Doctor’s Dishonesty: Factors For and Against Erasure

In a doctor’s appeal to the Administrative Court against a decision of the Medical Practitioner Tribunal which resulted in his name being erased from the Medical Register, Mr Justice Eyre reviewed the principles for and against a determination of erasure where there had been dishonest representations: Hyder v General Medical Council [2024] EWHC 2945 (Admin) 19 November 2024

Considering those factors standing in favour of erasure, first was the seriousness of any act of dishonesty by a doctor, particularly when the dishonesty in question involved a false assertion as to the doctor’s qualification.

Findings of dishonesty lay at the top end of the spectrum of gravity of misconduct. Honesty and integrity were fundamental in relation to qualifications and the system of applying for medical positions: General Medical Council v Theodoropoulos [2017] EWHC 1984 (Admin) Lewis J.

The Court had regard also to the judgments of R (Farah) v General Medical Council [2008] EWHC 731 (Admin), Makki v General Medical Council [2009] EWHC 3180 (Admin), Naheed v General Medical Council [2011] EWHC 702 (Admin), and Ranga v General Medical Council [2022] EWHC 2595 (Admin).

Even if the dishonest statements were not made for gain, they were nonetheless serious. But, as Makki demonstrated, dishonesty did not necessarily and as a matter of course mean that erasure must follow.

In the present case the Tribunal was concerned not just with one occasion on which the doctor had dishonestly claimed to have a qualification which he did not have but a number of such occasions occurring over a period of three and a half years.

The absence of insight on the part of the doctor was a matter of real significance. The Tribunal’s conclusion that the doctor lacked insight could not be faulted. In light of that there was considerable scope for doubt as to the reliability of the doctor’s assertions as to the importance he attached to honesty and a consequent concern as to the risk of repetition.

Imposition of the sanction of erasure was consistent with the Guidance. Although it was true that the doctor’s dishonesty had not been covered up, it did not mean that para 109(h) of the Guidance was not engaged. The paragraph was concerned with dishonesty which was “persistent and/or covered up”. Dishonesty did not need to be continuous to be persistent. Here the doctor engaged in repeated acts of dishonesty over a prolonged period and the Tribunal was entirely justified in treating that as persistent conduct. The doctor engaged in repeated serious dishonesty and the decision to direct erasure was entirely consistent with the guidance.

Factors falling on the other side of the balance were, firstly, that there had been no further allegation of any dishonest conduct in a period of six years until sanction determination, but that was of very limited weight when account was taken of the doctor’s lack of insight.

Although it was asserted that the dishonesty did not take place within a professional setting and that the dishonest statements were not made to any fellow professional or other patient, the dishonest statements related to the doctor’s qualifications and were made in a setting closely related to his work, namely, to locum agencies who were putting him forward for medical positions. The importance of honesty when a doctor was stating his qualifications had been repeatedly emphasised by the courts. The doctor’s case was very different from that of a doctor who had been dishonest in some matter wholly unrelated to his life as a doctor (though even such dishonesty was to be seen as an important matter).

There was no suggestion that the appellant was anything other than a competent doctor. It was, indeed, a grave matter to deprive the public of the services of a competent doctor and a grave matter to deprive a professional of his livelihood. Those considerations were of weight but could not be determinative.

It was submitted that the effect of the disciplinary process had been to preclude the doctor from practising as a doctor for periods totalling about 15 months, had caused his move to qualify as a general practitioner to be put on hold, and it was sufficient to mark the gravity of the doctor’s conduct.

That point would have some force if the purpose of the disciplinary regime was the punishment of defaulting medical professionals, but it was not. The point had some limited relevance when considering what was necessary for the purpose of upholding professional standards but was not relevant to the objectives of protecting the public (where the crucial consideration was the risk of repetition) and was of minimal, if any, relevance to that of maintaining proper professional standards.

The Tribunal’s decision was not wrong. The sanction of erasure was neither excessive nor disproportionate. The doctor repeatedly made false statements as to his qualifications. He did so dishonestly over a period of three and a half years in the context of making statements to locum agencies. He failed to provide any adequate explanation as to why he acted in that way, let alone provide any real assurance that there was no real risk of repetition. Far from being excessive, erasure was an entirely appropriate sanction.