Doctors and Domestic Violence in GMC Cases
The GMC annually receives complaints from spouses or ex-spouses, or their friends and relatives, that a doctor has been violent at home or elsewhere toward their ex-partner or children. Each year a number of doctors will be convicted of the criminal offence of assault or harassment in a domestic violence context. However, a number of false complaints are also made to the GMC each year, out of spite or as a tool to obtain custody of children. In either situation, the GMC will investigate. Some cases are closed on paper and some progress.
The GMC will refer certain complaints it receives from complainants to the police, or wait until the police have investigated an alleged crime. Where there is no conviction or charge (or there has been an acquittal), the GMC might still take action against a doctor on the evidence that it has been obtained by the police or which can be obtained by the GMC. If domestic violence complainants are willing to testify then the GMC may proceed to a hearing.
A doctor who is found to have committed domestic violence (against a spouse or partner, older persons, or their own children), clearly brings the profession into disrepute and also undermines confidence in the profession. In such circumstances a doctor might be given a formal GMC warning, which sits on their registration for a period of two years, or be given guidance at the closure (on paper) of the case. See more on this subject at: GMC Investigations.
Doctors might find that the allegations are referred to an interim orders tribunal (IOT), where the strength of the evidence will be examined and given appropriate weight, leading to a risk assessment as to whether or not a doctor should be suspended or given conditions of practise (restrictions)
Where a doctor is referred to a fitness to practise tribunal hearing, and while there is a possibility fo a warning being imposed, where domestic violence has been found proved, the greater likelihood is that a period of suspension will be imposed. In some instances, a doctor’s name might be erased from the register.
A doctor who is facing criminal allegations should ensure that they have a lawyer attend with them at any police-led interview that they are invited to. What the doctor says and doesn’t say can have an effect on the proceedings that follow, whether they be criminal or GMC proceedings. Where a doctor denies the allegations, they may need to defend their case in a criminal court, civil court, or at the GMC. A lawyer who can represent the doctor at such hearings should ideally be instructed.
Legal aid may be available to some doctors in criminal cases but their earning capacity and assets will often take them above the eligibility threshold. Most doctors prefer to instruct a lawyer on a private basis any way. Doctor are not entitled to legal aid in GMC proceedings, save on appeal, and again subject to eligibility criteria being met. Obtaining legal aid for appeals is now very difficult indeed.
The Local Authority Designated Officer (LADO) will also be consulted by employers and the police, where a doctor is said to have committed domestic violence in front of or nearby children, or been violent towards children. Social workers will generally be instructed to speak to the children, and other individuals, including the complainant and the alleged perpetrator. LADOs will liaise will employers and employers will consider excluding a doctor who is facing such allegations. For more information about LADO procedures, look up the relevant local municipal authority (council) to find their procedures and policies. The GMC will usually liaise with the LADO and vice versa, to meet their respective statutory obligations.
LADO is often not transparent in its decision-making, and on occasions they will make decisions in the absence of taking the doctor’s account into consideration. (The lawfulness of this approach is doubtful, as it does not afford a doctor a fair opportunity to contribute to any risk assessment. Some allegations might be false and a doctor might have an alibi or other explanation that undermines the allegation.)
Section 47 of the Children’s Act 1989, Part 5:
“47 Local authority’s duty to investigate.
(1) Where a local authority— …
(a) are informed that a child who lives, or is found, in their area—
(b) have reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm,
the authority shall make, or cause to be made, such enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard or promote the child’s welfare … .”
The views of the parents should be taken into account in most instances. In AB & Anor, R (on the application of) v The London Borough of Haringey [2013] EWHC 416 (Admin) the High Court observed that:
8. The use of section 47 and the measures that may be taken by a local authority following its use are predominantly aimed at securing the best interests of children. Its use is intended to be child-focused and to take account of the child’s views and wishes without unduly and unfairly disrupting her family life. The use of section 47 should also take account of the personal and family rights of a child’s parents or carers so long as that does not interfere with the overriding duty of child protection and development.
