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Marinovich v General Medical Council [2002] UKPC 36 (24 June 2002)

ADVANCE COPY

Privy Council Appeal No. 100 of 2001

Dr. Leonard Mark Marinovich Appellant

v.

The General Medical Council Respondent

FROM

THE PROFESSIONAL CONDUCT COMMITTEE

OF THE GENERAL MEDICAL COUNCIL

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JUDGMENT OF THE LORDS OF THE JUDICIAL

COMMITTEE OF THE PRIVY COUNCIL,

Delivered the 24th June 2002

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

Present at the hearing:-

Lord Hope of Craighead

Sir Christopher Slade

Sir Philip Otton

[Delivered by Lord Hope of Craighead]

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1. On 30 November 2001 the Professional Conduct Committee of the General Medical Council found that the appellant, Dr Leonard Marinovich, had been guilty of serious professional misconduct and directed that his name be erased from the register. An order had been previously made for his interim suspension by the Interim Orders Committee. In place of that order, which was revoked, the Committee made an order that his registration be suspended with immediate effect. He has now appealed against that determination to their Lordships’ Board.
Background
2. The appellant trained and qualified as a physician both in the United Kingdom and in Australia, where he practised for many years as a psychiatrist. For 25 years he was senior psychiatrist at the Royal Women’s Hospital in Melbourne. Latterly he was in practice as a psychiatrist in Darwin. In October 1999 he left Australia and came to live in this country. On 22 October 1999 he reactivated his registration here as a medical practitioner. In November 1999 he took up a post as a locum consultant psychiatrist in general psychiatry at Durham General Hospital. From November 2000 to March 2001, when his employment was terminated, he held a similar post at a hospital in Worthing.
3. On 14 October 1999, prior to his departure from Australia, the appellant was found guilty of unprofessional conduct by the Medical Board of the Northern Territory. The Board held that on several occasions he had provided inappropriate treatment to a female psychiatric patient by way of massages and that on one of these occasions he had had sexual intercourse with her. A fine was imposed on him in respect of the inappropriate massages and his registration in Australia was cancelled in respect of the act of sexual intercourse.
4. The events which had given rise to these findings were brought to the attention of the Preliminary Proceedings Committee of the General Medical Council when his registration in this country was reactivated. On 2 March 2000 the Preliminary Proceedings Committee determined that a charge should be formulated against him in respect of the same matters. A charge in the following terms was referred for inquiry to the Professional Conduct Committee:

“1. At all times you were a registered medical practitioner practising from consulting rooms at Unit 1, Tiwi Medical Centre, Darwin, Northern Territory, Australia;

2. From July 1995 and at all material times [Mrs A] was your patient and under your care as her psychiatrist;

3. On 25 October 1996 you gave a body massage to [Mrs A]

(a) Whilst giving the body massage you stated, inter alia, that [Mrs A] had beautiful skin and was lovely to massage,

(b) The giving of the body massage on 25 October 1996 was (i) inappropriate, (ii) contrary to the best interest of your patient, (iii) an abuse of your professional position;

4. On 20 November 1996 you gave a body massage to [Mrs A]

(a) During the body massage you touched [Mrs A’s] (i) breasts, (ii) tops of her inner thighs

(b) Whilst giving the body massage you stated, inter alia, that [Mrs A] had beautiful skin and was lovely to massage

(c) The giving of the body massage on 20 November 1996 was (i) inappropriate, (ii) contrary to the best interest of your patient, (iii) an abuse of your professional position;

5. On 27 November 1996 you gave a body massage to [Mrs A]

(a) During the body massage you (i) touched [Mrs A’s] breasts, (ii) touched [Mrs A’s] vagina, (iii) touched [Mrs A’s] clitoris, (iv) kissed her

(b) Whilst giving the body massage you stated, inter alia that (i) you were going to give her a ‘special massage’ for her birthday, (ii) you were warming her up for [A]

(c) The giving of the body massage on 27 November 1996 was (i) inappropriate, (ii) contrary to the best interest of your patient, (iii) an abuse of your professional position;

6. After the body massage was conducted on 27 November 1996 you had sexual intercourse with [Mrs A];

7. Having sexual intercourse on 27 November 1996 was (i) inappropriate, (ii) contrary to the best interest of your patient, (iii) an abuse of your professional position;

And that in relation to the facts alleged you have been guilty of serious professional misconduct.”

