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	England and Wales High Court (Administrative Court) Decisions
You are here: BAILII >> Databases >> England and Wales High Court (Administrative Court) Decisions >> Bhatnagar v General Medical Council [2014] EWHC 2562 (Admin) (24 July 2014) URL: http://www.bailii.org/ew/cases/EWHC/Admin/2014/2562.html Cite as: [2014] EWHC 2562 (Admin)

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IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT

		Royal Courts of Justice Strand, London, WC2A 2LL
		24 July 2014

Mr Justice Supperstone :

Introduction

1. This is an application brought under section 41A(10) of the Medical Act 1983 ("the Act") seeking the termination of an interim suspension order imposed upon the Applicant, Dr Bhatnagar, by the Medical Practitioners' Tribunal Service's Interim Orders Panel ("IOP") on 7 April 2014 by which Dr Bhatnagar's registration as a medical practitioner was suspended.
2. Dr Bhatnagar is a Consultant Opthalmologist and was self employed prior to his suspension.
3. The issue raised by this application, as formulated by Mr Simon Butler, who appears for Dr Bhatnagar, is whether the decision of the IOP was unnecessary, disproportionate and wrong in all the circumstances.

The Facts

4. The material facts relating to the period leading up to the hearing before the IOP on 17 January 2013 are set out by Edwards-Stuart J in his judgment in Dr Bhatnagar v GMC [2013] EWHC 3412 (Admin) at paragraphs 6-14 which I gratefully adopt:

"6. Dr Bhatnagar qualified as a doctor in 1968. For the past 15 years or more he has been the proprietor of private hospitals. From April 1999 to October 2009 he was a director of Parkfield Hospital Ltd (previously known as Birkdale Clinic (Rotherham) Ltd). That hospital ran into serious financial difficulties and went into administration in October 2009. Dr Bhatnagar was also a director of Rotherham Private Hospital Ltd.

7. Between July 2008 and October 2009 a Fitness to Practise Panel ("FTP Panel") considered allegations against Dr Bhatnagar arising out of the management of the Birkdale Clinic at Daventry during 2005 and 2006 to the effect that Dr Bhatnagar's management of the clinic was deficient. Dr Bhatnagar admitted one of the complaints and many others were found proved. Dr Bhatnagar's defence was that he was not responsible for the day to day management of the clinic, which he left to others. The FTP Panel found also that Dr Bhatnagar's conduct in allowing endoscopy services to be provided when he knew that he had not received written confirmation that such services could be provided, was dishonest and showed a cavalier disregard for proper processes. The FTP Panel found that Dr Bhatnagar's fitness to practice was impaired by misconduct. However it noted that there was no evidence of any actual harm to a patient. In October 2009 the FTP [Panel] imposed a period of suspension of six months, but the registration was not suspended forthwith.

8. In June and October 2009 the Care Quality Commission inspected the clinic in Rotherham, which was under the control of Dr Bhatnagar, and identified a number of areas of concern. This came to the attention of the GMC in 2011 and resulted in a Rule 7 letter to Dr Bhatnagar dated 11 August 2011 setting out the allegations that had been made against him. Dr Bhatnagar's defence was again that he did not have the day to day management of the clinic and so was not responsible for what had happened. A hearing to investigate these complaints was subsequently fixed for 15 October 2012.

9. By an e-mail dated 16 September 2011 Mr Niraj Manglam, a former employee at one of Dr Bhatnagar's clinics, made a number of allegations against a Dr M, whom he alleged to be Dr Bhatnagar's mistress, and various allegations against Dr Bhatnagar himself. The allegations, in brief, were as follows:

(i) There was a high level of forging and fabrication of documents taking place at the clinic under the direct instruction of Dr Bhatnagar.

(ii) Dr Bhatnagar and Dr M fabricated a letter purporting to appoint Dr M as the manager of the clinic in order to mislead the FTP Panel that considered the allegations against Dr Bhatnagar in 2008/09.

