Amitabh Kumar v General Medical Council

A. Introduction

1. Dr Amitabh Kumar challenges the decision, made by the Medical Practitioners’ Tribunal (“the Tribunal”) on 1 April 2025, that his name be erased from the register of medical practitioners (“the Register”).

2. Dr Kumar first registered with the GMC on 22 August 2013. He had qualified as a doctor in 1996 after training at King George’s Medical College in Lucknow, India. On 15 August 2014 Dr Kumar was convicted, following a guilty plea, of a sexual assault on 15-year-old girl contrary to section 3 of the Sexual Offences Act 2003 . The events leading to that conviction had taken place 18 April 2014, on a bus, when Dr Kumar touched the neck and hair of a 15-year-old girl passenger and used his foot to rub her leg. He was sentenced to a community punishment and placed on the Sex Offenders Register for 5 years. In July 2015 Dr Kumar’s case was considered at a hearing of the Fitness to Practise Panel of the GMC (“the Panel”). The Panel concluded that Dr Kumar’s fitness to practise was impaired both by reason of the conviction and because he had failed to report that conviction to the GMC. The Panel decided that Dr Kumar’s registration should be suspended for 12 months.

3. Dr Kumar has remained on suspension ever since. The decision to suspend has been reviewed on a number of occasions. First, at hearings: in July 2017 where the suspension was extended for 9 months; in May 2018 when a further suspension period of 8 months was imposed; at a hearing in January and March 2019 which resulted the suspension being extended by 8 months; and then in September 2019 when the suspension was extended for another 12 months.

4. The hearing in September 2019 was the last time before April 2025 that Dr Kumar’s position was considered at a hearing. Between 2019 and 2025 the suspension was continued after consideration at what are referred to as a “Review on the Papers” (“ROP”). Rule 21B of the GMC’s Fitness to Practise Rules provides as follows: “ 21B. Review on the papers (1) A matter must be considered on the papers where it has been referred to the MPTS for them to arrange for it to be considered by a Medical Practitioners Tribunal at a review hearing and the MPTS receives confirmation in writing from the practitioner and the Registrar that the parties agree to the terms of a direction, revocation or variation which that Tribunal could make under section 35D(5), (6), (8), (10) or (12) of the Act . (2) Consideration on the papers under paragraph (1) may be carried out by the Chair of the Medical Practitioners Tribunal, or the Tribunal itself. (3) Where the Chair of the Medical Practitioners Tribunal or the Tribunal itself determines that the Tribunal should hold a hearing to consider the matter and the MPTS arrange a hearing for that purpose in accordance with section 35D(13), the other provisions of this Part are to apply for the purposes of that hearing.” In this case, ROPs took place in August 2020 (resulting in extension of the suspension for 12 months); August 2021 (a further 12 months extension); August 2022 (another extension for 12 months); July 2023 (an extension of 9 months); and May 2024 (a further extension of the suspension for 9 months). A more detailed narrative of what happened on these occasions, starting with the 2015 hearing is set out in the Tribunal’s decision under challenge in these proceedings. That decision is annexed to this judgment. (1) The 2025 review process

5. The matter of Dr Kumar’s suspension then came for consideration at the end 2024. On 5 November 2024 the GMC wrote to Dr Kumar informing him that a review hearing would take place on 28 February 2025. The letter requested Dr Kumar provide evidence on various matters, all concerning what he had done since the last review had taken place. The letter then referred to the possibility that the matter might be considered at an ROP, and asked for the information requested to be provided by 26 November 2024 so that a decision could be made on whether review on the papers was the appropriate course.

6. Dr Kumar responded, by email dated 18 November 2024, as follows: “With reference to your letter of 05 November 2024, I submit the following. That, I have recently undergone intensive therapy for Post Traumatic Stress Disorder during the past couple of months. However, as can sometimes be the case, this therapy has itself acted as a trigger further worsening my mental health. Consequently I am currently awaiting further counselling, which is unlikely to commence before another couple of months as intimated by my previous therapist. In view of the facts and circumstances stated herein above, I submit that I am currently not in the right shape mentally to undertake any kind of clinical training, education and/or attachment and therefore, as a matter of priority, to concentrate on my overall health and wellbeing, I am herein proposing for my suspension to be further extended by another 12 months. I humbly request that my proposal may kindly be accepted and my upcoming MPTS review may please be conducted on paper, thus sparing me additional stress at this difficult time.” [sic] No documents appear to have been provided by Dr Kumar with that email.

