Court allows for conditional registration of doctors

The Medical Council is entitled to propose the attachment of conditions, subject to court approval, on the retention of a doctor's name on the General Register of Medical Practitioners - even where that doctor has not been found guilty of professional misconduct, the High Court found yesterday.

Mr Justice Kelly rejected a challenge by Dr Richard Casey, of Mount Merrion Avenue, Black rock, Co Dublin, to the Medical Council's proposal to attach conditions to the retention of his name on the register and awarded costs against the doctor, who has 21 days in which to apply to the High Court for cancellation of the council's decision last December.

The judge said the case raised questions about the powers of the council under part five of the Medical Practitioners Act 1978. The answers "have implications for every member of the medical profession who may be the subject of an investigation on foot of a complaint of professional misconduct or an allegation of unfitness to practise medicine".

The case arose from a complaint to the council by a patient who attended Dr Casey at a clinic in October 1996. Five allegations of misconduct were made - that Dr Casey failed to apply standards of clinical judgment and competence required of a person in his position; to treat the patient with dignity and respect due to her; to communicate adequately; that he brought the profession into disrepute and acted in a manner derogatory to the profession.

The Fitness to Practise Committee of the council found there was insufficient evidence to find Dr Casey guilty of professional misconduct. It "strongly advised" him to avail of continuing medical education and continuing professional development courses in general practice, to keep more comprehensive clinical notes and to attend a course in communication skills which "could be advantageous to him in dealing with problems which arise in modern general practice".

The committee said Dr Casey, if in doubt, should consider the presence of a "chaperone" when dealing with patients.

Later Dr Casey was asked to appear before the council, which advised him to attend a course in communications skills and to study a guide to ethical conduct and behaviour in relation to his professional conduct. The council also proposed to attach conditions, subject to court approval, to the retention of Dr Casey's name on the register. These included the doctor completing a recognised course in general practice and family planning and maintaining adequate clinical records.

The council said its decisions were because of the concern of the committee and the council "about aspects of your care for patients, having regard to the evidence presented". In judicial review proceedings, Dr Casey argued it was the end of the matter once the committee had acquitted him of professional misconduct. He claimed its advice to him had no binding or legal effect.

In his reserved judgment yesterday, Mr Justice Kelly said the principal question was whether sections 47 and 48 of the Act (which provide that the council may attach conditions to the retention of a practitioner's name in the register and advise, admonish or censure on professional conduct) might be applied in the absence of a finding of guilt of professional misconduct.

Neither section required an adverse finding by the committee on the conduct of a practitioner before they were acted upon by the council. All that was required for the council was that there should have been an inquiry and a report made by the committee. Once that was done, the council was entitled to attach conditions to the retention of the person on the medical register or to advise, admonish and censure them.

The judge also rejected Dr Casey's claim that by using sections 47 and 48 of the Act, the council was effectively reversing the finding of the committee that there was no evidence of professional misconduct by Dr Casey.