5. On 17 May 2000 the Preliminary Proceedings Committee considered whether it was necessary for the protection of members of the public for it to make an order under section 42(3) of the Medical Act 1983. The appellant was present at that meeting and was represented by counsel. At the conclusion of the proceedings the Committee made the following determination:

“In accordance with section 42 of the Medical Act 1983, as amended, the Preliminary Proceedings Committee has determined that, pending the hearing of your case by the Professional Conduct Committee, it is necessary for the protection of members of the public and in your interests that your registration should be subject to the following conditions for a period of six months, or until the Professional Conduct Committee has concluded this case, whichever is the earlier.

1. Except in life threatening emergencies

a. You should confine your medical practice to NHS Hospital posts.

b. You should restrict your medical practice to clinical settings.

c. You should undertake all consultations with female patients in the immediate presence of a chaperone who is another medical practitioner registered with the GMC, or a practitioner registered with the United Kingdom Central Council of Nursing, Midwifery and Health Visiting. If any patients object to the presence of the chaperone, you should not proceed with the consultation. You should note the name of the chaperone in the patient’s notes.

2. You shall notify all current employers, prospective employers and locum agencies, whether for paid or voluntary employment at the time of the application of the matters which have been referred for inquiry by the GMC’s Professional Conduct Committee and of these conditions.

3. You shall notify the Registrar at the GMC of any posts for which you apply at the time of the application, and of any posts which you undertake.

4. You should not use massage as part of your treatment of any patients under any circumstances.

In reaching their decision the Committee have taken account of the serious nature of the allegations which, if proved, demonstrate conduct which poses a serious risk to your patients.

Your registration will become subject to the specified conditions when written notice of the decision is deemed to have been served upon you.”

Notification of that determination was deemed to have been served upon the appellant on 19 May 2000. A copy of the notification was sent to his solicitors, and on 22 May 2000 he signed and returned another copy of it as confirmation that he had received the original.
6. On 3 August 2000 the Medical Act 1983 (Amendment) Order 2000 (SI 2000/1803) was brought into force. It amended the Medical Act 1983 by providing for a new statutory committee of the General Medical Council to be called the Interim Orders Committee. On 24 October 2000 the Interim Orders Committee met to consider whether it was necessary for the protection of members of the public or was otherwise in the public interest or in the appellant’s own interests to make an order under section 41A(1) of the Medical Act 1983 as amended. The appellant was present at that meeting but he was not represented. At the conclusion of the proceedings the Chairman announced that the Committee was satisfied, for the same reasons as those which had been given by the Preliminary Proceedings Committee, that it was necessary to impose an order for interim conditions on his registration for a period of 18 months. The conditions which it imposed on his registration were in the same terms as those which had been imposed by the Preliminary Proceedings Committee. Notification of this determination was deemed to have been served on the appellant on 26 October 2000. On 27 October 2000 he signed and returned a copy of the notification as confirmation that he had received the original.
7. By the time when the appellant’s case came before the Professional Conduct Committee on 26 November 2001 for a hearing on the charge relating to the allegations which had been made against him about his conduct in Australia, a notice had been served on him alleging that he had acted in breach of the orders for conditional registration made against him by the Preliminary Proceedings Committee on 17 May 2000 and the Interim Orders Committee on 24 October 2000. It was alleged that he had failed (a) to inform his employers of the existence and true nature of the interim conditions imposed on his registration, (b) to undertake all consultations with female patients in the immediate presence of a chaperone who was another medical practitioner registered with the GMC or a practitioner registered with the United Kingdom Central Council of Nursing Midwifery and Health Visiting and (c) to confine his medical practice to clinical settings.
8. On 29 November 2001, having heard evidence and submissions during that and the three preceding days, the Professional Conduct Committee made the following findings:

“Heads 1 and 2 of the charge have been admitted and found proved.

The preamble of Head 3 has been admitted and found proved. Head 3a has not been found proved. Heads 3b (i), (ii) and (iii) have been found proved.

The preamble of Head 4 has been admitted and found proved. Heads 4a (i) and (ii) have not been found proved. Head 4b has not been found proved. Head 4c (i), (ii) and (iii) have been found proved.

The preamble of Head 5 has been admitted and found proved. Heads 5a (i), (ii), (iii) and (iv) have not been found proved. Heads 5b (i) and (ii) have not been found proved. Heads 5c (i), (ii) and (iii) have been found proved.

Head 6 has not been found proved.

Head 7 (i), (ii) and (iii) have not been found proved.”

