General Medical Council v Dr Azubuike Udoye [2021] EWCA 1511 (Admin)

Dr Udoye appeared before the MPTS facing charges of dishonesty. He did not give evidence and the case concluded with a finding of no misconduct. Perhaps unsurprisingly, the GMC utilised its right of appeal, under s.40 of the Medical Act 1983. Mr Justice Holgate had no difficulty in upholding the appeal and remitting a number of allegations for consideration by a differently constituted Tribunal.

The facts of the case were that Dr Udoye qualified as a doctor in Nigeria and later sought inclusion in the GMC’s GP register. Having unsuccessfully sought a certificate of eligibility for GP registration, he joined a GP Induction and Refresher scheme (a scheme for doctors previously included in the GP register whereas Dr Udoye had never been included).

The relevant allegations before the MPTS related to Dr Udoye’s completion of the scheme’s registration form (in which he stated that he was included in the GMC’s GP register) and practising as a GP during the scheme. The Tribunal concluded:

• that Dr Udoye had not practised as a GP as his work was supervised meaning that he had not practised as an “independent” GP; and
• that the GMC had not proved on the balance of probabilities that Dr Udoye had acted dishonestly when completing the registration form as the evidence in terms of a dishonest or innocent explanation was finely balanced.

The GMC appealed on the grounds that the Tribunal had misinterpreted the allegation that Dr Udoye had not practised as a GP and that the Tribunal had not given proper consideration to whether an adverse inference should be drawn from Dr Udoye’s decision not to give evidence.

Mr Justice Holgate held that the Tribunal had erred in adding the word “independent” into the allegation that Dr Udoye had practised as a GP, there was no justification for adding this word and that the language of the allegation was “perfectly straightforward and clear”.

It is set out that the GMC’s position regarding the meaning of the charge was made clear in writing, in response to a submission of no case to answer, with that response being adopted in closing submissions. Mr Justice Holgate comments that it is a pity that the Tribunal did not confirm that they had the document in question and that they had re-read the relevant passage before the hearing concluded. A pity indeed given the cost of the appeal process and the inevitable delay and costs arising from the need for a further MPTS hearing.

It was also held that the Tribunal’s reasoning was flawed in respect of the application of the principles set out in R (Kuzmin) v General Medical Council [2019] EWHC 2129 (Admin) when considering whether or not an adverse inference should be drawn.

Kuzmin established that an adverse inference can be drawn from a registrant refusing to give evidence. It was held that whether to draw an adverse inference would be dependent upon the facts of the case but that generally, no adverse inference would be appropriate unless the following criteria are met:

i) a prima facie case to answer has been established;

ii) the individual has been given appropriate notice and an appropriate warning that, if he does not give evidence, then such an inference may be drawn; and an opportunity to explain why it would not be reasonable for him to give evidence and, if it is found that he has no reasonable explanation, an opportunity to give evidence;

iii) there is no reasonable explanation for his not giving evidence; and

iv) there are no other circumstances in the particular case which would make it unfair to draw such an inference.

It is in considering (iv) that the Tribunal went astray as they are said to have “embarked upon a full evaluation of the merits of the allegation disregarding the issue of whether an adverse inference should be drawn”.

Mr Justice Holgate held that it is plain that criterion (iv) is only concerned with procedural unfairness (with all of the Kuzmin criteria being rooted in principles of fairness) and that a Tribunal should not examine all of the evidence for or against the allegation to decide whether the criterion has been met.

Should it be established that the criteria set out in Kuzmin are met, the Tribunal should go on to consider whether it is appropriate to draw an adverse inference and can at that stage take into account important public interest considerations. Should an adverse inference be drawn, that is one factor to be taken into account when deciding whether the allegation is proved. A decision should be made as to how much weight is to be given to the adverse inference, with it being possible that no significant weight will be given. When considering the weight to be attached, a Tribunal should consider the impact of there being no opportunity to test the credibility of the registrant’s evidence or the merits of any innocent explanation that has been put forward by way of submissions alone.

Mr Justice Holgate held that in view of equal weight having been given by the Tribunal to all other matters for and against the allegation, the issue of whether an adverse inference should be drawn and how much weight should be given to it was “obviously material” and that the Tribunal’s reasoning, in disregarding that process, was legally flawed.

In conclusion, it seems that the Tribunal strayed into interpreting and adding to the allegations when there was no need to do so. Further, faced with a possible dishonest or innocent explanation and without the benefit of the registrant giving evidence, the Tribunal failed to follow the careful, staged approach that is required when a registrant declines to give evidence. A Tribunal must consider procedural fairness at the outset then decide whether to draw an adverse inference before assessing the evidence and whether or not an allegation is proved. Conflating these processes will only lead to trouble and potentially a fresh hearing before another Tribunal.  

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Laura Smith, Associate, BLM
laura.smith@blmlaw.com