Stefan v General Medical Council
| Jurisdiction | UK Non-devolved |
| Judge | Lord Clyde |
| Judgment Date | 08 March 1999 |
| Neutral Citation | [2002] UKPC 10 |
| Judgment citation (vLex) | [1999] UKPC J0308-1 |
| Court | Privy Council |
| Docket Number | Appeal No. 16 of 1998 |
| Date | 08 March 1999 |
[1999] UKPC J0308-1
Present at the hearing:-
Lord Browne-Wilkinson
Lord Steyn
Lord Clyde
Lord Hutton
Lord Hobhouse of Woodborough
Privy Council
[Delivered by Lord Clyde]
Dr. Marta Stefan appeals to Her Majesty in Council from a decision of the Health Committee of the General Medical Council given on 23rd February 1998 under section 37 of the Medical Act 1983. The decision as recorded in the transcript of the proceedings was in the following terms:-
"Dr. Stefan, the Committee have carefully considered all the information presented to them and continue to be deeply concerned about your medical condition. The Committee have again judged your fitness to practise to be seriously impaired and have directed that your registration be suspended indefinitely."
Dr. Stefan's case had been before the Health Committee on six occasions before the hearing on 23rd February 1998 which terminated in the decision now under appeal. Initially, in February 1993, the hearing was adjourned for the obtaining of medical reports. Thereafter on each of the following occasions the Committee held her fitness to practise was seriously impaired. In June 1993 and in June 1994 the Committee granted a conditional registration for periods of eight months. In February 1995, February 1996 and February 1997 the Committee suspended her registration for periods respectively of 8 months, 12 months and 12 months. Appeal to Her Majesty in Council from a decision of the Health Committee under section 37 of the Act of 1983 is expressly permitted under section 40, but section 40(5) provides that no appeal shall lie from a decision of the Health Committee except upon a question of law. Dr. Stefan appealed unsuccessfully to Her Majesty in Council from the decision given in June 1993, the decision given in February 1995 and the decision given in February 1997. She also applied for redress from the European Commission of Human Rights (Application no. 29419/95) following on the decision of the Committee given in June 1993 and her unsuccessful appeal to Her Majesty in Council from that decision. The Commission however declared her application to be inadmissible.
The Health Committee are a statutory committee of the General Medical Council established under section 1(3) of, and paragraph 22 of Schedule 1 to, the Medical Act 1983. Section 37(1) of that Act concerns the situation where "the fitness to practise of a fully registered person is judged by the Health Committee to be seriously impaired by reason of his physical or mental condition'. The section provides that the Committee may, if they think fit, either direct a suspension of the person's registration for a period not exceeding twelve months, or impose conditions on his registration for a period not exceeding three years. By section 4 of the Medical (Professional Performance) Act 1995 there was inserted a new subsection 37(3A) to the Act of 1983 whereby the Health Committee might, where a suspension had lasted for at least two years, give a direction extending the period of suspension indefinitely. Such a direction requires to be given not more than two months before the period of suspension would otherwise expire. The hearing in February 1998 was the first occasion in the case of Dr. Stefan when the imposition of an indefinite suspension was available to the Committee. Section 37(3B) makes provision for a review by the Committee of an indefinite suspension at the request of the person suspended but permits such review only at intervals of two years.
When the present appeal first came for hearing before their Lordships' Board a question arose as to the reasons for the decision of the Committee, and in particular a question whether there was any duty on the Committee to state their reasons. There were no other grounds of law advanced which were identified as possibly supporting the appeal. Dr. Stefan was appearing on her own behalf and in order that the point might be more fully explored it was arranged that the appeal should be put out again for hearing before a larger Board, as was duly done. This hearing was attended not only by Dr. Stefan in person and counsel for the General Medical Council but also by Mr. Havers, Q.C. as amicus curiae. Their Lordships record their particular gratitude to Mr. Havers for the assistance which he provided in that capacity.
