Professional Standards Authority for Health and Social Care v (1) General Medical Council (2) Parvan Kaur Uppal, [2015] EWHC 1304

Judgement date: 14 May 2015

Background

In September 2014 Dr Uppal faced proceedings brought by the General Medical Council based on the following events.  On 13 December 2011 whilst employed as a GP Registrar at a medical practice, Dr Uppal had a telephone consultation with Baby A’s mother following which Baby A was taken to A and E and was admitted to hospital.  On 30 December 2011 Dr Uppal informed her GP trainer that she had spoken with the baby’s mother following Baby A’s discharge from hospital when she had not in fact done so.  It was said that this behaviour was both misleading and dishonest.  Dr Uppal admitted the facts of the allegation but denied that her fitness to practice was impaired.

A panel of the Medical Practitioners’ Tribunal Service (MPTS) found the admitted facts proved and concluded that her fitness to practise was not impaired as this was an isolated episode and Dr Uppal had demonstrated insight and taken steps to avoid any repetition.  She was a GP trainee, and there was evidence of her exemplary professional and personal conduct from her senior colleagues and trainers.  They also found that a warning was not necessary, appropriate or proportionate. 

The Professional Standards Authority (PSA) referred this decision to the High Court under section 29 of the National Health Service Reform and Health Care Profession Act 202 on the grounds that the Panel’s decision was unduly lenient and wrong, in particular that they had erred in not finding impairment, not to issue a warning and for giving inadequate reasons.  The PSA initially alleged that the GMC  had under-prosecuted the charge, however this was withdrawn shortly before the hearing.

The test

The Court reiterated the relevant test in such applications, namely that laid down by the court of Appeal in Ruscillo v Council for Regulation of Healthcare Professionals [2004] EWCA Civ 1356; an appeal under section 29 should be allowed if the relevant decision was ‘wrong’ or if there has been ‘a serious procedural or other irregularity’.  The test for undue leniency should involve, we are told, a consideration of whether the decision reached had due regard for the safety of the public and the reputation of the profession, having regard to the material facts. 

Findings on misconduct

The MPTS panel had heard evidence that Dr Uppal had not only lied to her GP trainer about making the call but also maintained this position for some time on being questioned, before eventually admitting that the call was never made.  However, the panel also heard the context in which the lie was told to her senior colleagues; namely a difficult working environment in which she was unsupported, uncomfortable and constantly monitored.  She felt unable to explain a mistake.  The panel accepted this account of the working conditions.  When assessing impairment the Panel noted

  • That this was an isolated incident over a short period of time more than two years previously
  • The dishonesty did not impact on patient care, was not for financial gain and did not seem to benefit her in personally in any way
  • When confronted with her behaviour she admitted lying and apologised to her GP trainer and since then has always accepted full responsibility for her actions

The PSA submitted that the panel failed to identify the true extent and nature of the misconduct and hence its seriousness.  They pointed out that she was lying to senior colleagues and questioning the integrity of the baby’s mother who had complained about not being contacted.  They also highlighted that the lie continued between 28 December 2011 to 13 January 1012 and that there was a benefit to her as it was clearly exculpatory.  The Court rejected the PSA’s submissions; it was clear that the Panel had taken these matters into account.

Findings on Impairment

The PSA submitted that the failure of the Panel to find impairment was unduly lenient and therefore wrong.  They relied upon the points previously made and the fact that there had been a serious breach of Good Medical Practice. They referred to the Indicative Sanction Guidance stating that the Panel had given insufficient weight to the public interest and excessive weight to Dr Uppal’s apology, insight, remediation, low risk of repetition and the favourable reports from senior doctors at her current practice.  They used the cases of Parkinson v NMC [2010] EWHC 1898  and R v NMC and Kingdom [2007] EWHC 1806  to bolster their view that the fitness to practice of a doctor who acts dishonestly is impaired by that dishonesty.

Mrs Justice Lang DBE held that this was not an accurate reflection of the statutory regime or the authorities.  Having reviewed a number of relevant cases it was clear that even in cases of dishonesty a separate assessment of impairment is required; not every act of dishonesty results in impairment.  It was held that the Panel had regard to all relevant factors and were in a better position that she to assess impairment.  It was noted that this was an ‘exceptional case’ on the facts.  It was an isolated lapse in an otherwise unblemished career and that the risk of repetition was extremely low, not least due to her insight and steps taken to remediate.

Warning

The Court did find, however, that applying the appropriate part of the relevant guidance documents, this was a case where a warning was appropriate because Dr Uppal was in clear breach of the standards in Good Medical Practice.  The failure to issue a warning was unduly lenient, did not uphold standards in the profession and was capable of undermining public confidence in the profession.  The appeal was allowed on this sole ground.

A case which provides an example of those exceptional cases where dishonesty will not result in impairment.  It is clear that early admissions, insight, remedial steps taken on the part of the practitioner and good references were key to this outcome and may be well heeded by those facing similar charges.