7. On 9 December 2024 the GMC replied as follows: “Thanks, for your email. I’m sorry to hear that your mental health has been triggered. An assistant registrar has considered your request for a review on papers. They have decided that as you have been suspended for consecutive periods since 2016 and haven’t been able to provide the necessary evidence that you have kept your skills up to date and that your return to unrestricted practice wouldn’t put patient safety at risk, that your case should be reviewed at an oral hearing, rather than on papers.” The reasons for this decision were stated in an email dated 18 December 2024, sent by the GMC sent after Dr Kumar had asked that the Assistant Registrar’s reasons be given. “ Reasons for decision Dr Kumar has been suspended for consecutive periods since 2016. He has unable to provide the information set out by the AR in directing a further review of the case (evidence that he has kept his skills up to date and that his return to unrestricted practice won’t put patient safety at risk). Whilst Dr Kumar has indicated a further period of suspension is preferable and has requested a review on the papers with this in mind, considering the matter at an oral hearing would enable us to keep alternative sanctions in mind, given the lack of progress or remediation to date.”

8. The review hearing commenced on 28 February 2025 and was listed for a day. Dr Kumar attended by video link (at his own request). At the beginning of the afternoon session the video connection failed and at that time the hearing was adjourned (see the decision to this effect at Annex B to the Tribunal’s decision). However, by the time the hearing had to be adjourned, the Tribunal had taken the opportunity to hear submissions on the fitness to practise issue and to consider a witness statement dated 27 February 2025 made by Dr Kumar for the review hearing. So far as concerns the former, Dr Kumar accepted that his fitness to practise remained impaired. So far as concerns the latter, the thrust of Dr Kumar’s evidence in the witness statement was that his conviction in 2014 had a been a wrongful conviction, based on evidence that was either false or had been manufactured. The statement also set out Dr Kumar’s views about the 2025 review hearing. “I have experienced far too many lying PCs and KCs, in my over 10 years experience of first hand dealings with the Legal Justice system, to believe in the integrity and sanctity of the "Rule of Law" doctrine. In my evidence based opinion there is no "Rule of Law", only rule of lawyers, sitting on prosecution and/or persecution (as in my case), and defence and/or defeat (as in my case again) as also, sitting on Judgement. A lack of integrity among lawyers has come to the fore following the Post Office Public Inquiry … Fast forward more than a decade, over to this Review Hearing and the same applies, as the prosecuting (persecuting, in my opinion) General Medical Council are happy to turn a blind eye to the wilful lack of sight displayed by their unnamed assistant registrar, who blatantly and wilfully turned a blind eye to the sensitive disclosure of my poor mental health and yet at the same time, have the audacity to question my insight. Due process placed the unnamed GMC assistant registrar under a bounden duty to approach decision making impartially, with an open mind (and with open eyes, as a prerequisite to an open mind) taking into account all the facts before them and considering all lines of inquiry. Instead, this unnamed GMC AR replaced this duty of due diligence with undue negligence, by wilfully turning a blind eye to significant disclosure of my poor mental health, (coming from a doctor belonging to South Asian community about which numerous news articles have gone on to highlight the stigma associated with mental illnesses, within the community). In their excessive zeal to haul me before a Tribunal, this unnamed GMC AR has abused his authority and due process, to mete out cruel, inhumane, insensitive and degrading treatment under the guise of exercising their decision making powers.. This Review Hearing is founded on the unnamed GMC AR’s wilfully blind decision making. The fact of a Review Hearing panel founded on the AR’s wilfully blind decision making, claiming a lack of jurisdiction in challenging the AR’s wilfully blind decision making, renders the GMC AR completely unaccountable for their actions. What this means is that the unnamed GMC AR is above any law and a law unto themselves. As far as I understand there is no legal basis for the alleged immunity from scrutiny of this unnamed GMC AR's actions, who purportedly exercises their decision making powers in public interest. This very premise besides being legally untenable also renders this entire Review Hearing into an unjust, abuse of process, where those who enrich themselves (as in being financially remunerated for their attendance at this Review Hearing) on the basis of this GMC AR’s wilfully blind decision making are now sitting in Judgement on my future and yet claim to have no jurisdiction over this AR, against whose unlawful, cruel, inhumane and degrading actions I have no legal remedies or recourse, other than to endure these farcical proceedings, despite my poor mental health. The prejudice and predetermination underlying this Review Hearing is further highlighted by its perhaps "all female and all White" composition (my inference is based on the names of the Review Hearing panelists and therefore not conclusive), designed to create a discriminatory and hostile environment during the said Hearing, to facilitate the predetermined outcome of my erasure. In my over 10 years experience of attending MPTS hearings, I cannot recall a single all female and all White panel, before. And with all due respect to my Black and/or Muslim colleagues, I cannot shy away from recording my perception and objection that, had I belonged to any of the said groupings, the MPTS and/or GMC would have thought a hundred times before constituting a sanitised panel such as this one, where not a single Panelist is male or non- White, just to preempt any potential allegations of discrimination or racism. As it is, I am neither Black nor Muslim and hence, the softest of targets to be targeted by this sanitised panel. Again, apart from this Review Hearing lacking any semblance of legal independence due to the absence of an independent legal advisor, there is also a self-evident and clear conflict of interest with the General Medical Council, as the actions of one of the panelist designated as Registrant, are under the direct control and scrutiny of the General Medical Council, the prosecuting party. Essentially, the bottom line as I see it is that any action following the wilfully blind decision making of the unnamed GMC AR is prejudiced, farcical and legally untenable and regardless of the opinion of those who stand to gain from the perpetuation of these prejudiced and legally untenable proceedings, it is my duty to point out the extremely prejudiced, biased and legally untenable nature of these proceedings, especially given the unusually sanitised all female and all White composition of the Review Hearing panel, with all due respect for the panelists. The reason I am participating in these prejudiced and legally untenable proceedings is to not provide the panel with any excuse of my non compliance/non-engagement and non participation, whilst reiterating that my participation in these proceedings is without prejudice to my Legal Rights and/or any Legal Remedies available to me.” [sic]