It was not seriously contended that the Committee had given a sufficient statement of the reasons for their decision. From the record of the proceedings it can be seen that in the first sentence the chairman narrated that the Committee had carefully considered all the information presented to them. That information included reports and records going back several years. But it is not indicated that this consideration had any relevance beyond what is then stated, that the Committee "continue to be deeply concerned about your mental condition". What then follows is a statement of the conclusion in the terms of the statute and the direction for indefinite suspension. No reason is given to support the conclusion that there is still a serious impairment of fitness due to a mental condition nor why an indefinite suspension is appropriate.
The concern about the need for reasons which was raised at the first hearing of the present appeal was in part prompted by the view expressed by the Board in Libman v. General Medical Council [1972] A.C. 217, 221, where the Lord Chancellor, Lord Hailsham of St. Marylebone, observed:-
"Beyond a bare statement of its findings of fact, the Disciplinary Committee does not in general give reasons for its decision as in the case of a trial in the High Court by judge alone from which an appeal by way of rehearing lies to the Court of Appeal."
The Board has certainly in the past recognised the practice of the Discipline Committee and their successor, the Professional Conduct Committee, not to give reasons. That practice of the Professional Practice Committee was described by Lord Scarman in Rai v. The General Medical Council (14th May 1984) as "usual and accepted" and "well established". His Lordship added the observation:-
"Though there is no obligation, the Committee has the power to give reasons: and their Lordships suggest that giving reasons can be beneficial, and assist justice:- (1) in a complex case to enable the doctor to understand the Committee's reasons for finding against him; (2) where guidance can usefully be provided to the profession, especially in difficult fields of practice such as the treatment of drug addicts; and (3) because a reasoned finding can improve and strengthen the appeal process."
These observations were subsequently recognised as related to the giving of reasons for a finding of serious professional misconduct and not to the imposition of a particular penalty, the reasons for which would usually be apparent from the transcript of the evidence ( Rodgers v. The General Medical Council (19th November 1984)) and the giving of which have been said to be neither necessary or desirable ( Evans v. The General Medical Council (19th November 1984)).
Counsel for the respondent in the present appeal was concerned to draw distinctions between the Professional Conduct Committee and the Health Committee and their Lordships accept that there are some points of difference between them. One of these is that the appeal permitted under section 40 of the Act against a decision of the Professional Conduct Committee is at large, while an appeal against a decision of the Health Committee is, by virtue of section 40(5) limited to a point of law. In the present case their Lordships are concerned solely with the existence of an obligation on the Health Committee to give reasons for their decisions and not with the position regarding the giving of reasons by the Professional Conduct Committee. They expressly refrain from expressing any view on that matter.
There is no express statutory duty on the Health Committee to state reasons for its decisions. The procedure which it is required to follow is prescribed in The General Medical Council Health Committee (Procedure) Rules Order of Council 1987-1997 ( S.I. 1987 No. 2174, as amended by S.I. 1996 No. 1219 and S.I. 1997 No. 1529). But neither in the Act of 1983 nor in the Rules is any such express obligation to be found. In such a situation an obligation to give reasons may nevertheless be found to exist. This may arise through construction of the statutory provisions as a matter of implied intention. Alternatively it may be held to exist by operation of the common law as a matter of fairness. In the latter case account may require to be taken of the statutory provisions so that some overlapping of the material may occur in the pursuit of these two approaches. Furthermore, particularly in connection with the approach at common law the question arises whether, if there is an obligation to give reasons, it is one which arises in the special circumstances of the particular case or whether it is of application to all decisions made by the body in question, that is, in the present case, the Health Committee.
Their Lordships turn first to consider whether there is an obligation implied in the statutory provisions. This requires consideration of the Act and, more particularly, of the Rules Order to which reference has already been made. It can be seen at once that they set out in considerable detail the procedures to be followed when information has been given or a complaint has been made which raises a question about the fitness of a practitioner to practise. The Rules cover the initial processes, the preparatory arrangements for hearings, and the management of hearings and of resumed hearings. Under Rule 22 the Committee...
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