Onwude v General Medical Council  EWHC 601 (Admin)
The Court's conclusions in relation to the dishonesty are, put simply, a victory of common sense. More interestingly, and of wider application, was the way in which the Court approached the issue of providing treatment to friends, in particular, that the case of Hussein was not followed. It is suggested that to prevent doctors from providing any medical care to friends under any circumstances is unrealistic and too inflexible for the realities of medical practice. The most important issue is whether the proximity or type of relationship affects a doctor's ability to be objective and to provide the appropriate treatment or advice. This, it is suggested, should be considered on the facts of each case. No doubt further guidance either from the Courts or the GMC would be welcomed by practitioners.
An appeal against the Medical Practitioners Tribunal's decision to erase following a finding of dishonesty and that a doctor had acted inappropriately in providing medical care to personal friends.
Mr Onwude, a consultant gynaecologist, had been friends with a married couple. All three entered into a business venture. During that time the Appellant provided the couple with general medical treatment, which included treating the wife's ulcerated leg and prescribing medication for them both. They had agreed at the time that he would not charge for treatment. Ultimately the business venture and friendship broke down. The Appellant then issued invoices for the treatment, allegedly as part of the re-organisation of the financial arrangements following the end of the venture. The couple complained to the respondent GMC.
At the hearing the husband refused to give evidence in relation to the financial arrangements relying on a confidentiality clause within, despite there being an exception in relation to disclosure to regulatory bodies.
The Tribunal found that the Appellant:
- had been dishonest and not open about fees both before treatment and before sending the invoices;
- had intentionally caused distress by sending the invoices;
- should not have prescribed medication to close personal friends;
- had acted outside his field of professional competence because he was not a GP;
- had kept insufficient patient records;
- had failed to inform the patients' NHS and private GPs about their treatment.
An appeal was lodged and Collins J held:
- In relation to the dishonesty allegation the factual context was that it was common ground that he had informed the couple that no fees would be charged but later, after the relationship had broken down, he had changed his mind and had sent the invoice. This did not amount to dishonesty and no reasonable Tribunal could have found dishonesty.
- The legal assessor had been wrong to advise that the confidentiality agreement protected the husband from giving evidence as to the financial arrangements as this was central as to why the invoices had been sent. Had the husband refused to give evidence this was likely to have affected his credibility or he might have given evidence supporting the Appellant. The finding of intent to cause distress was not justified.
- The guidance stated that wherever possible doctors should avoid caring for those with whom they had a close personal relationship. This was not limited to family members, but it was not clear how far it extended. In Hussein v General Medical Council  EWHC 3535 (Admin) the Court stated that doctors should not provide medical care to friends. It was concluded that this could not be correct. Whilst doctors should take considerable care if treating a close friend, due to the need to remain objective, excluding "friends" was wrong and put the matter far too high. It was not clear where to draw the line, but it could not be said that in every circumstance treating a close friend was wrongful. Merely finding that a close personal relationship existed was insufficient to find serious misconduct.
- There was no suggestion that the medications prescribed had been inappropriate or wrong. However, GPs were required to be on the GP register, and the Appellant had perhaps technically been in breach.
- It was important for doctors to maintain good patient records. The Tribunal had been entitled to decide that the record-keeping had been insufficient.
- The Tribunal had not been wrong to find that the private GP should have been notified.
The Tribunal had been wholly wrong regarding dishonesty, intent to cause distress, and openness prior to treatment, and to regard treatment of close friends as meriting action in the circumstances. The remaining technical breaches were remitted to the Tribunal to consider whether they amounted to serious professional misconduct.