9. The Tribunal’s decision on the fitness to practise issue (i.e. whether Dr Kumar’s fitness to practise continued to be impaired), was as follows: “31. The Tribunal bore in mind the tone and content of the witness statement provided by Dr Kumar dated 27 February 2025, in which his opening words were ‘this farce began…’, and in which he described his conviction as a “wrongful arrest” and that it was a “perversion of course of justice”. He also criticised the victim of his sexual assault, as well as the Police, GMC and MPTS within this statement. The Tribunal was concerned that Dr Kumar’s witness statement was indictive that his insight was deteriorating, instead of developing. Indeed, the Tribunal considered that Dr Kumar had little understanding of the gravity of the offence and the impact it had on the victim and the wider medical profession. The Tribunal considered that Dr Kumar does not have sufficient insight into the relevant matters.

32. The Tribunal considered the matter, prosecuted by Mersey Rail, for which a Statutory Declaration was subsequently made. It acknowledged that that this is not evidence of any further conviction and therefore it placed no weight on it.

33. The Tribunal also took into account that there was very limited evidence before it to demonstrate that Dr Kumar has taken any steps to remediate or reflect on his misconduct. There is also limited information before it and no documentary evidence to demonstrate that Dr Kumar has kept his clinical skills and knowledge up to date.

34. This Tribunal has therefore determined that Dr Kumar’s fitness to practise is impaired by reason of misconduct.”

10. The hearing resumed on 1 April 2025 when the Tribunal considered the question of sanction. Dr Kumar did not attend the hearing on 1 April 2025. He had been notified of the date of the resumed hearing and had been sent a video link so that he could, once again, attend the hearing remotely. Early in the morning on 1 April 2025 Dr Kumar sent an email to the Tribunal saying that he would not be attending the hearing. He did, however, (with that email) provide a further witness statement. In that witness statement Dr Kumar said that he had decided not to attend the resumed hearing because of the “hostile and demeaning” conduct of counsel who had appeared for the GMC during the first part of the hearing on 28 February 2025.

11. The Tribunal accepted the witness statement sent on 1 April 2025 as further evidence from Dr Kumar and considered it accordingly. The statement referred again to the 2014 conviction. Dr Kumar said that the evidence provided by the complainant at that time did not support the complaint made; he said the police falsified the date of his interview to make it appear that he had been interviewed after the complaint and other witnesses when in fact he had been interviewed first; he asserted that the police who had conducted the investigation had perverted the course of justice and had discriminated against him on grounds of his race. Dr Kumar denied having committed the offence to which he had pleaded guilty.

12. In this statement, Dr Kumar was also critical of the decision to consider the review of the suspension at a hearing rather than by an ROP. Dr Kumar stated the decision to proceed at a hearing was wrong and had been made negligently. He was also critical of the Tribunal. “11. Unfortunately, I no longer have any reason to believe the integrity of this highly sanitised, discriminatory and prejudiced Tribunal panel whose sole purpose appears to be to reach a predetermined outcome, under a predetermined agenda. As it is, the fact is that this Panel and all of the other MPTS Tribunal hearings are financed by the GMC and have the conflicting presence of a GMC registrant within the panel, who remains under the regulatory control of the General Medical Council, potentially contaminating its purported independence even further.