It should be noted that the allegations that the appellant said things to the patient whilst giving the body massages, that he touched the patient intimately on 20 and 27 November 1996 and that he had sexual intercourse with her on 27 November 1996 were found not to have been proved. When the Chairman announced these findings he said that the Committee had concluded that the facts which it had found proved were not insufficient to support a finding of serious professional misconduct.
9. Counsel for the General Medical Council then addressed the Committee under rule 28 of the General Medical Council Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules. She informed the Committee that the appellant had been subject to an inquiry by the Medical Board of the Northern Territory in Australia in relation to the matters which had been before the Committee for its decision as well as some wider issues and that the Board had determined, applying the civil standard of proof on a balance of probabilities, that he had been guilty of unprofessional conduct. She told the Committee that the Board had concluded that, as well as having provided inappropriate treatment by way of massages on psychiatric visits, he had had sexual intercourse with the patient on 27 November 1996 and that the appellant’s appeal against these decisions had been unsuccessful. She then drew the attention of the Committee to the interim conditions that had been imposed on his registration by the Preliminary Proceedings Committee and by the Interim Orders Committee and to the allegations that these conditions had been breached. Having heard the appellant’s response to these allegations, the Committee adjourned the hearing to the following day so that evidence could be led on this matter and the appellant might address it by way of mitigation.
10. On 30 November 2002 the Committee heard evidence in regard to the allegation that the interim conditions had been breached and it also heard submissions by the appellant by way of mitigation. It then proceeded to consider and determine whether, having regard to the facts proved in the proceedings on the original charge and the evidence adduced under rule 28, the appellant had been guilty of serious professional misconduct. After the Committee had completed its deliberations the Chairman announced its decision in the following terms:

“Dr Marinovich, trust is at the very core of the relationship between patents and their doctors. Doctors are under a responsibility to ensure that this trust is maintained at all times. The Committee were deeply concerned by the matters that have been drawn to their attention.

In 1996, the time at which the events which have been considered by this Committee took place, you were a psychiatrist in private practice in Darwin, Australia. You had in your care Mrs A. The Committee have heard that Mrs A had become increasingly dependent upon you as her psychiatrist due to emotional, mental and physical problems that she was experiencing. In addition to seeing you regularly, she telephoned you at home and at your invitation socialised with you and your wife. During a period of extreme vulnerability on the part of Mrs A, you suggested an option of undergoing massage treatment in order to alleviate her anxiety. You have confirmed to the Committee that you were aware of the guidelines issued by the Royal Australian and New Zealand College of Psychiatrists. It is clear that in view of these guidelines, and Mrs A’s condition, you should not have carried out this treatment yourself and instead should have referred Mrs A to undertake this treatment elsewhere. Your decision to give Mrs A massage on three occasions was highly unethical, constituting as it did physical contact for sustained periods with a patient whom we were quite satisfied was at the time extremely vulnerable, emotional and highly dependent. Not only did this constitute an abuse of trust and an abuse of your professional position, but the Committee are also in no doubt that massage treatment carried out by you was entirely inappropriate and contrary to Mrs A’s best interest.

The Committee have heard that on 22 October 1999 you reactivated your registration as a medical practitioner in the United Kingdom. Following investigation by the GMC you were notified of the Preliminary Proceedings Committee’s, and later the Interim Orders Committee’s, directions that your registration be subject to conditions restricting your practice. We are satisfied on the evidence of Dr Fisher, Dr Angus and on your own evidence that during your employment in the County Durham and Darlington Priority Service NHS Trust and Worthing Priority Care NHS Trust you breached the conditions imposed. You undertook consultations, including domiciliary visits with female patients without always having in your immediate presence a chaperone who was a registered medical or nursing practitioner, nor did you fulfil the requirement to record their details. In carrying out domiciliary visits you also breached the condition that you should only carry out your medical practice in a clinical setting. You deliberately failed to notify your employer or agency of the matters that had been referred for inquiry, and you did not notify the GMC of the post to which you had been appointed.

You have repeatedly and intentionally flouted the conditions attached to your registration and have acted in a profoundly dishonest manner. Further, your explanations for your breaches of these conditions have shown an alarming lack of insight. Your conduct has reflected such a serious departure from the basic principles of medical practice, and the standard of conduct that the public are entitled to expect of doctors, that the Committee have no difficulty in finding you guilty of serious professional misconduct.

