medical Council
| Jurisdiction | England & Wales |
| Judge | Mr Justice Fordham |
| Judgment Date | 24 January 2023 |
| Neutral Citation | [2023] EWHC 100 (Admin) |
| Docket Number | Case No: CO/3715/2021 |
| Court | Queen's Bench Division (Administrative Court) |
[2023] EWHC 100 (Admin)
Mr Justice Fordham
Case No: CO/3715/2021
IN THE HIGH COURT OF JUSTICE
KING'S BENCH DIVISION
ADMINISTRATIVE COURT
SITTING IN MANCHESTER
Daniel Matovu (instructed by Direct Access) for the Claimant
Ivan Hare KC (instructed by GMC Legal) for the Defendant
Hearing date: 13/12/22
Approved Judgment
I direct that no official shorthand note shall be taken of this Judgment and that copies of this version as handed down may be treated as authentic.
THE HON. Mr Justice Fordham
Introduction
This claim, pursuant to section 41A(10)(b) of the Medical Act 1983 (the “1983 Act”), asks the Court to revoke an “interim conditional registration” order (“ICRO”). The ICRO was imposed by an Interim Orders Tribunal (“Tribunal”), pursuant to section 41A(1)(b) of the 1983 Act, on 14 September 2021, after a two-day hearing. It was imposed for the statutory maximum period of 18 months (section 41A(1)(b)) to 12 March 2023. Since being imposed, the ICRO has subsequently been maintained by a Tribunal on statutorily-required reviews, pursuant to section 41A(2) of the 1983 Act, on 9 March 2022 and 25 August 2022. Provision regarding interim orders – including ICROs – is made in Part 7 (Rules 25–27) of the General Medical Council (Fitness to Practise) Rules 2004 (the “2004 Rules”). Certain alleged “non-compliance” aspects of the Claimant's case were the subject of a three day hearing before Morris J in May 2021, culminating in a judgment (15.6.21): see Ramaswamy v GMC [2021] EWHC 1619 (Admin) (the “2021 Judgment”). The present claim for revocation first came before me for a substantive hearing on 29 March 2022 and I adjourned it at the Claimant's request: see [2022] EWHC 732 (Admin). In the run up to the hearing, I declined the Defendant (“GMC”)'s application for a further adjournment to a date in early 2023. The Defendant submitted that such an adjournment was an appropriate course in circumstances where: (i) a substantive hearing on remitted issues of alleged “non-compliance” (2021 Judgment §155), had adjourned part-heard on 30 November 2022 to hearing dates on 9–11 and 25–27 January 2023; and (ii) the ICRO, being due to expire on 12 March 2023, was likely to require an application to this Court for an extension. The Defendant's position was that it would make best sense for this claim for revocation of the ICRO to be considered, alongside those other matters and on an updated basis, early in 2023. That course was strongly opposed by the Claimant and I did not accede to it. I took the view that the Claimant was, in principle, entitled to have her claim for revocation heard on its merits, pursuant to her statutory entitlement of access to the Court. The substantive hearing before me was a “hybrid hearing”. That was because of travel difficulties caused by a National Rail Strike. I was in the courtroom. So was Mr Matovu, the Claimant's barrister. The Claimant attended remotely. So did Mr Hare KC, the Defendant's barrister. Arrangements were made to ensure that the Claimant could send mobile phone messages to Mr Matovu, to replicate the passing of notes had they been together in the courtroom. Members of the press or public could attend in person or, as published through the Cause List, remotely and open justice was secured.
The Guidance
There is relevant Guidance for the Tribunal on “Imposing Interim Orders”. The version of the Guidance relied on before me is dated 30 October 2018. Under a heading “Powers of the IOT” the Guidance provides as follows at §§6–7:
Powers of the IOT. 6. An IOT may make an order when it considers it necessary to do so for the protection of members of the public or it is otherwise desirable in the public interest to maintain public confidence and uphold proper standards of conduct and behaviour. The IOT may also make orders where it is in the interests of the doctor. 7. An IOT does not make findings of fact or determine the allegations against the doctor .