12. The fact that the Tribunal resorted to cherry picking from my scanty evidence, as is self-evident from the attached transcript, is clear evidence of prejudice and a closed mind-set on the Tribunal’s part, working on confirmation bias to find evidence which confirms its biases and suits its predetermined agenda of reaching a pre-determined conclusion and/or outcome.” The statement also addressed the issue of his insight into his misconduct. One part of the statement on this point was as follows: “15. A natural function of insight development is its evolution over time, given the benefit of what is also termed as hindsight, and hindsight is never referred to in pejorative terms as deteriorating insight. At the current time, without being unduly influenced and manipulated by my manipulative defending (actually defeating) lawyer, I can independently decide for myself, and after 10 years of evolution of insight via benefit of hindsight, I’ve reached the evidence based conclusion, that the crime as alleged by the witnesses, was fundamental impossible of occurring. …

18. As for my insight, which another unbiased (or certainly less biased Tribunal) MPTS RH panel (of 25th/26th July 2017), held as demonstrated exceptional insight. Now, this exceptional insight has further evolved over time and with benefit of hindsight. However, this evolution is now being portrayed and labelled by your Tribunal as deterioration of my insight and the only possible way to reconcile and align my once exceptional insight to this evidence cherrypicking Tribunal’s insight, is to once again believe and accept the fundamentally impossible proposition of the occurrence of this offense, a course of action I am no longer able to pursue, as it is my duty to uphold my dignity, sanity and integrity by not engaging with this farce and being bullied and coerced into accepting the possibility of occurrence of a fundamentally impossible offence, as per factual evidential statements provided by the West Yorkshire Police. I am sorry, I am no longer able to follow this course of action, in order to align my insight to the insight of a Tribunal, which is wilfully ignoring and cherry picking evidence to suit its predetermined objective(s) and outcome(s).”

13. The Tribunal’s conclusion on sanction was explained in detail from paragraph 49 of its decision. The Tribunal identified three aggravating considerations. “51. The Tribunal consider the following to be aggravating features of Dr Kumar’s case: • Dr Kumar’s persistent lack of insight which has deteriorated over time; • The significant passage of time Dr Kumar has had to develop insight and remediate his misconduct; • The deterioration of Dr Kumar’s clinical skills during the 10-year period he has been suspended and the 15 years that he not practised in a clinical role.” The Tribunal then considered whether the health issues Dr Kumar had referred to in his evidence, could be mitigating, but concluded that little weight should attach to this because Dr Kumar had not provided medical evidence to support this contention.

14. Next, the Tribunal considered the range of sanctions open to it, starting with the least severe course available. In this part of its decision the Tribunal considered whether Dr Kumar’s suspension should continue. It decided against that course. “62. The Tribunal considered that Dr Kumar has not even attempted to maintain clinical knowledge through online CPD or courses and has not acted upon any of the recommendations made by previous Tribunals for example to contact his local Deanery to seek a clinical attachment. The Tribunal has noted that there has been sufficient time since the ending of the Sex Offenders Registration notification and ceasing of covid restrictions to enable Dr Kumar to engage with these recommendations.

63. The Tribunal considered that when taking into account the deterioration of Dr Kumar’s clinical skills and knowledge and his persistent lack of insight and failure to remediate the concerns surrounding his practice, all three limbs of the overarching objective were engaged in this case.

64. The Tribunal was of the view that imposing a further sanction of suspension on Dr Kumar’s registration is unlikely to produce a different outcome at this stage of the ongoing regulatory proceedings particularly given that the original suspension was imposed ten years ago, with little evidence of positive change throughout that lengthy period of time.

65. The Tribunal considered that Dr Kumar has a duty to attempt to remediate his misconduct and adhere to the principles set out in GMP. The Tribunal determined that he has continuously failed to do so and accordingly, it cannot be satisfied that Dr Kumar would avail of a further period of suspension to remediate and become safe to look after patients.

66. Therefore, the Tribunal concluded that a period of suspension would not be appropriate to sufficiently maintain and uphold proper professional standards and protect the public confidence in the profession.”

15. The Tribunal’s conclusion was that Dr Kumar should be erased from the Register. The Tribunal referred to the material parts of the GMC’s sanctions guidance, and then continued as follows: “69. The Tribunal considered that Dr Kumar has had many years to address the concerns regarding his practice and has persistently failed to do so.

