Professional standards and codes of conduct undoubtedly differ greatly between different jurisdictions. In an environment where healthcare professionals are increasingly mobile, many examples exist across the healthcare professions of registrants maintaining multiple registrations at any given time and often practising in multiple jurisdictions within a registration period, even from month to month.

Cross-jurisdictional Practice

This mobility is further enhanced by the provisions of the Mutual Recognition of Professional Qualifications Directive (SI S.I. No. 8/2017) and the very permissive conditions contained therein in respect of the temporary and occasional provision of services by relevant professionals, moving within states of the EEA (European Economic Area).

Technology also plays a part in cross jurisdictional practice, with an increase in ‘telemedicine’, involving the provision of advices and care from a medical practitioner who is situate in one jurisdiction to a patient who is situate in another. Such is the prevalence of telemedicine that it is specifically addressed in the Medical Council’s Guide to Professional Conduct and Ethics - 8th Edition and also in the Medical Council publication Working with Yours Doctor: Useful Information for Patients (October 2016).

In such a climate, it is imperative to be aware of the applicable regulatory regime(s) at any given time. The issue has been considered in the recent UK decision of Sastry v. General Medical Council [2019] EWHC 390 (Admin).

Sastry v. General Medical Council

The recent case of Sastry considered whether a Consultant Medical Oncologist, who was registered with the General Medical Council (“GMC”), the regulator for medical practitioners in the UK, should be held to the standards of professional conduct of the GMC while practising in Mumbai, India.

Dr Pantula Sastry faced allegations which arose from his treatment of a patient in Mumbai between 2013 and 2014. Dr Sastry had worked in the UK prior and subsequently to the index incident, and had maintained GMC registration throughout.

Complaint to GMC

The allegations arose from Dr Sastry’s treatment of Patient A, who was suffering from lymphoma. Dr Sastry had undertaken a form of autologous cell transplant with allegedly too few stems cells. The patient’s bone marrow and cell production failed to recover in response to the transplant and the patient died shortly after this treatment.

The patient’s son filed a complaint with the General Medical Council (GMC) in respect of the treatment afforded to his mother by Dr Sastry. Upon investigation, Dr Sastry’s fitness to practice was found to be impaired by reason of misconduct, resulting in Dr Sastry being erased from the GMC register.

Appeal

Dr Sastry appealed the MPTS decision to the High Court for England and Wales on the basis that he felt the MPTS had not given sufficient regard to the fact that the index incident took place in India, and that the ‘Indian context’ should therefore be applied. Dr Sastry argued that the MPTS had wrongfully relied on UK expert evidence in finding him impaired to practise and had held him to a UK/GMC standard when there were no equivalent guidelines in India which could be applied. Dr Sastry further objected to the MPTS assessing his competency based on Good Medical Practice (“GMP”), the GMC’s key guidance.

In dismissing Dr Sastry’s appeal, the High Court held that in circumstances where no professional competency guidelines existed, such as was the case in India, the principles of GMP could be used as they were “sufficiently high-level to be able to be adapted as necessary to accommodate differing guidelines and conditions which may exist in another country”.

In delivering judgment, the High Court noted that when the MPTS find themselves investigating a matter such as this where no professional guidelines exist in the jurisdiction, they are permitted to assess the doctor’s fitness to practise using GMP as a guideline however they must take into consideration the particular limitations or local practices which may exist in other jurisdictions. The Court held that the MPTS had afforded this consideration to the index incident.

Irish Context

Although a UK decision and not binding in this jurisdiction, the Court’s comments highlight the vigilance required by medical professionals maintaining registration in multiple jurisdictions.

In Ireland, section 57(2) of the Medical Practitioners Act 2007 provides that complaints may be made in respect of medical practitioners regarding conduct/ practice, notwithstanding that the conduct/practice occurred outside the jurisdiction.

In addition, medical practitioners maintaining more than one registration may find themselves subject to multiple regulatory regimes in terms of the maintenance of professional competence. In Ireland, any medical practitioner on the register who practises in the Republic of Ireland for thirty days or more is required to comply in full with the Medical Council’s Professional Competence requirements as set out in S.I. No. 171 of 2011- Rules for the Maintenance of Professional Competence (No. 1). Failure to comply with professional competence requirements may result in a complaint to the Medical Council and, potentially a Fitness to Practise Inquiry.

Given the potential implications for a medical practitioner in the event of a complaint, particularly with the potential for multiple regulatory regimes to apply, practitioners are advised to familiarise themselves with the conditions of registration in all jurisdictions where they hold or are considering registration.