Doctors are under an obligation to act in an honest and trustworthy manner. The dishonest and manipulative behaviour that you have displayed has no place in, and undermines the standing of, the medical profession. Given the extreme serious nature of the matters that have been drawn to their attention, the Committee have concluded that neither the imposition of conditions nor an order for suspension would serve the public interest. They have accordingly directed that your name be erased from the Register.”

The Committee went on to determine whether it was necessary for the protection of members of the public or in the appellant’s own interest to impose an order for the immediate suspension of his registration. Its conclusion was that, given the extremely serious nature of the findings against him, it was necessary for the protection of members of the public that his registration be suspended with immediate effect.
11. The appellant has appealed against the finding of the Committee that the massages were inappropriate, contrary to the best interests of the patient and an abuse of his professional position on the ground that this finding was wrong and against the weight of the evidence. He points out that the Committee did not find it proved that he had any sexual or other ulterior motive for conducting the massages and that there was no evidence that the patient had suffered any physical or psychological harm as a result of them. He submits that there was insufficient evidence to establish more than that he committed an error of clinical judgment in failing to refer the patient to another masseur for what he genuinely believed was sensible and appropriate treatment.
12. As regards the question of sanction, the appellant makes three points. First, he says that the disclosure that the Medical Board of the Northern Territory in Australia had concluded on the balance of probabilities that he had had sexual intercourse with the patient on 27 November 1996 was prejudicial and unfair as it had no probative value and carried the risk of influencing the Committee in its choice of sanction. Secondly, he says that the Committee failed to take into account, or at least to take into account sufficiently, various matters which he had raised by way of mitigation. Thirdly, he says that any sanction ought properly to have comprised a reprimand or a period of suspension from practice.
Whether the massages were inappropriate
13. Mr Miller made it clear at the outset of his submissions that he accepted that that the appellant’s breaches of the interim conditions on his registration amounted to serious professional misconduct. The question to which he addressed his argument was whether the same could be said of his conduct in relation to the massages. He submitted that it could not, when proper regard was had to the state of the evidence.
14. Much of the evidence was taken up with the patient’s allegations that the massages which the appellant performed on 20 and 27 November 1996 involved intimate touching and with the allegation that on 27 November 1996 he had had sexual intercourse with her. That evidence must now be left out of account, as the Committee found that those allegations had not been proved. The respondent’s expert witness, Professor Carolyn Quadrio, had prepared a psychiatric report in which she expressed the opinion that the appellant’s conduct fell seriously short of the accepted standards of practice in 1996 in Australia. Her report gave an account of an interview with the patient in November 1998, during which the patient gave a detailed account of herself, her background and her relationship with the appellant. Professor Quadrio’s opinion and conclusions were based to a large extent on the patient’s account of the physical contact which the appellant had had with her. In view of the Committee’s finding that it had not been proved that the appellant touched the patient intimately or had sexual intercourse with her, as the patient alleged in her evidence to the Committee, that part of Professor Quadrio’s evidence too must now be left out of account.
15. The question whether the Committee’s finding that the massages were inappropriate, contrary to the patient’s best interests and an abuse of his professional position was justified must be approached on the assumption that at no time did the appellant touch her intimately and that his treatment of her was entirely devoid of any sexual element on his part. The appellant’s case was that his decision to perform the massages was taken solely on professional grounds and that they were carried out in circumstances which provided adequate safeguards. Their Lordships note that there was no evidence that the patient suffered any physical or psychological harm as a result of the massages.
16. That having been said, there remain in the undisputed material which was before the Committee these significant facts. The patient had a history of childhood sexual abuse and of depression following a miscarriage which was exacerbated by the deaths of her mother and mother-in-law. The appellant was fully aware of this background (day 2/72-73). His own assessment of her was that she was clinically depressed and had a panic disorder when she first consulted him. The Committee was entitled to conclude from the evidence that she had become increasingly dependent upon him as her psychiatrist, and that in the light of her past history and background she was extremely vulnerable when he suggested the possibility of treatment by way of massage as a means of relieving her anxiety. According to his own description of what took place (day 2/56-57), each of the massages lasted for half an hour. They were performed under towels on a massage table in his consulting room. The only clothing which the patient had on was her knickers. He was dressed in shorts and a T shirt. The door was ajar and the appellant’s wife was sitting in an adjoining reception room. But no-one else was present with the patient in the consulting room when the appellant was massaging her.
17. Among the ethical guidelines issued by the Royal Australian and New Zealand College of Psychiatrists is ethical guideline 8, which is entitled “Sexual relationships with patients”. Paragraph 4 of this Guideline, in the wording which was approved for circulation in August 1990, states:

“Sexual relationships between current patients and their psychiatrists are never acceptable and constitute unethical behaviour. The term ‘sexual relationship’ is not restricted to sexual intercourse. In this guideline, sexual relationship includes: any form of physical contact, whether initiated by the patient or the psychiatrist, which has as its purpose some form of sexual gratification, or which might reasonably be construed by the patient as having that purpose.”