70. The Tribunal took the view that Dr Kumar has now disengaged with the hearing process and is therefore unlikely to endeavour to remediate the concerns regarding his practice.

71. In all the circumstances, the Tribunal determined that no lesser sanction than erasure would adequately promote and maintain public confidence in the medical profession and promote and maintain proper professional standards and conduct for members of that profession.

72. Therefore, the Tribunal determined to erase Dr Kumar’s name from the Medical Register.” (2) The grounds of appeal

16. Dr Kumar appeals against the Tribunal’s decision on the following grounds. First , that it unfairly refused to admit evidence concerning the Assistant Registrar’s decision not to conduct the review as an ROP. (The substance of this point is that at the hearing, Dr Kumar asked that the Assistant Registrar be required to attend the hearing to give evidence, and the Tribunal refused this request.) Secondly , that the Tribunal acted wrongly and irrationally when it departed from a conclusion reached at the time of the review in 2017 that Dr Kumar had insight into his conduct. Thirdly , it is submitted that the sanction of erasure from the Register was disproportionate and was reached by the Tribunal inconsistently with the Sanctions Guidance published by the GMC. Fourthly , it is contended that the Tribunal acted in breach ECHR article 3 by disregarding evidence relating to Dr Kumar’s mental health. Fifthly, it is said that the Tribunal’s decision was affected by systemic bias and/or was predetermined, and that the Tribunal was wrong to proceed in Dr Kumar’s absence on 1 April 2025. B. Decision Ground 1

17. This ground is directed to the Tribunal’s decision on 28 February 2025 not to accede to Dr Kumar’s application to require the Assistant Registrar who had decided the suspension should be considered at a review hearing rather than an ROP to attend the hearing and give evidence on the reasons for his decision. The Tribunal’s decision on this application is at Annex A to its decision. The Tribunal approached this issue by reference to Rule 34 of the Fitness to Practise Rules, which is a power to admit any evidence considered “fair and relevant” to the case being heard by the tribunal. Dr Kumar’s case was that the Assistant Registrar’s decision in favour of a hearing process was wrong and had failed to pay attention to his health. The Assistant Registrar should, contended Dr Kumar, have agreed to continue the suspension without the need for a hearing.

18. In his Skeleton Argument for this hearing and in the submissions he made to me, Dr Kumar contended that evidence of the Assistant Registrar’s reasons would have been relevant to the Tribunal’s decision on sanction. He further submitted that the decision that his suspension should be considered at a hearing demonstrated procedural bias, alternatively a predetermined decision that he should be erased from the Register.

19. The Tribunal’s decision was that evidence from the Assistant Registrar explaining the decision that suspension should not be considered at a further paper review was not relevant to the issues before it – i.e., Dr Kumar’s fitness to practise and, if he was not fit to practise, whether the suspension should be continued or whether other action should be taken.

20. I can see no error in this conclusion. The Tribunal was correct to conclude that the Assistant Registrar’s decision was not relevant to the issues it had to consider. The Assistant Registrar’s decision went only to the form of the proceeding to consider whether the suspension should continue; his decision was only that a hearing should be convened. By the time of the Tribunal hearing, any challenge to that decision was academic. Nor could the decision to have a hearing be construed as revealing any form of bias or predetermination towards an outcome other than continuation of the suspension. At the hearing all options remained open to the Tribunal, including continuation of the suspension (the decision that Dr Kumar wanted). The Assistant Registrar’s reasons were immaterial, both to the decision on sanction and, for that matter also, to the prior decision on fitness to practise. In this case, even though there was no dispute that Dr Kumar’s fitness to practise was impaired, the reason for that impairment (and whether it was limited to Dr Kumar’s lack of up-to-date clinical skills) would be relevant to the decision on sanction. Those were matters for the Tribunal, taking account of all evidence available. Whatever the Assistant Registrar’s reasons were for his decision that these matters be considered at a hearing they were not matters relevant to either of the matters that the Tribunal had to decide.

21. For sake of completeness I add that there is no plausible argument that the decision taken by the Assistant Registrar, that this suspension should be considered at a hearing, was wrong. Dr Kumar’s suspension had not been considered at a hearing since September 2019. The review on paper process requires the Registrar to consent to continuation of a suspension. The conclusion that after 5 years, whether or not Dr Kumar’s suspension should continue should be considered at a hearing was plainly the correct decision. In these circumstances, there is no room for any inference of bias to arise from that decision.