Under a heading “Test Applied”, the Guidance says this at §§23–27:
Test Applied. 23. The IOT must consider, in accordance with section 41A, whether to impose an interim order. If the IOT is satisfied that: (a) in all the circumstances that there may be impairment of the doctor's fitness to practise which poses a real risk to members of the public, or may adversely affect the public interest or the interests of the practitioner; and (b) after balancing the interests of the doctor and the interests of the public, that an interim order is necessary to guard against such risk, the appropriate order should be made. 24. In reaching a decision whether to impose an interim order an IOT should consider the following issues: (a) The seriousness of risk to members of the public if the doctor continues to hold unrestricted registration. In assessing this risk the IOT should consider the seriousness of the allegations, the weight of the information, including information about the likelihood of a further incident or incidents occurring during the relevant period. (b) Whether public confidence in the medical profession is likely to be seriously damaged if the doctor continues to hold unrestricted registration during the relevant period. (c) Whether it is in the doctor's interests to hold unrestricted registration. For example, the doctor may clearly lack insight and need to be protected from him or herself. 25. In weighing up these factors, the IOT must carefully consider the proportionality of their response in dealing with the risk to the public interest (including patient safety and public confidence) and the adverse consequences of any action on the doctor's own interests. 26. In assessing whether or not it is appropriate to take action, the IOT should consider the seriousness of any police charges and the acceptability of their decision on interim action should the doctor later be convicted or acquitted (including public confidence issues as above). 27. When considering whether or not to make an interim order, the IOT cannot accept any undertakings given by the doctor as it has no power to accept them and they are, in any event, unenforceable .
Under a heading “Doctor's Health”, the Guidance says this at §32:
Doctor's Health. 32. Where there are issues about the doctor's health, the IOT should bear in mind that its primary duty is to protect members of the public and the wider public interest, and not to assume responsibility for, or give priority to, the treatment or rehabilitation of the doctor. However, where the IOT considers it appropriate to make an order for interim conditions, these may include conditions relating to the ongoing treatment and supervision of the doctor .
Under a heading “Reasons for Decisions” the Guidance says this at §§51–52:
Reasons for Decisions. 51. Rule 27(4)(g) of the Rules makes clear that when announcing its decision the IOT “shall give its reasons for that decision”… An IOT must therefore ensure that reasons are given for any decisions taken, including decisions not to impose an order. The courts do not expect an IOT to give long detailed reasons but the reasons given must be clear and explain how the decisions were reached, including identifying the interest(s) for which the order is considered necessary. 52. Although IOT decisions should be fairly concise, they must include the following information with specific reference to the distinct features and particular facts of each individual case. (a) The risk to patients should be clearly identified to support the proportionality of any action it was necessary to take. (b) The risk to public confidence in the profession if the doctor continued working without restriction on their registration and the allegations are later proved, to support the proportionality of any interim action taken. (c) Where an order is made primarily because it is desirable in the public interest to uphold public confidence and there are no concerns about clinical practice specific reasons should be given for why this is appropriate. (d) Reasons for the initial period of time for which an interim order is imposed. (e) Where no order is imposed, clear reasons must be given .
The Conditions of the ICRO
The Conditions of the ICRO imposed on the Claimant on 14 September 2021 are as follows:
(1) She must personally ensure that the GMC is notified of the following information within seven calendar days of the date these conditions become effective: (a) of the details of her current post, including: (i) her job title (ii) her job location (iii) her responsible officer (or their nominated deputy); (b) the contact details for her employer and any contracting body, including her direct line manager; (c) of any organisation where she has practising privileges and/or admitting rights; (d) of any training programmes she is in; (e) of the contact details of any locum agency or out-of-hours service she is registered with. (2) She must personally ensure the GMC is notified: (a) of any post she accepts, before starting it; (b) that all relevant people have been notified of her conditions, in accordance with condition (6)(c) if any formal disciplinary proceedings against her are started by her employer and/or contracting body, within seven calendar days of being formally notified of such proceedings; (d) if any of her posts, practising privileges or admitting rights have been suspended or terminated by her employer before the agreed date within seven calendar days of being notified of the termination (e) if she applies for a post outside the UK. (3) She must allow the GMC to exchange information with her employer and/or any contracting body for which she provides medical services. (4) She must not work in any locum post or fixed term contract of less than 4 weeks duration. (5) She...
To continue reading
Request your trial