The High Court has quashed parts of a Medical Practitioners Tribunal Service (MPTS) determination concerning consultant gynaecologist Dr Ali Shokouh-Amiri, finding that the tribunal’s reasoning was inadequate and that it failed to engage properly with central expert and witness evidence.
The judgment in General Medical Council v Shokouh-Amiri [2026] EWHC 2226 (Admin), handed down on 28 August 2026, is significant for doctors facing GMC fitness to practise proceedings. It demonstrates that specialist tribunals have considerable discretion when assessing evidence, but that discretion is not unlimited. Tribunal decisions must be intelligible, evidence-based and sufficiently reasoned to allow the parties: and any appellate court: to understand why particular conclusions were reached.
The case also provides practical guidance for doctors and their legal teams on preparing witness evidence, presenting expert evidence and identifying appealable errors in an MPTS decision.
The background to the case
Dr Shokouh-Amiri was a consultant gynaecologist working in Guernsey during the events considered by the tribunal. The GMC brought proceedings involving six patients and 22 allegations.
The allegations included:
- A ureteric injury following hysterectomy surgery involving Patient B;
- Removal of patients’ ovaries without consent;
- Failures to provide chaperones during intimate examinations;
- Alleged inappropriate and sexually motivated conduct towards several patients;
- Alleged dishonesty relating to medical records; and
- Retention of clinical information on a personal mobile telephone.
Following a hearing in January 2025, the MPTS found some allegations proved. These included failures to provide chaperones, the removal of ovaries without consent in relation to two patients, aspects of clinical care and certain physical contact.
However, the tribunal rejected a number of the more serious allegations, including the allegation concerning the ureter injury and several allegations relating to Patient F. It concluded that Dr Shokouh-Amiri’s fitness to practise was not currently impaired and decided not to impose a sanction, although it issued a formal warning.
The GMC appealed under section 40A of the Medical Act 1983, arguing that the MPTS decision was not sufficient for the protection of the public.
What did the High Court decide?
The GMC advanced four grounds of appeal. The High Court allowed two and rejected two.
The successful grounds concerned:
- The tribunal’s finding that the ureter injury allegation involving Patient B was not proved; and
- The tribunal’s findings that various allegations concerning Patient F were not proved.
The High Court rejected the GMC’s wider challenges concerning cross-admissibility and the tribunal’s assessment of impairment on the facts that remained unaffected.
The Court concluded that the relevant MPTS decision should be quashed. This included the conclusion that Dr Shokouh-Amiri’s fitness to practise was not impaired and the decision not to make a direction.
The case was remitted to the MPTS for a fresh hearing before a differently constituted tribunal. That tribunal must reconsider only the factual allegations identified by the High Court as affected by error, together with the issue of impairment.
Patient B: failure to address the central expert evidence
The first successful ground concerned the allegation that Dr Shokouh-Amiri failed to check Patient B’s ureters during a laparoscopic hysterectomy.
Patient B attended hospital shortly after the operation with abdominal symptoms, pain and a raised inflammatory marker. A later scan identified a ureteric injury and urine leakage.
The GMC’s expert, Mr Paul Wood, considered that the clinical presentation shortly after the operation was central to the question of whether the injury was a direct transection during surgery or an indirect thermal injury which developed later.
His evidence was that the timing and nature of Patient B’s presentation were, on the balance of probabilities, indicative of a direct injury during the operation. He also stated that a competent examination of the ureters should have identified such an injury.
The tribunal accepted Dr Shokouh-Amiri’s evidence that he had checked the ureters and reasoned that a direct injury would have been obvious to an experienced surgeon. It therefore concluded that the injury was more likely to have been indirect and that the allegation was not proved.
The difficulty, according to the High Court, was that the tribunal did not address the central issue on which the expert’s opinion depended: Patient B’s presentation shortly after surgery.
The determination made no reference to the relevant post-operative presentation, despite detailed submissions from both parties and repeated expert evidence about its importance. The tribunal also failed to explain why it rejected or did not accept the expert’s analysis.
The High Court found an element of circular reasoning. The tribunal appeared to reason that:
- Dr Shokouh-Amiri said he checked the ureters;
- A direct injury would have been obvious;
- He did not identify an injury;
- Therefore, the injury was not direct; and
- His evidence that he checked the ureters could be accepted.
That reasoning assumed the answer to the very issue the tribunal had to determine. It did not properly resolve whether the clinical evidence indicated that a direct injury had occurred and whether the absence of detection demonstrated a failure to check.
The Court concluded that the tribunal had failed to consider, understand or resolve a central issue. The finding was therefore wrong or, alternatively, the reasons were not intelligible and constituted a serious procedural irregularity causing injustice.