22. Nor can it be said that the Assistant Registrar’s decision on this occasion had ignored what Dr Kumar had said about his health in his email dated 18 November 2024. The reasons that the Assistant Registrar had given (in the email dated 18 December 2024) were cogent reasons. Those matters simply outweighed Dr Kumar’s preference for an ROP. Moreover, the only decision taken by the Assistant Registrar was whether or not a hearing should take place. If Dr Kumar wanted to delay the hearing on health grounds, he could have asked the Tribunal to do that. If that matter had been raised it would have been for the Tribunal to decide whether there was good reason to delay the hearing. So far as I can tell Dr Kumar did not, either before the hearing on 28 February 2025 or before the resumed hearing on 1 April 2025, ask the Tribunal to adjourn because he was not fit to attend. Ground 2.

23. The Tribunal noted that following the review hearing that took place in 2017, the tribunal hearing that review had concluded that it was: “11. … satisfied that Dr Kumar had demonstrated exceptional insight and now understood the gravity of the offence, which resulted in him no longer being impaired by reason of his conviction. However, the 2017 Tribunal considered there to be insufficient evidence of remediation, particularly in maintaining his skills and knowledge. The 2017 Tribunal concluded that Dr Kumar’s fitness to practise remained impaired by reason of misconduct.

12. In considering sanction, the 2017 Tribunal was impressed by Dr Kumar’s level of insight but concerned about the absence of evidence of maintaining skills and knowledge. The 2017 Tribunal suspended Dr Kumar’s registration for a period of nine months to provide Dr Kumar with the opportunity to seek and secure clinical attachments, as well as to undertake necessary courses. The 2017 Tribunal provided recommendations for evidence to be obtained by Dr Kumar that would assist a reviewing Tribunal.” Dr Kumar’s submission now is that the Tribunal ought not to have “departed from” the conclusion reached following the 2017 review hearing on his insight into his misconduct (i.e. the criminal offence he had pleaded guilty to in 2014 and his failure to report the matter to the GMC).

24. I reject that submission. Whatever the position in 2017, the Tribunal in 2025 had to consider all the evidence available to it. This much is clear from Rule 22 of the Fitness to Practise Rules which set out the procedure to be followed at a review hearing; each such hearing is an evidentiary hearing. Any other conclusion would be surprising. To take Dr Kumar’s situation as an example. His suspension had been reviewed on successive occasions over a 10-year period. The whole point of those reviews was to consider the situation afresh taking account of up to date information. The conclusion reached in 2017 based on Dr Kumar’s evidence on that occasion was not set in stone.

25. Thus, the Tribunal was entitled, if not required, to consider the question of insight taking account of both the statements made by Dr Kumar for the 2025 hearing (the one dated 27 February 2025 and the one provided immediately before the hearing on 1 April 2025). I have set out paragraph 31 of the Tribunal’s decision (see above at paragraph 9). That paragraph explains, clearly and appropriately, the Tribunal’s conclusion on Dr Kumar’s insight into his misconduct by reference to the evidence available in 2025. I consider that conclusion was correct.

26. In his Skeleton Argument for this hearing and in his submissions to me, Dr Kumar submitted that the Tribunal’s “departure” from the views on insight reached by the 2017 tribunal was irrational. It was nothing of the sort. The decision in 2025 rested on the evidence then available and it is impossible to characterise that decision as wrong. Nor is it right, in any relevant sense, to characterise the decision in 2025 as a “departure” from the 2017 decision. Each decision rested on the information available at the time it was made. Ground 3

27. I do not consider that the sanction of erasure from the Register was disproportionate. Nor do I consider the decision to impose that sanction was inconsistent with the GMC’s Sanctions Guidance.

28. Dr Kumar’s submission is that the Tribunal failed to explain why continued suspension had ceased to be appropriate.

29. The general approach in the Sanctions Guidance is that the sanction imposed should be the least restrictive and should be “proportionate weighing the interest of the public against those of the doctor” (Guidance at paragraph 20). The available sanctions are listed at paragraph 66 of the Sanctions Guidance. Erasure from the Register is the most severe sanction; suspension of registration is the next most severe sanction. As to suspension, the Guidance states as follows at paragraph 92. “92. Suspension will be an appropriate response to misconduct that is so serious that action must be taken to protect members of the public and maintain public confidence in the profession. A period of suspension will be appropriate for conduct that is serious but falls short of being fundamentally incompatible with continued registration (ie for which erasure is more likely to be the appropriate sanction because the tribunal considers that the doctor should not practise again either for public safety reasons or to protect the reputation of the profession).” This, then is the rationale for a decision to suspend registration or, as in this case, a decision to continue such suspension. However, it is also clear that suspension is not an end in itself. Suspensions must be reviewed, and suspension is to be imposed with a view to remediation and thus ultimately with a view to the suspension of the doctor’s registration being lifted (see for example the Guidance at paragraphs 95, 100 and 101). Indefinite suspension is limited to cases where the reason for suspension is the doctor’s English language skills, or his health. In such cases erasure from the Register is not an option: see Guidance at paragraphs 104 and 107.

