Case No: CO/13848/2012
Neutral Citation Number: [2013] EWHC 525 (Admin)
IN THE HIGH COURT OF JUSTICE
MANCHESTER CIVIL JUSTICE CENTRE

Manchester Civil Justice Centre
1 Bridge Street West
Manchester
M60 9DJ

Date: Friday 25th January 2013

Before:

HIS HONOUR JUDGE GRAHAM WOOD QC

- - - - - - - - - - - - - - - - - - - - -

Between:

	GMC 	
Claimant	
	- and -		
	
DR. Mantides	

Defendant	

- - - - - - - - - - - - - - - - - - - - -

(DAR Transcript of 
WordWave International Limited
A Merrill Communications Company
165 Fleet Street, London EC4A 2DY
Tel No:  020 7404 1400  Fax No: 020 7404 1424
Official Shorthand Writers to the Court)

- - - - - - - - - - - - - - - - - - - - -

Mr Davis appeared for the Claimant.

The Defendant did not appear and was not represented.

- - - - - - - - - - - - - - - - - - - - -
Judgment

His Honour Judge Graham Wood QC:

1.	This claim has been brought by the General Medical Council under Section 41A of the Medical Act 1983 as amended, and it seeks an extension of the interim order previously imposed by an interim orders panel for a period of five months, from 27 January 2013 when it will expire, until 26 June 2013.  The reason for the five months sought is that this will cover the period from now until a significant period after the meeting of the fitness to practise panel, (FTTP) which I am told will take place in March of this year.  That FTTP, will be dealing with the outstanding fitness to practise issues, including whether or not the Defendant's fitness to practise is impaired and, if it is impaired, whether or not sanctions should be imposed, there having been an earlier hearing on the basis of fact-finding in November of this year.

2.	The background to this case can be stated very briefly as follows.  The Defendant, it would seem, was a fairly newly qualified doctor who had been working at a hospital in Wales when considerable concerns were expressed about his competence. So great were those concerns that his employment with the Hywel Dda Health Board was terminated on 1 June 2010.  Immediately thereafter,  concerns were brought to the attention of the General Medical Council, and as a result of the investigation that was implemented there were several hearings before an interim orders panel.  Initially the Defendant's registration was the subject of conditions for a period of 18 months and then extended for a further period following review.  The first review was in January 2011 and there was a further review in June 2011.  

3.	Although the interim orders panel can impose an order for a period of up to 18 months, it is required to keep those orders under regular review.  After the expiry of 18 months it is incumbent upon the Claimant to make an application to the High Court for further renewal.  I will come back to the first application in a moment, but first I complete the chronology.

4.	On 9 January 2012 there was an assessor's report which has been quite significant in this case because it is the report which was based upon a test of competence carried out on 23 and 24 November 2011.  This test of competence, which is contained in the bundle that has been supplied to this court, revealed very extensive concerns about the Defendant's ability to perform his functions as a doctor and indeed showed that in many respects his competence fell significantly below that which would be expected of a competent doctor, with very low scoring across a broad range of testing.  Overall, just by way of example, his knowledge scored at 33.33 per cent, which indicated that he had an insufficient core medical knowledge to practice, even as an entrant at Foundation Year level 1.  

5.	As a result of the assessment of competence as later appeared to be the case, the Defendant's interim order was continued.  On 2 December 2011 there had not actually been a report based on the competence assessment, but conditions were maintained.  A report obtained on 9 January 2012 does not appear to have led to any further extension of an interim order because the High Court at that stage was asked to consider extending the earlier interim order of panel review which had maintained the conditions.  

6.	However, a significant problem subsequently came to light. Whilst it appeared that the Defendant had consented to the order, the order therefore being sealed by the High Court office without there actually being any attendance by either party, it subsequently transpired that the caseworker who had been entrusted by the General Medical Council to process the order had falsely inserted the name of the Defendant and his signature in the consent order. Therefore, as far as the court was concerned in January of last year there was to be no contested hearing because Dr Mantides had agreed to the extension of the order.

7.	In fact, as subsequently turned out, that did not mean that the order was necessarily a nullity even though the Defendant's consent had been falsely indicated to the court.  Matters continued with a further interim orders panel review in February 2012.  By that stage the assessment report was available and therefore understandably, instead of the conditions continuing, the Defendant's registration was suspended.  

8.	The matter on 21 March 2012 was now to be referred to a fitness to practice panel. There were further reviews which took place in April and September 2012 when the suspension was maintained.  Mr Davis tells this court, and I accept, that by then the problem with the caseworker had come to light and the GMC was cooperating with the police, and indeed I believe the High Court may well have been informed of the problem.  Certainly the Defendant was informed, because quite properly he made an application expressing concern before the FTTP on 26 November 2012.  He was claiming that the proceedings were an abuse because of the fraudulent obtaining of his signature.  The FTTP concluded, having received advice from a legal assessor, that the proceedings were not a nullity; there was an extent interim orders panel review and maintenance of the suspension order which was deemed valid. Therefore the panel continued to hear the case, making certain findings which indicated that all the facts the subject of the heads of charge were proved apart from 2C, which related to the maintaining of good medical practice.

9.	That is the background.  The interim orders panel suspension expires on 27 January 2013 unless it is extended by this court under the powers available to the court under the Medical Act in Section 41.  As I have indicated, I have been told by Mr Davis that there will be a resumption of this hearing in April 2013 when the impairment and sanctions stages will be dealt with over a three day hearing.  