(iii) Dr M also helped Dr Bhatnagar to forward a letter to the Clydesdale Bank fraudulently purporting to make a genuine offer to buy the buildings occupied by the clinic.

(iv) That on various occasions Dr M and Dr Bhatnagar had stayed together in the RMO's room at the clinic.

(v) Dr M ill-treated a patient in December 2010, but when the matter was reported to Dr Bhatnagar he chose to ignore it.

10. On 24 October 2011 the GMC wrote to Dr Bhatnagar enclosing a copy of the e-mail from Mr Manglam and inviting his response within four weeks. On 16 November 2011 Dr Bhatnagar sent his initial response to these allegations to the GMC. In this document he blamed Mr Manglam for a number of shortcomings at the clinic, since, he said, Mr Manglam was the registered manager. He denied all allegations of fabrication of documents and accused Mr Manglam of corrupting or altering data held on the clinic's computer system.

11. On 22 November 2011 the GMC notified Dr Bhatnagar that the allegations in relation to the management of Parkfield Hospital in 2009, namely that his governance and management of the clinic was deficient, were to be referred to the FTP Panel. The letter did not refer to the allegations made by Mr Manglam in the e-mail of 16 September 2011.

12. On 3 August 2012 the GMC wrote to Dr Bhatnagar to say that it had now reviewed the case with counsel, who had advised that the new allegations made by Mr Manglam were inextricably linked with the existing allegations and that there was an overwhelming public interest in having all matters heard together. Accordingly, the GMC gave notice that it intended to vacate the hearing that had been fixed for October 2012.

13. On 12 December 2012 the GMC wrote to Dr Bhatnagar enclosing the witness statements of Mr Manglam and a solicitor, Sian Morris. The letter also referred to voice recordings obtained by Mr Manglam, the transcripts of some of which were attached to Mr Manglam's witness statement.

14. On 4 January 2013 the GMC wrote to Mr Bhatnagar notifying him that it had been decided to refer his case to an IOP to consider whether or not it was in the public interest that an order should be made suspending Dr Bhatnagar's registration, or imposing conditions on his registration. The letter invited Dr Bhatnagar to appear before the IOP on 10 January 2013. That hearing was postponed for a week to 17 January 2013 at Dr Bhatnagar's request."

5. On 17 January 2013 the IOP imposed an interim order of suspension on Dr Bhatnagar's registration for a period of 12 months.
6. Dr Bhatnagar challenged that decision. His application was heard by Edwards-Stuart J on 28 June 2013.
7. On 16 July and 11 October 2013, differently constituted panels of the IOP reviewed the interim order of suspension and determined that an interim order of conditions was appropriate.
8. On 31 October 2013, prior to handing down judgment Edwards-Stuart J gave leave to Dr Bhatnagar to adduce evidence of the IOP determinations of 16 July and 11 October 2013. On 11 November 2013 Edwards-Stuart J dismissed Dr Bhatnagar's application to terminate the interim order of suspension.
9. On 7 April 2014 a differently constituted Panel of the IOP reviewed the interim order of conditions and determined that an interim suspension order was appropriate.

The Decision of Edwards-Stuart J of 11 November 2013

10. Having reviewed the material produced by Mr Manglam (paras 38-49), the evidence of Ms Morris (paras 50-51), the Care Quality Commission allegations (paras 52-53), and the allegations before the 2008/09 FTP Panel (paras 54-56), Edwards-Stuart J considered "the proper approach" to be adopted. He stated:

"57. The issue for the IOP was whether the combination of the allegations made by the Care Quality Commission and the allegations of dishonesty made by Mr Manglam, together with the conduct revealed by Ms Morris's witness statement and the findings of the 2008/09 FTP Panel, justified suspension. That is to say whether they justified a conclusion that the suspension was necessary in the public interest.

58. The IOP had to ask itself—and did ask itself—what a reasonable onlooker would think, in the event of the doctor ultimately being convicted of formal allegations arising from the complaints that had been outlined, about his being allowed to go on practising in the meantime. If this hypothetical onlooker would expect the doctor to be suspended from practice, then it would be legitimate to conclude that it was necessary that he should be suspended in order to maintain confidence in the medical profession.