The appellant told the Committee that he was aware of these guidelines.
18. At the end of her report Professor Quadrio said that, if the contact had gone no further than massage with the patient undressed and the psychiatrist partly undressed, this would be totally unacceptable to the appellant’s peers in Australia in 1996. In her evidence to the Committee (day 2/4) she said that even if massage of the patient was purely for the release of tension or stress it would not be appropriate. This was because of the nature of the relationship between the patient and the psychiatrist. That kind of physical touch was likely to arouse very complicated feelings in the patient which would be very likely to be sexualised by her even if the practitioner had no intention to sexualise the contact. She said (day 2/25) that it would very rarely be wise for a psychiatrist to provide massage to a patient for therapeutic purposes. In the case of someone with the patient’s kind of background there would be no basis on which it would be a wise decision. The appellant did not lead any independent expert evidence.
19. Their Lordships are in no doubt that the Committee were entitled to conclude in the light of this evidence that the appellant’s conduct was inappropriate and contrary to the patient’s best interests, and that it was an abuse of his professional position. As the Chairman made clear in the reasons which he gave for the Committee’s determination, the case against the appellant has to be judged in the light of the patient’s background and her relationship with him when the massages were being performed. There was ample evidence to support the Committee’s findings that at the time she was extremely vulnerable, emotional and highly dependent on him. In the light of those findings, the Committee were entitled to hold that for the appellant to have physical contact with her for sustained periods while performing the massages was a breach of trust and highly unethical. The argument that their determination was wrong and against the weight of the evidence must be rejected.
Disclosure of the proceedings in Australia
20. The allegations that the appellant had breached the interim conditions which had been imposed on his registration were not drawn to the attention of the Committee until it had made its determination as to which parts of the charge had been proved to its satisfaction. It was at this stage that counsel for the respondent mentioned, in the course of her submissions under rule 28 of the Procedure Rules, that the Medical Board of the Northern Territory in Australia had found it proved on a balance of probabilities that the appellant had sexual intercourse with the patient on 27 November 1996. The appellant submits that this disclosure was prejudicial and unfair as the information had no probative value and it carried the risk of influencing the Committee in its choice of sanction.
21. There is no doubt that the allegations that the appellant had breached the interim conditions were relevant to his character and to the question whether, taking all the circumstances into account, he was guilty of serious professional misconduct. Mr Miller did not suggest otherwise. Nor has it been suggested that it was inappropriate for counsel for the respondent to tell the Committee that the appellant had been found guilty of unprofessional conduct in the disciplinary proceedings relating to his conduct with the patient which were taken against him in Australia. It was common ground that the findings of the Medical Board of the Northern Territory in Australia were part of the evidence which was put before the Preliminary Proceedings Committee and the Interim Orders Committee when they decided to impose interim conditions on his registration in this country. A reference to these findings in general terms by way of background information would have been unexceptionable.
22. The complaint is directed to the fact that, in the course of this disclosure, the Committee was told that the appellant had been found guilty in Australia of the most serious part of the charge before the Committee on a balance of probabilities which, applying the higher standard which requires to be satisfied in this country, the Committee itself had found not to have been proved. It is the imparting of this particular piece of information, which was in conflict with the Committee’s own finding, that is said to have been objectionable.
23. Their Lordships can well understand why counsel thought it appropriate to bring this matter to the attention of the Committee. By this stage the Committee was ware that the appellant’s registration in Australia had been cancelled, and it was in the appellant’s interest that it should be told the facts. This enabled him to argue that, as the sexual element had not be established against him in these proceedings, a sanction less than erasure was appropriate. These considerations do not however, in themselves, remove all force from the objection. It was of course not open to the Committee to alter its findings as to the parts of the charge which had been proved. They had already been announced. But the important question whether the appellant had been guilty of serious professional misconduct still had to be determined, and the question of sanction also was still in issue. The appellant was entitled to a fair trial on these issues by a tribunal which was impartial. There is no hint in the reasons which the Chairman gave for the Committee’s determination that it had regard in any way to the disclosure about the findings of the Medical Board in Australia. But the matter does not end there. The question is whether, looking at the matter objectively, there is a real possibility that the Committee’s decision on these issues was influenced by the disclosure to the appellant’s prejudice.
24. Their Lordships have had regard to the following points in their consideration as to how this question should be answered. Counsel for the General Medical Council was careful to tell the Committee that the decision by the Medical Board in Australia had been reached by applying the lower standard of proof. This shows that she was anxious to put the disclosure into its proper context. There can be no doubt that the Committee would have understood the point she was making. It had already been told by the Legal Assessor that the higher standard was the one that had to be applied in this case. The Chairman referred to this when he was announcing the Committee’s findings (day 4/32). Then there is the way the Chairman dealt with the matter when it was raised again during the next stage of the hearing. When he was addressing the Committee in mitigation the appellant sought to rely on what had happened in Australia as an excuse for his failure to notify his employers in this country of the matters which had been referred for inquiry by the Professional Conduct Committee. The Chairman intervened during these submissions on two occasions. On the first occasion (day 5/27) he said:

