Case summary – Yassin v GMC [2015] EWHC 2955 (admin)

Posted by Antonia Dowgray on

High level summary

In an appeal against a direction of the Fitness to Practise Panel ("the Panel") to erase the Appellant from the medical register. The appeal was confined to the Panel's determination on the facts and the grounds included a concern regarding a lack of specificity in some of the allegations and that, in relation to two findings of dishonesty, the Panel was wrong or failed to provide adequate reasons. There was a further ground based on new medical evidence.

Cranston J dismissed the appeal. While Cranston J found the Panel was not entitled to make the finding of misconduct and dishonesty associated with charge 14, the serious misconduct in other findings of dishonesty over the period August 2011 to July 2012, coupled with the dishonesty found at a previous 2011 hearing and a further incident in 2015, justified the Panel's conclusions.

Facts

Ms Yassin ("the Appellant") qualified as a medical student in Scotland, and commenced work as a Foundation Year 1 ("FY1") trainee doctor in August 2008.  There was a Fitness to Practise hearing in 2011 relating to events in 2009. The Panel, in that hearing, found that the Appellant had dishonestly changed marks awarded to her in written feedback from two nurses to give a better impression of her professional performance, and dishonestly fabricated a story to explain a failure to order blood tests for a patient who collapsed a few days later. The Panel suspended her for three months, concluding that her attitude, when giving evidence, demonstrated a serious lack of insight into her failings.

In 2012, the Appellant was referred again to the General Medical Council ("the GMC") as a result of events between August 2011 and July 2012, when she had been a Foundation Year 2 ("FY2") trainee assigned in Oxfordshire and Buckinghamshire. The Panel found that 53 of the charges were proved, and nine of them involved dishonesty. 

In summary, charge 14 provided that, from time to time between August 2011 and July 2012, the Appellant, when asked why outstanding jobs for patients had not been completed falsely claimed that: (i) she did not know the jobs needed doing; (ii) she had not been allocated the task; and (iii) the job had been completed.

The Panel reached the conclusion that erasure was appropriate in light of the Indicative Sanctions Guidance. The Panel had regard to the Appellant's long standing dishonesty, her continued efforts to cover up her misconduct, and her evasiveness in situations where she should have been wholly open and honest. The Panel found that the Appellant had persistently demonstrated that her integrity could not be relied upon and concluded it was not in the public interest to retain a doctor who continued to place her own interests ahead of her patients and colleagues.

The grounds of the appeal were as follows:

  • The Panel had been wrong in failing to stay charges 2(a) – (i)(l), 8(c) – (d) and 14 (e)(i) – (iii), or, alternatively, the Panel was wrong in finding those proved, since they were insufficiently particularised to allow the Appellant to understand the case against her and meaningfully respond to it.
  • As a consequence, the "parasitic" findings of dishonesty in charge 20 in respect of charge 14(e) were also wrong.

Judgment

Handed down by Mr Justice Cranston.

Cranston J firstly looked at the law regarding particularisation of the charges in this type of case. Cranston J referred to the decision of Beatson J (as he was then) in R (Johnson and Maggs) v Nursing and Midwifery Council [2008] EWHC 885 (Admin). In that case the Appellants submitted that they had a right to be informed in detail of the nature and cause of the accusation against them, and to be given full particulars of the case that had to be met. As to a stay in such cases, Beatson J held it was an exceptional remedy, only to be used where the trial process cannot deal with the points raised (paragraph 18).

Cranston J, applying Johnson and Maggs, found there was no basis for a stay as regards any of the charges in the case. As regards charges 2 and 8, Cranston J had no hesitation in concluding that the Appellant had failed to show that, in all the circumstances, including the evidence the GMC had advanced, she had insufficient information to know what case she had to meet or that she had been unable to defend herself (paragraph 20).

Cranston J reiterated that "allegations of dishonesty need to be carefully formulated and specific allegations need to be made". He stated "that does not mean that a Panel cannot fairly consider someone's state of mind in relation to false claims, save by reference to the circumstances of the specific case. The key is fairness" (paragraph 25).

In Cranston J's judgment, charge 14 "did not have sufficient specificity to meet the fairness standard, given that it was associated with an allegation of dishonesty." He noted there were no examples of the Appellant "acting in the manner alleged, of who asked her to complete the given task, or an illustration of what the task was, or to which patient or condition it related". Charge 14 further alleged that the Appellant stated she did not know a job needed doing, but without any detail of the circumstances. In particular, Cranston J said that "nothing was provided to explain how the inference of falsity could be drawn". In his judgment, it was "not good enough to make a bald allegation as contained in this charge as a basis for the finding of dishonesty" (paragraph 27).

Cranston J found overall, after applying the principles taken from the authorities on appeals by way of re-hearing, "it is difficult to see how the Panel's conclusion on the Appellant's honesty can be challenged." He noted the Panel heard from many witnesses over a number of weeks, including the Appellant and came to conclusions on the credibility of the witnesses, which it set out clearly. Justice Cranston found the Panel's findings of fact were unassailable, and the inferences it drew and the secondary findings of fact the Panel made were entitled to considerable difference. 

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Antonia is a Senior Associate in our Professional Regulatory team based in London.

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