59. Mr Butler made the point that there is no allegation that Dr Bhatnagar has caused any harm to a patient and, indeed, there is no suggestion that he has personally ever been guilty of harming a patient through medical malpractice. In the context of suspension this is a powerful point. If a doctor has practised for many years without directly harming a patient, what justification exists for suspending him?

60. In my view the answer lies in the allegations of dishonesty in connection with his practice and, in particular, dishonesty calculated to pervert the course of the GMC's regulatory procedures. This is, to my mind, quite different from, for example, committing fraud by abusing a position as a governor of a school, see Patel v The GMC [2002] EWHC 3688 (Admin). The allegations made by Mr Manglam go close to the heart of Dr Bhatnagar's activities as a doctor, not as, for example, a school governor or a property owner.

61. I consider that a reasonable onlooker would be concerned if a doctor who was accused of fabricating or altering the records of one of his clinics in order to avoid suspension was permitted to continue to practise, assuming of course that the allegations appear to be supported by cogent evidence and were not just unsubstantiated claims. He or she would be reinforced in his conclusion if he or she knew that at an earlier hearing another FTP Panel had found that Dr Bhatnagar had been guilty of dishonesty in the management of the clinic.

62. The reasonable onlooker test is, in effect, a combined test of necessity and proportionality. However, it still remains for the IOP and the court to consider the consequences of the sanction in the context of the individual case. I agree with the IOP that, on the material before it, there was no appropriate condition that could meet the circumstances of this case: the question was whether or not Dr Bhatnagar should be permitted to continue to practise pending the final hearing.

63. Dr Bhatnagar is 66 and, at that age, a suspension would be likely to make it difficult, if not impossible, for him to find other work. It is clearly a draconian measure. However, in my view Dr Bhatnagar has demonstrated that he is not to be trusted. He has shown a persistent disregard for the requirements of good management and that he is prepared to resort to calculated dishonesty in order to get his way.

64. In these circumstances I consider that upon the material before the IOP it was not unnecessary, disproportionate or wrong to suspend Dr Bhatnagar. …"

11. Edwards-Stuart J concluded:

"70. I therefore considered that this was one of those rare cases where interim suspension was justified and that the IOP was entitled to reach the conclusion that it did. I concluded that I would have reached the same conclusion on the material before it.

71. Accordingly, I notified the parties on 2 July 2013 that I had decided to dismiss this application and I then prepared this judgment in draft setting out my reasons for that conclusion."

12. However, after preparing his judgment in draft (but before it had been issued to the parties) the judge was informed that Dr Bhatnagar has made an application to adduce further evidence, namely the determination of the IOP made on 16 July 2013. He decided there should be an oral hearing of this application which was fixed for 31 October 2013. By that time there had been a further three month review on 11 October 2013. The application to adduce further evidence was amended in order to put that decision before the court also, which the judge granted. At paragraphs 76-84 of his judgment the judge considered the determinations of the IOP made on 16 July and 11 October 2013.
13. Edwards-Stuart J described the reasons given by the IOP for its decision to substitute conditions for suspension on 16 July 2013 as being "fairly cursory" (para 76). He noted (at para 80) that the further IOP on 11 October 2013 said:

"… There is no new information before it today which justifies any departure from the decision of the previous review Panel."

14. Edwards-Stuart J continued (at para 81):

"Unfortunately, these observations do not provide much assistance in understanding what it was that led the previous IOP to substitute conditions for suspension. It seems clear that both panels were concerned at the effect on Dr Bhatnagar of an order of suspension from practice. This is a factor that inevitably has more weight as time goes on without any date for a hearing of the allegations having been fixed."

