An irrational finding could reluctantly be quashed by the High Court

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A Consultant Gastroenterologist successfully persuaded the High Court to quash a decision made by the General Medical Council (“GMC”), that his failure to recognise hypoglycaemia in a 54 year old patient, referred to as “Patient X”, amounted to misconduct.

The case, heard at the High Court on 14 March 2012, concerned the consideration of findings made by the GMC, and the extent to which the High Court would be prepared to interfere with them.

Patient X had been admitted to a Gastroenterology Ward, having been admitted to Hospital on 14 November 2007. Patient X had advanced liver disease as a complication of diabetes. Dr Aga was not told of Patient X’s admittance to Hospital until 11:30 on 19 November 2011.

At 11.30 Dr Aga went with his team to review Patient X’s condition as he knew of the background. In accordance with standard procedure, a trainee doctor briefed Dr Aga on the content of the patient notes. The trainee doctor did not tell Dr Aga that there had been four previous hypoglycaemic episodes prior to 19 November 2011, nor that there had previously been recurrent low blood glucose scores, although this information was contained in Patient X’s notes.

At 11:40 Dr Aga went to Patient X’s bedside and saw that he was unconscious. Dr Aga conducted routine checks of Patient X’s symptoms, without immediately making a diagnosis of hypoglycaemia. At 11.45 Dr Aga put in place an emergency management plan and ordered a blood glucose test. He then diagnosed hypoglycaemia and treated it accordingly. Patient X’s condition improved and his life was saved.

It was agreed during the GMC hearing into the case on 10 December 2010 that Dr Aga’s actions did not adversely affect Patient X. Dr Aga could also not be held to account for the lack of information that had been provided to him. However, expert evidence described Dr Aga’s failure to spot the hypoglycaemia at 11:40 as a “serious clinical error.”

The GMC found misconduct on the basis of the failure to immediately diagnose hypoglycaemia. The GMC did not find that impairment to Dr Aga’s fitness to practise existed, due to the presence of mitigating factors, such as insight.

In hearing Dr Aga’s application on 14 March 2012, Mr Justice Eady first expressed reluctance to become involved in an exercise whereby he was being invited to quash a decision made by the GMC, who had heard the live evidence and had particular medical knowledge.  In considering his judgment, Eady J had regard to Meadow v GMC [2007] QB 462, which stated that the following factors had to be considered in hearing such a case:

  • The body from whom the appeal lies is a specialist tribunal whose understanding of what the medical profession expects of its members in matters of medical practise deserves respect.
  • The tribunal had the benefit, which the Court normally does not, of hearing and seeing the witnesses on both sides.
  • The questions of primary and secondary fact and to the overall value judgment to be made by the tribunal, especially the last, are akin to jury questions to which there may reasonably be different answers.”

In his judgment, delivered on 28 March 2012, Eady J stated that “I am not attempting to substitute my judgment on a matter of medical knowledge, which I am wholly unqualified to do, but I am focusing on the use of ordinary language.” Notwithstanding this reluctance, Eady J stated that he found that the GMC’s finding of misconduct was irrational and therefore quashed it. 

It is unlikely that this case is indicative of a new trend of the judiciary being willing to set aside professional judgments made by specialist regulatory panels such as that of the GMC. Eady J expressed reluctance to set aside the GMC’s findings, and set out the case of Meadow as authority for that position. It is far more likely that Dr Aga’s unique case is one that turns on its own facts, instead of being seen to set a precedent.