GDC Watch Spring: Convictions.
by Victoria Holden
It would be fair to say that the recent erasure of Dr Hadiza Bawa-Garba from the medical register following a High Court challenge by the GMC against the MPTS decision to suspend her, has sparked outrage in the medical and dental professions. As someone who closely follows Fitness to Practise matters I was especially intrigued for reasons I shall explain in this article. Being convicted of a criminal offence, or accepting a caution brings with it a means by which a registrant will normally automatically face an allegation of impairment.  However, it is not for a Practice Committee to challenge the conviction or caution, or to punish a registrant again. In that sense, it is important to bear in mind the difference between a sentence and a sanction.  One is intended to punish the perpetrator for a crime committed in the past, whilst a sanction is intended to protect the public in the future. The GDC Indicative Sanctions Guidance explains to the Practice Committees how they should consider convictions and cautions, and reminds the PCC that it must give due consideration to the GDC guidance and standards which oblige registrants to maintain appropriate standards of personal and professional behaviour.  On the matter of cases involving serious sexual misconduct, for example, involvement in child pornography, the GDC PCC are advised that they may reasonably consider that erasure is the appropriate sanction. GDC FtP hearings duly demonstrate this principle is followed without exception, and there is a legal precedent established in the case CRHP v GDC & Fleischmann (the background was a conviction relating to distribution of indecent photographs of children) that a disciplinary sanction should not, as a rule, be less than a criminal sentence.   Bearing the GDC position in mind, and the gravity of child pornography offences both in terms of the moral reprehensibility and breach of public trust and confidence, it would be safe to assume that the GMC adopt the same principles.  
Except it would appear that they do not.  Incredibly, doctors convicted of child pornography offences are not automatically facing erasure from the medical register.  A paper in the Medico-Legal Journal written by Professor Kevin Dalton who is a Consultant obstetrician and gynaecologist as well as a Professor of Law looked closely at how doctors who had been convicted of child pornography offences were dealt with in GMP FtP proceedings.  Between the period of June 2003 and January 2006, 27 medical doctors were involved in Fitness to Practice hearings relating to their convictions.  In these 27 cases, the decision was erasure in 16 cases, suspension in 10 cases and conditions in 1 case.  Where the doctor was not present or represented which was in 13 of the cases, they were always erased.  By contrast, if the doctor was present or was represented, which was the other 14 cases, in only 3 cases were they erased.  Therefore – if they were neither present or represented at their disciplinary hearing they were 100% certain to be erased, and if they turned up or were at least represented there was only a 20% chance of being erased.  So 80% of doctors convicted of child pornography offences were considered fit to practise if they turned up and were represented. But that was pre-Shipman way back in 2003-2006 I hear you thinking, and haven’t times have changed and things have moved on since the introduction of the MPTS?  Well, actually, it appears that they have not changed very much at all, and may even have got somewhat more relaxed for our medical colleagues. A recent paper written in 2017  by John Martyn Chamberlain, a highly regarded Medical Criminologist at Cardiff University, looked at MPTS FtP decisions between 2005 and 2015 (the period before the GMC acquired the right to challenge the MPTS decisions) for doctors convicted of a wide range of offences criminal offences including dangerous driving, motoring offences, serious violence, sex offences, rape, possession of images of a child, sexual abuse, manslaughter, murder, domestic violence, fraud, drug offences, criminal damage, or other disorder offences. In this 10-year period there were 1,317 doctors convicted of 1,359 offences.  The 1,317 doctors represented 0.5% of the number of doctors on the register in 2015 (n273,761). During this time 2 doctors were erased for having a criminal conviction and these were for fraud, rather than murder, manslaughter or child pornography offences. So what about dental professionals? 
I approached the GDC by means of an FOI to ask for their figures for the same set of convictions over the same time period.  They were able to supply me with 5 year’s-worth of data for 2012-2016 within the funding limit applied to FOI requests, which is £450 and the equivalent of 18 hours of GDC-employee work.  This revealed the following information:
  • In 2015 there were approximately 112,000 dental registrants on the GDC register (around 41k dentists and 71k DCPs).
  • In total 930 dental registrants had cases considered which involved the convictions as listed above. As some of the cases involved more than one conviction there were 988 ‘considerations’ in that period.
  • Assuming this means that  930 dental registrants were convicted of 988 offences then by the same calculation as above, approximately 0.8% of dental registrants were convicted of offences.  Clearly, dental registrants are naughtier than the doctors.
  • 28 dental registrants were erased relating to a conviction in the 5-year period the GDC provided data for.
  • The convictions resulting in erasure involved child pornography images (n2), violence (n7), fraud and forgery (n12), theft and handling stolen goods (n3), drug offences (n4).
My grasp of statistics never was, and never will be, good enough to win me a Maths prize, but something appears to me to be way out of kilter here.  On the very basic assumption that doubling the years equates to doubling the numbers, then 56 dental-registrant erasures compared to 2-medical registrant erasures on the basis of having a conviction seems disproportionate in the extreme.  

It was reassuring to know that murdering someone, or being convicted of manslaughter would not see you erased from either register at least.  Unless you are Dr Hadiza Bawa-Garda, and I will leave you to draw your own conclusions as to the reasons that may lie behind that one.  Victoria Holden BDS  MFGDP(UK) DipImpDent RCS(Eng) (Adv Cert) FFGDP(UK) LLM General Dental Practitioner and Senior Dental Advisor at Taylor Defence Services References: 1. Dalton K, ‘What happens to medical doctors who are involved in child pornography?  A Case-based Transatlantic Overview’ [2006] MLJ Vol. 74(3) 114-123 2.  Chamberlain JM (2017) Doctoring with Conviction: Criminal Records and the Medical Profession. Brit. J Criminol.  doi:10.1093/bjc/azx016

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