15. However the judge was of the view that his decision to dismiss the appeal should stand. He stated:

"I have reached this decision for the following reasons. First, I had already made my decision and communicated it to the parties: this is not a case where judgment had been reserved. Whilst it is open to me to revoke or vary my decision, I consider that in this type of case there would have to be compelling circumstances before such a course would be appropriate. Second, my decision was based on the situation in January 2013, not upon the situation in July 2013. The continued uncertainty about when the substantive hearing will take place is a factor which could properly have carried more weight in July 2013 than in did in January 2013. Third, the determination of the IOP in July 2013 suggests on its fact that it took into account some further information – whenever arising – over and above that which was before the IOP in January 2013 (and which was therefore before me)… It seems fairly clear that the impact of suspension on Dr Bhatnagar was something that weighed heavily with the two IOPs. Fourth, even if the IOP (albeit differently constituted) has simply changed its mind as to the sanction that would have been appropriate in January 2013, that is not of itself a reason why my appraisal of the situation – reached independently – should change" (para 83).

The Decision of the IOP on 7 April 2014

16. The Panel stated that it was "mindful that the last two interim order panels had imposed interim conditions upon [Dr Bhatnagar's] registration and of the need for consistency between IOP panel decisions". However in reviewing his case and "considering all the current circumstances" it had decided to vary the interim order and replace it with one of interim suspension. The IOP stated the reasons for so doing to be as follows:

"(a) As stated previously the allegations as now formulated in the Rule 7 letter are wide ranging and extremely serious. They include new allegations that were not before the IOP in 2013. Whilst you attempted to demonstrate that you will in due course be able to disprove all of the allegations made against you, the panel was satisfied that the GMC's allegations were not without weight.

(b) The panel considered that taking all the allegations together a reasonable onlooker would be concerned if you were allowed to practice without restriction given the nature and seriousness of the allegations. The panel concluded that to maintain public confidence in the profession and the regulator required there to be an order of interim suspension whilst these matters are fully investigated.

(c) Whilst the previous reviewing interim order panels appear to have been persuaded that, on the grounds of proportionality, only interim conditions were required, this panel concluded that in the light of all the allegations you now face conditions are not appropriate. The panel accepted that suspension would have significant impact on you but took into account the fact that you indicated that in practical terms you considered such an order may make limited difference, as with these allegations hanging over you, you had little work. The panel reminded itself that you have been under investigation for a long period of time and the allegations may not be resolved for some time. However it was required to balance the effect of any decision on you against the wider public interest and in this case was satisfied in all the circumstances that the only appropriate and proportionate order was one of interim suspension."

The Law

The statutory framework

17. Section 41A of the Act, so far as is material, provides:

"(1) Where an Interim Orders Panel… are satisfied that it is necessary for the protection of members of the public or is otherwise in the public interest, or is in the interests of a fully registered person, for the registration of that person to be suspended or to be made subject to conditions, the Panel may make an order—

(a) that his registration in the register shall be suspended (that is to say, shall not have effect) during such period not exceeding 18 months as may be specified in the order (an 'interim suspension order'); or

(b) that his registration shall be conditional on his compliance, during such period not exceeding 18 months as may be specified in the order, with such requirements so specified as the Panel think fit to impose (an 'order for interim conditional registration').

(3) Where an interim suspension order or an order for interim conditional registration has been made in relation to any person under any provision of this section (including this subsection), an Interim Orders Panel or a Fitness to Practise Panel may, subject to sub-section (4) below—

(a) revoke the order or revoke any condition imposed by the order;

(b) vary any condition imposed by the order;

(c) if satisfied that to do so is necessary for the protection of members of the public or is otherwise in the public interest, or is in the interests of the person concerned, replace an order for interim conditional registration with an interim suspension order having effect for the remainder of the term of the former; or

(d) if satisfied that to do so is necessary for the protection of members of the public, or is otherwise in the public interest, or is in the interests of the person concerned, replace an interim suspension order with an order for interim conditional registration having effect for the remainder of the term of the former.

(10) Where an order has effect under any provision of this section, the relevant court may—

(a) in the case of an interim suspension order, terminate the suspension;

(b) in the case of an order for interim conditional registration, revoke or vary any condition imposed by the order;

(c) in either case, substitute for the period specified in the order (or in the order extending it) some other period which could have been specified in the order when it was made (or in the order extending it),

and the decision of the relevant court under any application under this sub-section shall be final."