10. A section 47 enquiry involves an in-depth child-centred assessment of a child’s developmental needs, of the harm she is suffering or may suffer, of the capacity of the child’s parents or carers to respond to the child’s needs and of the family and environmental factors that are playing a role in the harm she is suffering or may suffer. This intrusive assessment should take account of the views of the different agencies involved with and the external influences on the child and it must also directly involve both the parents and the child unless this will endanger the child. The necessary fact-gathering should include sessions with the child without her parents or carers present and it should ascertain that child’s wishes and aspirations wherever possible. The assessment, known as a core assessment, must be concluded so that a holistic view may be taken of the child’s needs, of the significant harm that the child is being or is at risk of being subjected to and the steps that can be implemented for the eradication of negative influences on the child and the promotion of favourable ones on her.
11. A section 47 enquiry has in recent years become very damaging for the life, career and family relationships of many who are parenting or caring for the child being assessed. There are now extensive statutory checks that must be made about adults who are caring for or working with children or who are coming into contact with them in an educational, health, pastoral or care context. Thus, involvement in a section 47 enquiry may often result in the ending of a career involving contact with children. This will usually be for good reason but this is not always so and there will rarely be a means for those unfairly marked out by involvement in a section 47 enquiry to eradicate that stain on their professional and personal reputation.
12. A section 47 enquiry can of course prove to be very damaging for a child, for her parents and for their mutual relationships. In particular, the lives of parents can be badly affected if and when adverse conclusions are made about the harm that they have inflicted on their child. These can include criminal prosecution, the loss or their child, intrusive involvement in their family and private lives, loss of employment or being barred from working with children and an adverse entry on their records held by reporting authorities such as the police and various regulatory bodies. A particular trigger for any of these adverse effects is the fact that a section 47 enquiry was undertaken in relation to their child at all since its threshold is that significant harm has occurred or that there is a risk of it occurring. Thus, a section 47 enquiry, which will often be reportable by the parents concerned, can blight their lives irrespective of the nature and extent of the significant harm or of their involvement in it or of the reasonableness of the suspicion that generated the enquiry in the first place.
(March 2013)
Regrettably, in our experience here at DDS, local authority investigations have frequently failed to speak to a parent (who is a doctor) to take into account their evidence on specific and relevant factual allegations, before making an unfavourable decision. The lawfulness of this will be fact-specific, and the filing of a judicial review may be necessary, to right the wrong. A complaint, through the complaints process, and a request for a review, might also be justified.
Proven Domestic Violence
A doctor who admits or is found to have committed domestic violence (against a partner, their children, or in front of their children) will usually have to take significant steps of remediation, in order to reassure the GMC or a tribunal, that they are fit to practise. Even where a doctor does not admit to the alleged domestic violence, it is recommended that they undertake steps of remediation. Such positive evidence can be advanced at IOT hearings, Rule 7 stage, and at fitness to practise hearings, and can have beneficial impacts. The importance of remediation, and the demonstration of insight is key to analysing whether a doctor has learned lessons, whether there is a risk of repetition, and can be reassuring to the public that the doctor means what they say
It should be noted that harassment, controlling behaviour, and abuse does not necessarily have to lead to physical violence for the authorities to take action against a doctor. Further, even where the police decide not to proceed with a prosecution, the GMC can still take up the same concerns and bring misconduct proceedings. There are a number of cases where the GMC had brought proceedings of assault and non-consensual sex, among other things, which could also be classified as criminal conduct in the criminal justice jurisdiction.
The NHS, as an employer, will usually implement safeguards, imposing restrictions (conditions) on a doctor of concern, or agreeing with the doctor voluntary undertakings, about supervision, restricted practice, and behavioural assessments (through NHS Resolution). Doctors (GPs) on the Performers List will likely see a PAG decision, and could face Performers List Decision Panel (PLDP) proceedings, and appeals. See our article: Medical Performers List – Primary Health Lists: Law and Hearings
A number of doctors have been convicted of controlling behaviour have been imprisoned. A custodial sentence will likely indicate that the doctor’s behaviour was towards the top end of seriousness, and the regulators will be concerned about the doctor’s fitness to practise medicine.
