Sastry v General Medical Council  EWHC 390 (Admin)
Dr Sastry faced allegations relating to his treatment of Patient A when he was working as a Consultant Medical Oncologist in Mumbai. The issue arose whether his conduct should be judged according to the standards of professional conduct that the GMC were entitled to expect in the UK or instead by reference to local standards and practices in Mumbai. The legal assessor advised the Tribunal:
“[M]y advice in relation to the Indian issue would be that the doctor needs to be judged by UK standards, GMC standards, but having regard to appropriateness the tribunal should take into account the circumstances—the hospital, the patient, and the facilities, etcetera—that were available to the doctor in India”
The tribunal at first instance heard expert evidence from a UK specialist for the GMC, and a UK specialist and an Indian consultant oncologist instructed by Dr Sastry. It found that the Indian consultant was neither an independent nor impartial expert witness and went on to reject much of his evidence.
The tribunal found that the appellant had known that it had been inappropriate to proceed with Patient A’s chemotherapy, and had failed to obtain fully informed consent for his treatment plan. Crucially, the tribunal found that he had repeatedly sought to mislead the tribunal and there was a risk of repetition. Perhaps unsurprisingly, he was erased.
On appeal Dr Sastry argued that the tribunal had failed to consider the Indian context appropriately. For example, whilst the law of informed consent is very well developed in the UK, he argued the position was different in India. The court rejected Dr Sastry’s position that it was wrong to assess his conduct by reference to Good Medical Practice (“GMP”). It considered:
“the MPT was right to use GMP as a reference by which to judge Dr Sastry’s behaviour, albeit being careful to take into account local conditions. The obligation to comply with GMP comes with registration. As appears from the GMC Guidance given to doctors…there are two types of registration: with a licence to practise and without. A doctor may not practise in the UK without a licence but doctors practising wholly outside the UK do not need to hold a licence, indeed they need not be registered with the GMC at all. However, the Guidance is clear: if doctors choose to be registered with the GMC they must follow GMP. Doctors seeking to obtain or retain GMC registration, with or without licence, are obliged to practise in accordance with GMP…
… the principles of good practice set out in GMP are sufficiently high-level to be able to be adapted as necessary to accommodate differing guidelines and conditions which may exist in another country”.
The court, moreover, was satisfied the tribunal had considered this context in making its assessment at the impairment stage.
Mrs Justice May commented that although she “might have had some concerns about the degree to which the MPT’s findings were dependent upon expert evidence from experts based here in the UK”, ultimately “the Indian context was of marginal relevance, given the MPT’s (unchallenged) findings…” based on Dr Sastry’s own evidence. It was his evidence which prompted the MPT to find that Dr Sastry “knew it to be inappropriate to proceed [with chemotherapy]..”, that he “fail[ed] to obtain fully informed consent for [his] treatment plan” and that he had “repeatedly sought to mislead [the MPT]” .
In those circumstances, the decision to erase was well within the tribunal’s power.
Of course it is not unheard of that doctors should practise abroad for a part or all of their careers. It is well known that professional standards differ from jurisdiction to jurisdiction and so it is unusual for the GMC to bring proceedings against a doctor practising overseas. However, the danger remains real. Registration brings responsibilities. If a doctor is maintaining GMC registration, he or she should expect to be judged by UK professional standards, regardless of where they practise.