In June 2008, a Fitness to Practise Panel (FTPP) of the General Medical Council (GMC) found dishonesty in connection with representations about an investment scheme proved against Dr Karwal and suspended her for 12 months. They had concerns about her insight and attitudinal issues.

Review hearings took place in December 2009 and March 2010. At the March 2010 review, the FTPP took into account evidence from two psychiatrists who had interviewed Dr Karwal in preparation for the review hearing. Dr Karwal told the psychiatrists she had been completely cleared of wrongdoing by the FTPP. In March 2010 the FTPP determined that Dr Karwal’s behaviour “continues to demonstrate a lack of insight and real acceptance of the findings of dishonesty.” The FTPP found Dr Karwal’s fitness to practise to be impaired and imposed a further nine month suspension.

Dr Karwal appealed, challenging that the FTPP allowed the GMC to present a case of lack of insight without warning or notice and asserting that the FTPP were not entitled on the facts to find lack of insight.

In relation to the first part of the appeal that the GMC presented the case without warning or notice, Mrs Justice Rafferty said that “the GMC’s indicative sanctions guidance” would be familiar to Dr Karwal and her legal representatives and concluded that this complaint could not be made out.

Justice Rafferty made reference in her judgment to paragraph 116 of the GMC’s Indicative Sanctions Guidance which says that an FTPP at a review must “satisfy itself that the doctor has fully appreciated the gravity of the offence.”

Justice Rafferty judged that not only Dr Karwal’s dishonesty but also her lack of insight was concerns explicit in the conclusions of the 2008 FTPP. The FTPP panel was not only entitled, but obliged to address them.

Mrs Justice Rafferty went on to say that insight (determining whether the doctor has appreciated the gravity) “is inevitably an issue at a review”.

The argument that the finding of impairment was against the weight of evidence also failed and the appeal was not allowed.

The case can be found here.