Background
The General Medical Council appealed under section 40A of the Medical Act 1983 from a Medical Practitioners Tribunal determination concerning Dr Ali Shokouh-Amiri, a consultant gynaecologist. The allegations arose from his treatment of six patients in Guernsey between 2017 and 2019 and included poor clinical treatment, inappropriate or sexually motivated conduct, failures to use chaperones, dishonesty, and improper retention of clinical information.
The Tribunal found some misconduct, including repeated failures to have a chaperone present and the removal of two patients’ ovaries without consent. It nevertheless found that Dr Shokouh-Amiri’s fitness to practise was not impaired and made no direction. The GMC challenged certain findings concerning Patients B and F, the Tribunal’s handling of cross-admissibility, and its conclusion on impairment.
The Court’s Holding
Mr Justice Morris allowed Grounds 1 and 2. He held that the Tribunal’s conclusions on Allegation 7 concerning Patient B and specified allegations concerning Patient F were wrong or unjust because of serious procedural irregularity. Those errors infected the Tribunal’s finding of no impairment and its decision not to make a direction, which the Court held would be quashed.
The Court rejected Grounds 3 and 4. The Tribunal’s handling of cross-admissibility did not render its findings concerning Patients A and D unjust. On the facts the Tribunal had found proved, its evaluations of misconduct and impairment did not involve an error of principle or fall outside the range of decisions reasonably open to it.
The Court reserved the precise terms of the order for further submissions. Its provisional view was that the matter should be remitted to the Medical Practitioners Tribunal Service for a differently constituted tribunal to reconsider only the affected factual allegations and the issue of impairment.
Key Takeaways
- Defective findings on individual allegations can invalidate a tribunal’s later conclusion that a doctor’s fitness to practise is not impaired.
- A regulatory tribunal must provide adequate and intelligible reasons, particularly when resolving complex factual disputes and competing witness accounts.
- The Court quashed the no-direction decision, but remittal to a differently constituted tribunal remained a provisional proposal pending submissions on the final order.
Why It Matters
The judgment illustrates the High Court’s restrained but substantive appellate role in medical disciplinary cases. Although primary factual findings ordinarily receive considerable deference, intervention is justified where findings are wrong or serious procedural irregularities make the result unjust.
It also distinguishes errors affecting factual findings from permissible professional evaluations. The Court declined to substitute its own view on misconduct and impairment merely because it might have balanced the relevant considerations differently, while requiring reconsideration once the flawed Patient B and Patient F findings undermined the Tribunal’s ultimate decision.