18. Under section 41A(10) this court is exercising an original jurisdiction and is not confined to exercising a judicial review jurisdiction. As King J observed in Houshian v General Medical Council [2012] EWHC 3458 (QB) at paragraph 2:

"It will show respect for and give appropriate weight to the decision of the Panel, given it is an expert body well acquainted with the requirements that a particular profession needs to uphold and with issues of public perception and confidence, but this court will nonetheless interfere with that decision if it is satisfied that the order was wrong. On this see GMC v Hiew [2007] 1 WLR 2007 at paragraph 27 per Arden LJ, and the observations of Davis J in Sheikh v GDC [2007] EWHC 2972 and those of Nicol J in Sandler v GMC [2010] EWHC 1029 (Admin)."

19. In Houshian King J continued:

"The public interest ground

12. As will be seen this case concerns an order imposed solely on the grounds of the public interest. Although of course the statutory grounds are no more and no less than those set out in the statutory provisions, I do not disagree with the approach of Davis J in Sheikh v GDC [2007] EWHC 2972 when at paragraph 15 having observed that as a matter of strict language, no grammatical interpolation of the word 'necessary' fell to be applied to the phrase 'or otherwise in the public interest', he said that if 'the public interest' is to be invoked in this context, then 'that does at least carry some implication of necessity and certainly carries with it the implication of desirability' and when he further said at paragraph 16 that 'in the context of imposing an interim suspension order on this particular basis, that the bar is set high and I think that in the ordinary case at least necessity is an appropriate yard stick. That is so because of reasons of proportionality.' I accept also the observations of Nicol J in Sandler v GMC [2010] EWHC 1029 when he said (paragraph 14) in commenting upon these passages in Sheikh that the court should be cautious about superimposing additional tests over and above those Parliament has set, but I nonetheless agree with Davis J that it is likely to be a relatively rare case where a suspension order will be made on an interim basis on the ground that it is in the public interest.

Proportionality

13. The importance of the principle of proportionality in determining whether an interim order should be made pending the resolution of as yet unproven allegations faced by the practitioner, cannot be over stated. A suspension has potentially three very important consequences for a practitioner. First there is the impact upon the person's right to earn a living: in this case the Applicant's pre-suspension salary was in the region of £150,000. Secondly, there is the obvious detriment to him in terms of his reputation. Thirdly it deprives the practitioner of showing that during the relevant period he has conducted himself well and competently and 'so as it were enhanced his prospects in front of the panel undertaking a final hearing' (per Davis J in Sheikh at paragraph 18). I note that in Sandler Nicol J agreed that 'the Panel must consider very carefully the proportionality of their measure (weighing the significance of any harm for the public interest in not suspending the doctor against the damage to him by preventing him from practising)'."

The GMC Guidance

20. The guidance issued by the GMC on the imposition of interim orders includes the following paragraphs on review of interim orders:

"42. With the exception of the circumstances mentioned in paragraph 9 above, the IOP must review an interim order within six months of the order being imposed, and thereafter, at intervals of no more than six months during the lifetime of the order. A review of an order may also be held at any time when new evidence relevant to the order becomes available. Further, following a first or subsequent review of the order, the doctor may also request an earlier review, which shall be heard as soon as practicable after three months from the date of the immediately preceding order (see also paragraph 9 above).

43. When reviewing interim orders an IOP must fully consider all the circumstances relating to the case, including any new information. It must decide whether the order should be maintained, varied, replaced or revoked. In doing so the IOP should apply the same test and take account of the same factors as set out in paragraphs 19-23 above."