“I will interrupt you. We are not going into the matter of Australia. That is something that it outside our consideration today. It is not something we are really taking into account. I do not think it is relevant to what we consider.”

On the second occasion (day 5/ 28) he said:

“You are going into the Australian matter which we do not want to hear about.”

25. These interventions show that the Chairman was well aware that the findings by the Medical Board of the Northern Territory in Australia had no bearing on the issues which the Committee still had to decide. His intervention made it clear to the Committee, if any reminder was needed, that it had to approach the remaining issues on the basis of its own findings of fact. In these circumstances their Lordships are satisfied that there is no real possibility that the Committee was influenced in its determination of these issues by what it was told about the findings of the Medical Board of the Northern Territory in Australia. In their judgment the appellant was not prejudiced by the disclosure.
The sanction
26. Mr Miller submitted that in all the circumstances the sanction ought properly to have been confined to a reprimand or a period of suspension from practice. He pointed out that prior to the events which gave rise to these proceedings the appellant had for 40 years led an unblemished career in Australia. In the course of that career he had practised for 25 years as senior psychiatrist in one of the world’s largest maternity hospitals. During all that time there had never been any suggestion against him of incompetence or sexual impropriety. The appellant told the Committee that as a result of the findings in Australia he had been ruined financially, socially and professionally. He said that he wished to be allowed to make a fresh start, on the clear understanding that he would never ever do massage again.
27. On the other hand, as the Chairman pointed out when he was giving the Committee’s reasons for its determination, the appellant’s unprofessional conduct in Australia was compounded by the fact that he repeatedly and intentionally flouted the conditions which had been attached to his registration in this country. Mr Miller said that the appellant had not found it possible to abide by these conditions which he regarded as unrealistic and that there was also a shortage of qualified persons to act as chaperone. But the Committee was of the opinion that he had acted in a profoundly dishonest manner which reflected a serious departure from the basic principles of medical practice. In its view a suspension from practice would not serve the public interest.
28. Their Lordships appreciate that, having regard to his age, it would not be realistic to expect the appellant’s name ever to be restored to the register in the event of its erasure. In the appellant’s case the effect of the Committee’s order is that his erasure is for life. But it has been said many times that the Professional Conduct Committee is the body which is best equipped to determine questions as to the sanction that should be imposed in the public interest for serious professional misconduct. This is because the assessment of the seriousness of the misconduct is essentially a matter for the Committee in the light of its experience. It is the body which is best qualified to judge what measures are required to maintain the standards and reputation of the profession.
29. That is not to say that their Lordships may not intervene if there are good grounds for doing so. But in this case their Lordships are satisfied that there are no such grounds. This was a case of such a grave nature that a finding that the appellant was unfit to practise was inevitable. The Committee was entitled to give greater weight to the public interest and to the need to maintain public confidence in the profession than to the consequences to the appellant of the imposition of the penalty. Their Lordships are quite unable to say that the sanction of erasure which the Committee decided to impose in this case, while undoubtedly severe, was wrong or unjustified.
Conclusion
30. For these reasons their Lordships will humbly advise Her Majesty that the appeal should be dismissed. The appellant must pay the costs of the proceedings before their Lordships’ Board.