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Do professionals have to comply with UK Regulator's standards when overseas?




Sastry v General Medical Council [2019] EWHC 390 (Admin)It is not unusual for a healthcare professional to practise in multiple countries over the course of their careers, however standards of care

Sastry v General Medical Council [2019] EWHC 390 (Admin)

It is not unusual for a healthcare professional to practise in multiple countries over the course of their careers, however standards of care and expectations of professionals can differ significantly between jurisdictions. This case explored whether a doctor would be expected to comply with GMC standards while practising overseas.

S was a GMC registered consultant oncologist. While the index incident took place in India, both before and after the incident he had practised in the UK and had maintained his GMC registration throughout. The allegations related to his treatment of a patient with lymphoma in Mumbai in 2014; S had undertaken a form of autologous cell transplant with allegedly too few stems cells. This resulted in the patient's death shortly after. The patient's son complained about his mother's treatment, resulting in the Medical Practitioners Tribunal Service (MPTS) deciding to erase S from the register.

On appeal, S argued that the MPTS had had no or insufficient regard to the fact that the incident had taken place in India; the MPTS had relied on expert evidence from the UK that S' actions amounted to misconduct, but there were no relevant guidelines in India that could be applied. The GMC's own guidelines stated that "doctors who work wholly outside the UK must abide by whatever regulatory requirements exist in the country in which they practise." However, the MPTS had not taken account of this and had not sought evidence on how such a treatment would be provided in India.

However, the High Court found that the principles of Good Medical Practice, the GMC's key guidance, were sufficiently high level that they could be adapted to apply to practice in another country. While the MPTS would need to take any local limitations or practices into context, it must apply UK professional standards when considering the conduct of a registrant. In this case the expert evidence had not focussed on S failing to meet UK guidelines on such transplants, but on the appropriateness of his actions more broadly. Furthermore, the MPTS' decision had in part been based on S' oral evidence, which it had found to be evasive and unreliable; this was not affected by the index events taking place in India.

With regard to the lack of evidence on the "Indian context" (as described by S' counsel), the High Court referred to R (Johnson) v NMC [2008] EWHC 885 which found that there was no independent duty of the regulator to gather evidence, providing that the registrant had a fair hearing based on all the facts of the case. In this case, the GMC's position had been that the doctor was required to meet the GMC's standards, rather than those for Indian doctors. In any event S had had the opportunity to provide evidence on the "Indian context"; he had obtained expert evidence from a consultant in India, but the MPTS had placed no weight on this evidence as the expert had not been reliable on the basis that he was "neither an independent, nor impartial expert witness".

It is unusual for a UK regulator to bring proceedings relating to acts which take place entirely overseas. However professionals and those employing them should note that their actions overseas could affect their UK registration. This may be particularly relevant for professionals working for multinational companies who may be required to practise overseas, or those involved in health tourism or in relatively unregulated jurisdictions who maintain UK registration for quality assurance/marketing purposes who work entirely outside the UK.

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