This insight considers the decision in the General Medical Council’s (GMC) appeal against the Medical Practitioners Tribunal decision relating to Dr Chitlapalli Sathyanath. The High Court upheld the GMC’s challenges to the approach taken to factual allegations and the issue of alleged sexual motivation.

The judgment in General Medical Council v Sathyanath [2026] EWHC 2479 (Admin) provides a useful summary of the law on appellate interference with different types of findings by disciplinary tribunals and the approach to be taken to allegations of sexual motivation.

Background

The allegations against the doctor related to a consultation with Patient A which involved him touching her groin area. It was alleged that those actions were not clinically indicated and were sexually motivated. The doctor argued that his actions were clinically indicated, and the Tribunal heard from GMC and defence experts on that issue.

A number of allegations were found proved, but the Tribunal found that the examination had been clinically indicated and the doctor’s actions were not sexually motivated. The Tribunal found that his fitness to practise was not impaired and issued a formal warning. The GMC appealed.

Appeal

In its appeal, the GMC challenged certain factual findings made by the Tribunal. The GMC also argued that the Tribunal had failed to consider indicators of sexual motivation and/or had not properly explained its finding that the conduct was not sexually motivated and that the finding of no impairment was wrong and/or not properly reasoned.

Mr Justice Morris identified three categories of findings by disciplinary tribunals and the associated degree of deference to be shown by the appeal court:

1. Findings of primary fact (based on direct perception): the governing principle is that the appeal court will be very slow to interfere with those findings made by the court below and will only do so in exceptional circumstances.
2. Findings of secondary or inferential fact (findings of fact based on inferences from primary facts): the appeal court may draw any inferences of fact which it considers justified on the evidence. In general, the appeal court will be more ready to interfere with such findings than with findings of evaluative judgment.
3. Findings based on evaluative judgment: the approach will vary depending on the nature of the evaluation. In general, the appeal court will not interfere unless satisfied that the conclusion of the panel lay outside the bounds within which reasonable disagreement is possible. Where the application of a legal standard involves no question of principle, but is a matter of degree on the facts of the case, the appeal court will be reluctant to interfere with the judgment reached by the panel; and the more factors involved in the assessment, the greater the reluctance to interfere.

Judgment

Mr Justice Morris held that:

1. The issue of sexual motivation was an issue of secondary fact. The Court should afford appropriate deference to the judgment of the disciplinary body as to a finding of primary fact where that was based in significant part on an assessment of the credibility of a witness. In such a case, the Court should apply similar caution as it would to a challenge to a finding of primary fact.
2. The Tribunal’s conclusion that the doctor’s conduct was clinically indicated was an evaluative finding of fact, based on matters of primary fact and medical expertise and opinion. As such, the issue was whether that conclusion was based on an error of principle or fell outside the bounds of what an adjudicative body could properly and reasonably have decided – and thus, was wrong.

In relation to the grounds of appeal, he held as follows:

1. The conclusion that the doctor’s conduct was clinically indicated was wrong. The Tribunal had considered whether the examination was clinically indicated when it should have considered whether the specific actions referred to in each of the allegations was clinically indicated. There was no evidence that some of those actions (that the Tribunal had found had occurred) were clinically indicated.
2. The Tribunal had based its finding that the conduct was not sexually motivated on its finding that the examination was clinically motivated, and as such that was based on a fundamental error. Further, the Tribunal had failed to take into account a number of material facts relevant to the issue of sexual motivation. These included the inherently sexual nature of slowly brushing the pubic region, the fact that the touching of the pubic area occurred before any examination of the groin, Patient A’s own view that the conduct was sexually motivated, where she had had extensive experience of groin examinations following breast cancer, the groin examination was not recorded in the clinical notes and that the doctor only examined the groin and not other areas that it would have been more important to check if he had been concerned about the recurrence of cancer.
3. The criticisms made of the Tribunal’s decision on impairment were not such as to amount to an error of principle in the specialist tribunal’s evaluative judgment, or that the Tribunal’s assessment fell outside the bounds of what an adjudicative body could properly and reasonably decide. Whilst this ground was rejected, it had become academic given the Judge’s findings on the other grounds.

Mr Justice Morris quashed the decisions on clinical indication, sexual motivation and impairment. He substituted a finding that the specific actions found proved were not clinically indicated and remitted the questions of sexual motivation, misconduct and impairment for consideration by a differently constituted panel.

Capsticks’ view

This case demonstrates the importance of disciplinary panels taking a granular approach to allegations involving evaluative issues, such as clinical indication and sexual motivation. Panels should address each specific action to which those allegations have been applied, rather than taking a holistic view and assessing the conduct as a whole. That approach may be appropriate when considering misconduct, impairment and sanction but is not correct at the fact-finding stage. The judgment also provides a useful reminder of the need for panels to consider all relevant factors when making findings of secondary/inferential fact and ensuring consistency with the other findings made.

Finally, the case demonstrates the willingness of the appeal court to substitute its own findings of fact in appropriate circumstances.

How Capsticks can help

Capsticks’ market-leading professional regulatory lawyers act for a wide range of statutory and non-statutory regulatory bodies. Our team of specialists is experienced at navigating complex issues such as those discussed in this article. To find out more, please contact Ros Foster, Partner in the Regulatory Division.