‘Violent Doctors’
Violent Doctors – the GMC Regulatory Response
Each year the GMC receives a number of allegations against doctors related to physical violence. Allegations of violence could include domestic violence, a pub brawl, psychological or physical violence at work or elsewhere, and sexual violence.
On occasions, doctors will be charged with a criminal offence and be convicted in the criminal courts. Where a doctor is convicted of a criminal offence, the GMC will usually bring conduct proceedings. Where a doctor is acquitted in the criminal courts, the GMC can still look at the same issues, testing the evidence “on the balance of probabilities” (the civil standard of proof), instead of using the “beyond reasonable doubt” test (the criminal standard of proof) – so making it easier to find alleged facts proved.
Cases where there has not been a criminal conviction
The GMC applies policy guidance when considering whether a doctor’s fitness to practise might be impaired by reason of their violent conduct. The case examiners will take into account the presumption that a doctor’s fitness to practise will be impaired by reason of the alleged violent conduct, which is relevant to the GMC Rule 7 stage of the investigation, when the case examiners decide whether to refer a case to a fitness to practise hearing before the Medical Practitioners Tribunal (MPT). The presumption is set out as follows, at paragraph 32:
32. Evidence a doctor has been violent, even when it relates to events in a doctor’s private life and regardless of whether it resulted in physical injury, is a very serious breach of our professional standards and poses a risk to confidence in the medical profession. Each case will need to be considered on its facts but, violent conduct, including common assault carries a presumption of impairment, requiring referral to tribunal apart from in exceptional circumstances. (Making decisions on cases at the end of the investigation stage: Guidance for the Investigation Committee and case examiners (August 2019))
Cases where there is a criminal conviction for violent conduct
The GMC Registrar will determine whether a criminal conviction should be referred to a fitness to practise hearing. The guidance states:
8 There is presumption that cases involving a conviction or caution should proceed to a MPT. However, there may be cases involving minor convictions or cautions that do not require referral to a MPT and may instead be dealt with by the issuing of a formal warning or, depending on the factors involved, by concluding a case with no action. (Guidance on convictions, cautions, determinations and other methods of disposal (October 2019))
If a case is not referred to a fitness to practise hearing, the case examiners will consider whether to impose a GMC warning. A warning, if imposed, is published on the GMC website against the doctor’s registration, for a period of two years.
Risk of Erasure for Violence that is Serious
Doctors who commit violent acts that are considered serious risk being erased from the medical register. They might alternatively face a long suspension of up to 12 months duration (with a review before they can return to full practise) – which would have the impact of preventing them from working as a doctor, so affecting their reputation and professional standing and their ability to earn a living.
Replying to a GMC allegation of conduct which involves violence must be done with great care. An admission can be used in the criminal courts as well as in GMC proceedings. On occasions, it is important to say very little. While on other occasions a doctor might want to explain their version of events to contextualise the alleged violence, such as acting proportionately in self defence or in the defence of others, or in defence or property, they should do so with great care. Where a doctor wishes to admit the act of violence they will also need to evidence insight and remediation.
GMC Good Medical Practice (the code of conduct for doctors) will often have been breached where a doctor has acted in a violent or aggressive manner, whether the conduct took place within their private life or professional life. A carefully considered reply, sent to the GMC, that takes stock of that breach, and shows an understanding of the importance of respecting professional values, will greatly assist a doctor’s prospects of success in many instances.
If you are a doctor facing allegations of violence and you wish to seek advice in relation to representation in the criminal courts or representation before the GMC, contact Doctors Defence Service in strict confidence and without obligation.