10.	Mr Davis has summarised the considerations for this court at paragraph 4 of his skeleton argument.  Essentially this court takes the same approach that will be taken by an interim orders panel when considering whether or not there ought to be an interim order imposed.  That requires a balancing exercise, balancing the need to ensure that the public is protected by the order that is imposed, also considering the public interest as well as the practitioner's own interests which have to be taken into account. 

11.	I have been referred to the leading case that deals with this court's jurisdiction: that of the GMC v Hiew [2007] EWCA Civ 369 and the observations of Arden LJ, which included three considerations, namely the nature and gravity of the allegations, the nature of the evidence to be relied upon, and the seriousness of the risk of harm to patients.  

12.	In this case, because the FTTP has already met and arrived at an adjudication on the facts, this court can be fairly confident that these requirements are satisfied if the order is to be extended because these allegations are of a grave nature which seriously question the ability of this doctor to treat patients, albeit in a fairly early years post qualification. The assessor's report contains a somewhat damming assessment of his competence and ability.  

13.	Of course whether or not the doctor's fitness to practise is ultimately found to be impaired is a matter for another determination, but at this stage I am concerned, as the interim orders panel has been concerned, with the question of balancing protection to the public, with those other factors, including public interest and the practitioner's own interests.

14.	As far as the seriousness of the harm to patients is concerned, that is amply demonstrated by the findings that have been made and the risk which patients would face were the doctor to be allowed at this stage to continue to work in employment as a doctor.

15.	In all the circumstances, I am satisfied that the court can approach this on the same basis that had been previously approached by the interim orders panel and to find that it is entirely appropriate that an interim order of suspension be in place and that it be extended for a period of five months.  The public needs to be protected from this doctor and the public interest is certainly served by the imposition of an interim order of suspension, and therefore the order will be made as sought; that is that a five month extension will be provided.  This will allow the FTTP to resume its hearing on the question of impairment of fitness to practise and, in the event that it cannot be resolved, it will allow steps to be taken to make a further application to this High Court if necessary.

I think that five months will take us to the 25 June, is that correct?  

MR DAVIS:  Em …

HHJ WOOD QC:  25 June 2013.

MR DAVIS:  Yes.  I am just …

HHJ WOOD QC:  26 June.

MR DAVIS:  26th yes.

HHJ WOOD QC:  26 June, yes.  Not from today but from the expiry of the order on the 27 January.  The order that is in the bundle, Mr Davis, I am sorry to interrupt you. The order that is in the bundle anticipates I think consent which has never been provided to this order.

MR DAVIS:  I have got a …

HHJ WOOD QC:  A draft …

MR DAVIS:  Another draft here which … Could I just have a moment, my solicitor is just mentioning ….  It is a small point but my solicitor's knowledge of the file is extensive and my solicitor does not think that the GMC informed the court of the High Court extension order.  I think in your judgment you said may well have informed the court …

HHJ WOOD QC:  Yes.

MR DAVIS:  The GMC certainly informed Dr Mantides and certainly informed the police which is also in your judgment, so I think the judgment probably is correct, but just to be clear having been through the file and I know my solicitor knows (inaudible) she doesn’t think that the court were actually informed at the time although they obviously are …

HHJ WOOD QC:  Well, the court certainly has come to know about the problem subsequently.

MR DAVIS:  Ah I see.

HHJ  WOOD:  Subsequently … I don’t know how it came to know it and if that is necessary that part of my ruling can be corrected, thank you very much

MR DAVIS:  Yes and in fact I think what you said was correct … yes 

HHJ  WOOD QC:  All right. Well that's ….

MR DAVIS:  … clarification.

HHJ WOOD QC:  Well that's very frank of your instructing solicitor to let me know that. It doesn’t make any difference to my ruling, no.  So this order here your instructing solicitor is trying to look behind you, Mr Davis, so perhaps if you just stay to one side,  it is just I think … I think that she understandably likes to engage as well with the process and she is straining herself to look one side and then the other.  You have got an order here which I can happily endorse, the only thing that remains to be dealt with of course is the summary assessment of costs.

MR DAVIS:  Yes.  I have got a costs schedule which has been served on the (inaudible) which …

HHJ WOOD QC:  I seem to remember when looking at it that it was not an excessive schedule.  It never is from the GMC... in my experience

MR DAVIS:  No it isn’t, that's right

HHJ WOOD QC:  And poor Ms O'Toole is only a grade D worker, so she has put a lot of hard work into this at the modest rate of £118 an hour

MR DAVIS:  I think talking to her outside probably, the hours she has put in aren’t reflected in the costs schedule

HHJ WOOD QC:  Well, that would certainly be my assessment. I have no difficulty in arriving at the conclusion that that is a reasonable assessment and even your fee, Mr Davis, is not overly stated so that is awarded as well. Together with VAT.  I think that the VAT is only on your fees is that right? Yes.  The GMC is not VAT registered.

MR DAVIS:  Yes that's right. VAT just on my fee, yes.

HHJ WOOD QC:  Yes.  Well I don’t think that Dr Mantides can have any complaints over that assessment which I make in the sum sought of £1491.00.  So we will just alter 2 to costs summarily assessed in the sum of £1,491.   Thank you.  Is there anything else that is required?

MR DAVIS:  I don’t think so.  

HHJ WOOD QC:  I will just put my own name at the top of this order.  I have signed that and I will now date it as at today.  I will pass that back to the court so copies can be made.  I don’t know whether it is customary for the bundles to be returned to the GMC but certainly I will give them back to my clerk…

MR DAVIS:  I am getting a nod from…

HHJ WOOD QC:  Right.  Save a few rainforests …  Can I also pass back with the certificate of service and your service bundle. Thank you Mr Davis, thank you.