30. At paragraph 109, the Guidance sets out a non-exhaustive list of situations in which erasure from the Register may be appropriate. The possibility of erasure from the Register is not limited to situations giving rise to a risk of patient harm. A tribunal is entitled to access each situation on its own terms. In this case, as in many other regulatory contexts, guidance is just that, a guide not a straitjacket.

31. In the present case the Tribunal’s reasons both for rejecting continuation of the suspension and for its decision to erase Dr Kumar’s name from the Register included the following. First , the Tribunal relied on the passage of time since suspension had first been imposed in 2015. At the time of the Tribunal’s decision on this occasion the suspension had been in place for almost 10 years. Second , the Tribunal considered the deterioration of Dr Kumar’s insight into his misconduct. Third , the Tribunal considered the deterioration of Dr Kumar’s clinical skills during the period of suspension. It is striking that, even after Dr Kumar was removed from the sex offenders register (which would have been no later than 2020), he had taken no steps to restore or maintain his clinical skills. When considering the question of sanction, the Tribunal also considered the three overarching objectives of the regulatory scheme stated at section 1 (1A) of the Medical Act 1983 : to promote the health and safety of the public; to maintain and promote public confidence in the medical profession; and to maintain and promote proper standards for the conduct of the profession.

32. Considering the Tribunal’s reasoning in the round, I am entirely satisfied that its decision not to continue the suspension but instead erase Dr Kumar’s name from the Register was both entirely consistent with the Guidance, and correct. It would have been wrong of the Tribunal, and clearly inconsistent with the overarching objectives of the regulatory scheme, to prolong this suspension beyond the 10 years it had already been in place. Dr Kumar was not fit to return to practise and there was no sign that that state of affairs was likely to change. Ground 4

33. Dr Kumar contends that the Tribunal disregarded evidence of his mental health and that this amounted to inhumane and degrading treatment contrary to ECHR article 3.

34. At paragraph 52 of its decision the Tribunal said this: “52. The Tribunal noted the fact that Dr Kumar has referred to having health issues during both this hearing and previous reviews. However, it accepted the GMC submission that little weight can be applied to this assertion as the Doctor has failed to provide any evidence of this. Further, Dr Kumar has told the Tribunal himself that he has continued to work for 6 of the 11 years he has been suspended, and he is working currently.” This conclusion reveals no error, and certainly nothing that could comprise or even approach article 3 ill-treatment. Ground 5

35. The submissions as to systemic unconscious bias, lack of independence, and conflict of interest all arise from arrangements that have been in place since 2015: see the GMC (Constitution of Panels, Tribunals and Investigation Committee) Rules 2015. The practical effect of these Rules is that a tribunal will comprise a legally qualified chairman/chairwoman together with a medical member and a lay member.

36. The first submission is that the existence of the legally qualified chairman/chairwoman as opposed to a system where tribunals are advised by a legal advisor gives rise to a conflict of interest and duty. There is no such conflict. The submission rests on a misunderstanding of the function of a legally qualified chairman/chairwoman which is, in addition to playing a full part in the merits determination of a case, also to provide the panel with a source of legal expertise. Such a role is entirely commonplace and of itself gives rise to no conflict of interest. There is nothing wrong with such arrangements in principle and, in this case, there is nothing to suggest that these arrangements gave rise to any difficulty or error.

37. The contention that an appearance of bias arises from the presence on a tribunal of a medically qualified member is also incorrect. Again, it is commonplace for regulatory disciplinary tribunals such as this one to have such persons within their membership. I do not accept that the presence on a tribunal of a member of the profession concerned, in this case a doctor, is capable per se of giving rise to any appearance of bias or predetermination. Whether the matter is considered at the level of the system or by how the system operated in this case, the standard to apply is that of the informed and fair-minded observer. Applying that standard, it cannot be said that the presence of a medically qualified person as a member of this Tribunal gave rise to any appearance of bias.

38. The final part of this ground is that the Tribunal displayed bias or predetermination (or at least would have been seen to do so by an informed and fair-minded observer) by failing to pay proper regard to Dr Kumar’s reasons for not attending the resumed hearing on 1 April 2025.