A doctor should be careful what they say about domestic violence allegations, when speaking to the police or GMC, or local authorities, as admissions and denials could be used against them in a number of legal jurisdictions (GMC, DBS, criminal, civil and family courts). In some instances, doctors will make admissions and express regret, and early admissions can indicate that a doctor is developing insight into their conduct.
The case law reminds us that a decision by a MPT tribunal for conduct that falls within the category of domestic violence, can lead to erasure from the GMC Medical Register. In Ibrahim v. General Medical Council [2022] EWHC 2936 (Admin) the appeal court held that erasure was an appropriate sanction (para 37):
“Conclusion: 37:”I have addressed issues on this appeal by way of a rehearing. I have exercised an objective judgment on all the materials. I have undertaken an exercise in evaluating, for myself, issues of public protection and issues relating to the reputation of the medical profession. But in doing all of this, I have found the Tribunal’s detailed and careful analysis and reasoning of great assistance. I adopt it because it is cogent and convincing and I agree with it. I find the sanction which was imposed in this case fully objectively justified, for the reasons given by the Tribunal. In my judgment, the sanction was not “wrong”; erasure was not “excessive” or “disproportionate”; suspension would not have met the public interest concerns properly identified, and erasure was objectively appropriate and necessary in the public interest. Erasure was necessary to promote and maintain proper conduct standards, and to promote and maintain public confidence in the medical profession, and to achieve both of those aspects of the statutory overarching objective. Having reached those views, on the particular facts and features of this individual case, I dismiss the appeal.” per Fordham J.
The history was set out by the judge (para 3) with the overarching objective explained subsequently (para 4):
“3. The context for the issues which the Tribunal was addressing concerned the domestic setting within a family home, involving a married couple: the Appellant and his ex-wife (“Ms A”), living with their young son (“Child B”). What had happened was this. On 17 April 2019 Ms A reported to the police an incident of domestic violence. The Appellant was charged with assaulting Ms A by beating. He denied the charge and pleaded not guilty. He was convicted by the magistrates on 19 September 2019. He was sentenced on 4 November 2019 to a community order with a fine. The conditions of the community order included the “building better relationships” (BBR) programme and a “rehabilitation activity requirement” (RAR). The Appellant complied with those requirements as called on to do. He completed the RAR with its 6 one-hour managing emotions sessions, and 6 one-hour counselling sessions. He completed one module out of the four modules of the BBR programme, being excused from the rest after the intervention of the Covid-19 pandemic. The community sentence and conditions were confirmed as expired on 22 January 2021. The GMC then took the case up, pursuant to its regulatory procedures, the Appellant having made a self-referral to the GMC on 10 May 2019. Ms A provided evidence to the GMC, to a large extent covering the same ground as “victim impact assessment” evidence which had been before the magistrates’ court. In due course, as I have mentioned, Ms A gave oral evidence at the hearing before the Tribunal; as did the Appellant.”
“The Overarching Objective 4. Section 1(1A) of the 1983 Act states that the “overarching objective” of the GMC in exercising its functions is the “protection of the public”. Section 1(1B) provides that the pursuit of the overarching objective involves the pursuit of the following objectives: (a) “to protect, promote and maintain the health, safety and well-being of the public”, (b) “to promote and maintain public confidence in the medical profession”, and (c) “to promote and maintain proper professional standards and conduct for members of that profession” Per Fordham J.
(November 2022)
With doctors facing such risks in domestic violence cases, a doctor should take steps to present appropriate and relevant evidence to the GMC. We can advise on the steps to take in a given case, and in particular how to provide reassuring evidence to deal with policy concerns arising under the umbrella of the overarching objective. The GMC’s overarching objective will be a key consideration to decision-makers, who must apply it pursuant to the sanctions guidance. A doctor who is facing domestic violence allegations should give considerable thought to how they will present evidence relating to facts and their credibility, evidence relevant to misconduct, and evidence relevant to impairment and sanction.
If you are a doctor facing allegations of domestic violence, call Doctors Defence Service on 0800 10 88 739 in strict confidence. Or use our online Contact Form.
