Dr Lawrence, a General Practitioner (GP), had assisted with medical and administrative work at her husband’s GP Practice between 2003 and 2004, and on two occasions in March 2005. A contention later arose from the partners of her husband’s GP Practice that Dr Lawrence had not worked at the GP Practice after those two occasions in March 2005. This dispute eventually resulted in County Court Proceedings, where it was ruled that Dr Lawrence had provided false and misleading evidence to the Court in relation to the nature of work she did; the time period for which she worked; and the date when she left the Practice.
Proceedings before a Fitness to Practise Panel (the Panel) were brought against Dr Lawrence, who faced an allegation of dishonesty on the basis that she had provided a witness statement and oral evidence to the County Court that she had worked for her husband’s practice on certain dates, when she had not in fact done so.
First Fitness to Practise Hearing
The charges were considered by the Panel in April 2014, which heard oral evidence from two of the Practice partners, and received a witness statement from the Practice Manager. Dr Lawrence was unrepresented in these proceedings, and felt unable to cross examine the witnesses herself. At the end of the first day of the proceedings, Dr Lawrence sought to obtain representation, but was unsuccessful. Dr Lawrence then absented herself from the remainder of the proceedings on the basis that it was unfair to continue without allowing her the opportunity to obtain representation.
The Panel decided to continue in Dr Lawrence’s absence on the basis that Dr Lawrence was clearly aware of the proceedings; that she did not provide the Panel with any detail as to whether she had made an attempt to obtain representation; and that the allegations were serious and historical. For the remainder of the proceedings, the Panel bore in mind Dr Lawrence’s absence, and “sought to question the witnesses on matters which it considered might have been raised by [Dr Lawrence]”.
The Panel found the dishonesty allegation proven. Findings of misconduct and current impairment thereafter followed. The Panel erased Dr Lawrence from the Medical Register.
Dr Lawrence appealed against the Panel’s decision, and Mr Justice Collins remitted the case back to the Panel on the basis that the Panel had erred (a) in its approach to dishonesty and (b) in failing to invite Dr Lawrence to attend the hearing and make representations before a decision was made on sanction. A summary of the High Court appeal judgement can be found here.
Second Fitness to Practise Hearing
On 5 October 2015, the Panel convened to consider Dr Lawrence’s case, further to the appeal judgement. It is important to note is that the Panel had not been ordered to reconsider the facts, which had been upheld by Mr Justice Collins. The Panel composed of two of the three panel members from the first Fitness to Practise hearing, whilst the third panel member had not previously sat on the case.
On 7 October 2015, the Panel concluded that Dr Lawrence’s actions were both misleading and dishonest, and determined that she was guilty of serious misconduct. In reaching that decision, the Panel considered that the period between 2009 and 2011, when Dr Lawrence was providing evidence to the County Court, was “a prolonged time in which [she] maintained an untrue account of the duration of [her] employment” and that it was “implausible that [she] had made an innocent mistake or negligent error, particularly given the significance attached to preparing a witness statement for County Court proceedings”. The Panel also considered that Dr Lawrence had a motive for making dishonest assertions, and that there was no evidence that Dr Lawrence had experienced any “loss of perspective” when giving evidence to the County Court. In addition, the Panel gave regard to the GMC’s guidance on Good Medical Practice, which emphasised the need for a doctor to be honest, trustworthy, and act with integrity.
On the morning of 8 October 2015, when Dr Lawrence was due to provide her submissions to the Panel in relation to sanction, Dr Lawrence did not attend the hearing. She had been due to attend for a 10:30am start. Efforts were made to contact Dr Lawrence to establish if she would be attending the hearing, and the Panel waited until 11am before deciding to resume in Dr Lawrence’s absence.
The Panel determined that the appropriate sanction was to erase Dr Lawrence from the Medical Register, thereby upholding the first Panel’s decision. The Panel reached this decision on the basis of Dr Lawrence’s “persistent dishonest conduct and…persistent lack of insight into the seriousness of her actions”.
At 13:59 on 8 October 2015, after the Panel had issued its judgement, Dr Lawrence emailed the Respondent’s solicitor saying:
“I am very sorry, I have been trying to come but I can’t enter the building. I cannot give anymore at this stage. Please inform the panel”.
The following day, Dr Lawrence emailed the Respondent’s solicitor again explaining that she had been in a state of “emotional breakdown”, and that she would make arrangements to attend the hearing the following Monday to provide submissions. At this stage, Dr Lawrence was unaware that the hearing had concluded.
After learning of the Panel’s decision, Dr Lawrence lodged a second appeal to the High Court.
Dr Lawrence based her appeal on several grounds, the main grounds being that the second Panel had considered sanction in her absence, and that the decision to impose erasure was too severe.
In reaching his decision, Mr Justice Holroyde reiterated that the second Panel were bound by the first Panel’s decision on the facts – that Dr Lawrence had made the false statements. Mr Justice Holroyde then added that the second Panel were “entitled” to determine that the false statements proved by Dr Lawrence were misleading and dishonest, having appropriately applied the two-stage Ghosh test of dishonesty. Mr Justice Holroyde was satisfied that it was “difficult to attribute the false statements to innocent mistake or misunderstanding”, leaving “limited scope for any explanation other than dishonesty”.
Proceeding in Absence
Mr Justice Holroyde explained that the second Panel had been right to proceed in Dr Lawrence’s absence, as Dr Lawrence “knew what was at stake” and was aware that the Panel had the power to proceed in her absence. Dr Lawrence had also left the Panel in a “state of ignorance” as to why she had not attended, and had not contacted the Panel to explain whether she would attend again in future, if at all. Whilst Dr Lawrence had been distressed about the case, it was claimed that she could have contacted the Panel or the Respondent if she wished to defer providing her submissions. Alternatively, she could have provided the Panel with written submissions.
In upholding the Panel’s decision to erase Dr Lawrence from the Medical Register, Mr Justice Holroyde based his decision on Dr Lawrence’s denials and insistence that she had done nothing wrong. He was also concerned by the fact that this was not a case that could be remedied by re-training or supervision. Mr Justice Holroyde highlighted that the Panel possessed “specialist knowledge” about what the profession expects of a registered medical practitioner, and for that reason, he was reluctant to interfere with the Panel’s conclusion that erasure was proportionate in this instance.
Dr Lawrence’s appeal was dismissed.
This case yet again highlights the reluctance of the High Court to interfere with a decision made by a Fitness to Practise Panel. As many High Court judges have opined, Fitness to Practise Panels are deemed to have ‘specialist knowledge’ of what the profession expects of a registered medical practitioner, and of what is needed to maintain public confidence in the profession.
Further, where a Registrant is clearly aware of on-going proceedings against them, a Fitness to Practise Panel may legitimately decide to proceed in the Registrant’s absence where the Registrant has voluntarily absented themself from the hearing, under the same circumstances as Dr Lawrence.