39. At paragraph 36 of its decision the Tribunal said this: “36. Having previously been present at the impairment stage of this review hearing and being made aware of the reconvened hearing date, Dr Kumar chose to voluntarily absent himself from the sanction stage of the hearing. The Tribunal confirmed that Dr Kumar had been provided with notice of the hearing and the hearing link and had sent an email at 1am this morning to state that he would not be attending today.

40. Prior to the resumed hearing on 1 April 2025 Dr Kumar had provided a statement that contained a mix of evidence and submission on the issue of sanction. There is then, no room for doubt that Dr Kumar knew of the hearing; knew of the matters to be considered at the hearing; and took the opportunity to address those matters. It is apparent from the Tribunal’s reasoning that it took the contents of this statement into account and gave them careful consideration. At paragraph 20 of the statement Dr Kumar had said this as to his reasons for non-attendance at the resumed hearing. “20. I would have loved to appear in person at the sanction stage of this hearing, however, given my distressing experience of the hostile and demeaning conduct of the GMC counsel, further compounded by the Tribunal Chair’s permissiveness and condonation of such conduct, despite my objections, I am left with no other choice, than to recuse my attendance at this Review Hearing of 01 April 2025, in order to preserve my psychological safety, sanity and wellbeing, out of my palpable fear of being attacked, humiliated and demeaned again by the GMC counsel. My fear and apprehensions stand further aggravated by the Tribunal chair’s permissiveness and condonation of GMC counsel’s previous hostile, disrespectful and demeaning conduct.”

41. I have seen a transcript of the hearing on 28 February 2025. In the course of his submissions to me, Dr Kumar said that at one point during that hearing counsel for the GMC was seen to shake her head when he was speaking; that at the beginning of the hearing counsel for the GMC incorrectly referred to him as “Mr Kumar” an error that was (after not too long) corrected but only after Dr Kumar had mentioned the matter; and also that at one point during the hearing the chairman said to Dr Kumar that he was being repetitive. Although I accept that a transcript of a hearing will not always provide the full flavour of what happened, having considered the transcript carefully I am entirely satisfied that there is no reasonable basis for the assertion in Dr Kumar’s witness statement that he was subjected to “hostile and demeaning conduct”. To my mind, none of the matters relied on is either exceptional or even particularly noteworthy.

42. For present purposes the issue is whether the Tribunal was entitled to proceed in Dr Kumar’s absence on 1 April 2025 for the reasons that it gave at paragraph 36 of its decision. By Rule 31 of the Fitness to Practise Rules a tribunal may proceed in the absence of a practitioner if it is satisfied that all reasonable efforts have been made to serve the practitioner with notice of the hearing as required by the Rules. In the present case there was no doubt that Dr Kumar did have notice of the resumed hearing on 1 April 205. It is also apparent from the Tribunal’s reasons that before deciding to proceed in Dr Kumar’s absence the Tribunal had satisfied itself that his failure to attend the resumed hearing was voluntary. In reaching that conclusion I do not doubt the Tribunal carefully considered the matters set out by Dr Kumar in paragraph 20 of his statement. Considering the position in the round, I am satisfied that the Tribunal was right to conclude that Dr Kumar’s decision not to attend the resumed hearing on 1 April 2025 was a voluntary decision, not a decision that had been taken under any form of duress arising from the way the hearing on 28 February 2025 had been conducted. The decision to proceed did not therefore give rise to any error on the part of the Tribunal.

43. One further point made by Dr Kumar is that the Tribunal’s decision to proceed in his absence on 1 April 2025 is itself a matter from which it can be inferred that the Tribunal had already decided that he should be erased from the Register. I do not accept this submission. First , for the reasons already given the Tribunal was entitled to proceed in Dr Kumar’s absence. Second , it is apparent from the Tribunal’s reasons that, in any event, it paid careful regard to the evidence and representations that Dr Kumar had made on the sanction issue and took those matters properly into account. Further , the Tribunal’s reasons for the sanction decision are clear and demonstrate a careful, principled and balanced consideration of the evidence and of the relevant professional standards in the Guidance.

44. Drawing these matters together there is no basis for any inference of apparent let alone actual predetermination of the decision on sanction. Any fair-minded and informed observer would not conclude that there was any possibility either of bias or of predetermination on the part of the Tribunal. C. Disposal

45. Drawing all matters together, I have concluded that there is no substance in any of the grounds of the appeal. In the premises, the appeal will be dismissed. ___________________________________