The Parties' Submissions and Discussion

21. Mr Butler submits that the decision of the Panel was fundamentally wrong and disproportionate for three reasons. First, the Panel concluded that they were considering "new allegations" (emphasis added) that were not before the IOP in 2013. That approach, he submits, is flawed. It is accepted that the GMC has reformulated the allegations. However, the focus of the evidence and the substance of the allegations had not changed since the order was reviewed on 16 July and 11 October 2013, and prior to the consent order in the High Court dated 9 January 2014 that extended the term of the initial 12 month interim order. Second, Dr Bhatnagar has a legitimate procedural expectation that the orders made on three previous occasions ought not to be thwarted. Third, the IOP failed to consider whether an order for interim conditional registration would be appropriate and proportionate, and failed to give reasons why it was not satisfied that conditions would appropriately address the public interest test, which it had identified.
22. Relevant to the first contention are the following parts of the Panel's decision:

"4. Mr Harvinder Singh Mangat provided a witness statement to the GMC on 18 October 2013 in which he gave an account of your conversations with him in relation to your insurance policy and applications. Mr Mangat alleged that you had made false declarations in respect of these.

5. Mr Niraj Manglam provided a supplementary statement on 18 November 2013 in which he alleged that you fabricated documents relating to meetings.

6. The GMC sent you a Rule 7 letter on 25 February 2014 which invited you to comment on the allegations against you.

…

18. You commented on the Rule 7 letter and allegations against you. You made submissions on those matters you dispute and told the panel that you deny the allegations.

…

22. In accordance with section 41A of the Medical Act 1983, as amended, the panel has determined that it is necessary to vary the existing interim order of conditions to an order of suspension.

23. The panel has determined that, based on the information before it today, …

24. In reaching its decision the panel has borne in mind the wide ranging nature of the allegations against you which were appended to the Rule 7 letter dated 25 February 2014. …

25. The panel has noted the witness statements from Mr Mangat and Niraj Manglam and your comments on these. It was concerned by the allegation that you may have misinformed the insurance company when applying for cover. The panel has borne in mind that if this is later proved to be true, it would have an adverse effect on the public interest. …

…

27. The panel noted that you dispute the allegations. It has borne in mind that it is not its function to make findings of fact, nor decide on the veracity of the allegations. The panel has, however, given such weight as it considered appropriate to the allegations.

28. The panel is satisfied that there are serious and wide ranging concerns about your conduct and probity as expressed in the allegations set out in the Rule 7 letter of 25 February 2014. Further it was satisfied that a reasonable and properly informed member of the public would be offended and surprised to learn that you were permitted to continue practising unrestricted until the allegations had been resolved."

23. Mr Butler submits that the allegations faced by Dr Bhatnagar on 7 April 2014 had not changed in nature and/or substance. First, he observes that the allegation concerning Dr Bhatnagar dishonestly obtaining insurance cover was before the IOP on previous occasions, as were documents sent by the insurance company to the GMC. Moreover the Panel incorrectly stated the content of Mr Mangat's witness statement. It does not allege that Dr Bhatnagar had made false declarations. Second, Mr Butler suggests that the witness statement provided by Mr Manglam dated 18 November 2013 amounted to no more than Mr Manglam maintaining that Dr Bhatnagar had fabricated notes of meetings retrospectively. These allegations, documents and evidence were before the IOP in July and October 2013.
24. Mr Simon Phillips QC, for the General Medical Council, submits that the new witness statements from Mr Mangat and Mr Manglam cannot be disregarded in the way Mr Butler suggests. Mr Mangat who is company secretary and in-house lawyer at the insurance broker, Simply Business, details the extent to which Dr Bhatnagar acted in a misleading way and the relevance of his misrepresentations in terms of insurance risk and insurance cover. The allegations contained within his statement demonstrate, Mr Phillips submits, that Dr Bhatnagar was effectively seeking, from an insurance perspective, to run a high risk business, namely a medical clinic, without making any/adequate disclosure to the broker. Mr Phillips comments that the issue of insurance cover is a matter of fundamental importance, as all medical professionals and IOP members are well aware.
25. Mr Butler relies on the observation of Edwards-Stuart J that the allegation that Dr Bhatnagar had dishonestly obtained insurance cover had no direct relevance to his fitness to practise and nor was it any evidence that he presented a risk to patients (para 49). However Mr Phillips submits that the Panel was entitled to have regard to Mr Mangat's witness statement of 18 October 2013 when considering the issue of risk to the public and the public interest.
26. Charges 8-14 in the Rule 7 letter which relate to the insurance issue, Mr Phillips submits, could not have been formulated in that format but for the new witness statement of Mr Mangat and the exhibits thereto. Mr Manglam had dealt with the insurance position in general terms in an earlier statement (see paras 47-58) that was before the IOP previously, however that statement was unsigned. It was for that reason that the Legal Assessor advised the Panel on 16 July 2013 to disregard it. Mr Phillips observes that it is perhaps not surprising that Edwards-Stuart J took the view that he did of the insurance matter on the basis of the admissible evidence that was before him at the time.
27. In addition Mr Phillips relies on the new witness statement from Mr Manglam which deals with additional documents fabricated by Dr Bhatnagar. This evidence adds, he submits, significantly to the earlier evidence from Mr Manglam, and is evidence to which the Panel on 7 April 2014 properly had regard.
28. In summary Mr Phillips submits that there were five matters to which the Panel could properly have regard when deciding that it was necessary to impose an interim suspension order: (1) it had the benefit of the carefully considered and detailed analysis in the reserved judgment of Edwards-Stuart J; (2) there was the new evidence which included the witness statements of Mr Mangat and Mr Manglam and the exhibits thereto. There were some additional 400 pages of documentation relating to matters in issue, including material from Companies House; (3) there was the new particularisation of the charges made against Dr Bhatnagar which had been synthesised into Rule 7 particulars. Further, the Panel had, as the transcript of the hearing on 7 April 2014 shows, heard what Dr Bhatnagar had to say about them; (4) there was the new procedural step, namely the Rule 7 letter (which Mr Phillips submits is of relevance when considering proportionality and duration of the order); and (5) there was new information available to the Panel which was also of relevance on the issue of proportionality, namely the position Dr Bhatnagar adopted before the Panel which was not that there should be a conditions order (as there had been since July 2013), but that the order should be revoked. He said that he "will not get work now" and that the order he sought would therefore only be "symbolic" (para 13).
29. Mr Butler submits that none of the matters to which Mr Phillips referred amount to "new" allegations. In my view Mr Butler attaches too much weight to the use of the word "new". It is clear from the Panel's determination that it had a clear understanding of the nature of the case that had been made against Dr Bhatnagar at earlier hearings and how the case was put on 7 April 2014. There had been no Rule 7 allegations at the earlier hearings which had pre-dated the Rule 7 letter. Further, whilst the Panel knew from a reading of Edwards-Stuart J's judgment that an insurance allegation had been made, the particulars of the allegation in the form set out in the Rule 7 letter were based on new evidence.
30. The Panel, as it recognised, had to exercise its own independent judgment (see para 30), and had to make a decision, having considered all the circumstances relating to the case, including any new information that was available to it on 7 April 2014.
31. In my view, having regard to the relevant legal principles, the Panel was entitled to reach the conclusion that it did. I would have reached the same conclusion on the material before it.
32. I can deal shortly with the other two grounds of challenge. I reject Mr Butler's suggestion that Dr Bhatnagar has been "subjected to game-changing". The Panel on 7 April 2014 had to reach its decision on the basis of the evidence presented at the hearing. As I have stated, on the basis of that evidence, it was entitled to reach the decision it did, and I have arrived at the same conclusion. Finally, I reject the criticism of the Panel that it failed to consider whether an order of interim conditions would be appropriate and proportionate. Dr Bhatnagar was not seeking such an order. The Panel was plainly of the view that neither revocation of the interim order, nor maintenance of the order of interim conditions, were appropriate and proportionate; in Dr Bhatnagar's words, revocation of the interim order would only have been "symbolic" for the reason he gave. I consider that the Panel was entitled to decide that in the current circumstances, having regard to the wide ranging and extremely serious nature of the allegations and the weight that it attached to them that the only appropriate and proportionate order was one of suspension. This is the conclusion that I have also reached.

Conclusion

33. For the reasons that I have given this application fails.