Patient F: factual errors and selective treatment of evidence
The second successful ground concerned several allegations of inappropriate sexual conduct involving Patient F during consultations on 4 and 7 December 2018.
The High Court did not determine that every allegation was proved. Instead, it found that the tribunal’s reasoning process was materially flawed and that the affected allegations required reconsideration by a new tribunal.
Several errors were identified.
Mischaracterising the consultation
The tribunal treated the 4 December consultation as involving a gynaecological examination. The evidence showed that the immediate reason for the appointment was rectal bleeding and that a rectal examination took place. There was no evidence of a gynaecological examination on that date.
This mattered because the tribunal relied on the supposed context of a gynaecological examination when concluding that questions about intimate matters were not inappropriate.
The High Court held that the factual foundation for that reasoning was unsupported by the evidence.
Selective use of expert evidence
The tribunal referred to part of Mr Wood’s expert opinion suggesting that discussion of sexual matters might be relevant in the context of a gynaecological history and symptoms such as bleeding after intercourse or painful sex.
However, it omitted the further part of his opinion stating that the exploration of more intimate details about a patient’s sex life, as described by Patient F, would be inappropriate and seriously below the expected standard.
The High Court considered this a selective and misleading treatment of the expert evidence. A tribunal does not have to accept an expert’s opinion, but it must engage with the material parts of that opinion, particularly where the evidence is central to the issue being decided.
Misdescribing the evidential chronology
In relation to another allegation, the tribunal treated part of Patient F’s evidence as if she had only later interpreted an innocent reference to going to the cinema as an analogy for having sex with another person.
The High Court found that the tribunal had omitted the earlier part of the account, in which Patient F described two separate comments. It also incorrectly described a passage from her GMC statement as part of her police statement and wrongly stated that she had not told the police that the doctor had used words to the effect alleged.
These were not simply minor drafting issues. They affected the tribunal’s understanding of the chronology and the substance of the evidence.
Misunderstanding Patient F’s self-doubt
The tribunal relied on Patient F’s references to questioning her own sanity and whether she had misunderstood or made up events.
The High Court found that this evidence had been misunderstood. Properly read, Patient F’s doubts concerned why a trusted medical professional would behave in the way alleged, and whether such conduct could really have happened: not whether she genuinely remembered the events.
The Court also noted that her early account to the police was detailed and that she had expressed a clear belief that the events had occurred.
The tribunal’s treatment of this evidence therefore failed to engage with the evidence as a whole.
The importance of adequate reasons
Under Rule 17 of the GMC Fitness to Practise Rules, an MPTS tribunal must give reasons for its findings of fact and its conclusions on impairment.
The High Court reaffirmed that reasons must be:
- Proper and adequate;
- Intelligible;
- Addressed to the substantial points raised by the parties;
- Consistent with the evidence; and
- Free from material errors of reasoning.
A tribunal is not required to write an unnecessarily long judgment or refer to every piece of evidence. In a straightforward dispute, it may be enough to explain briefly why one account is preferred over another.
The position changes where the case is complex, the evidence is contested or expert evidence is central. In those circumstances, the determination must show that the tribunal has confronted the important issues and explain why it accepted or rejected the relevant evidence.
The High Court referred to authorities including Southall v GMC and Byrne v GMC. The general principle is that an appellate court should be cautious before interfering with factual findings by a specialist tribunal. However, deference does not protect findings that are plainly wrong, out of tune with the evidence, based on a serious procedural irregularity or supported by reasons that cannot be understood.
When can an MPTS decision be appealed?
There are different appeal routes depending on who is appealing.
A doctor may have a statutory right of appeal under section 40 of the Medical Act 1983 against certain appealable decisions, including directions for erasure, suspension or conditions. Strict time limits apply, generally requiring an appeal to be filed within 28 days of notification of the decision.
The GMC has a separate power under section 40A to challenge certain tribunal decisions where it considers that the decision is not sufficient for public protection. That was the route used in Shokouh-Amiri, because the tribunal had found no impairment and had made no direction.
An appeal is not an opportunity simply to reargue the entire case or substitute a different view of the evidence. The appellant must identify a proper basis for intervention, such as:
- An error of law or legal misdirection;
- A material misunderstanding or misreading of evidence;
- Findings unsupported by the evidential record;
- Inadequate or unintelligible reasons;
- A serious procedural irregularity causing injustice; or
- An error in the approach to impairment or sanction.
The MPTS appeals guidance and the current legislation should be checked carefully. Specialist advice should be obtained urgently because missing the applicable deadline may seriously prejudice an appeal.
Practical lessons for doctors facing GMC proceedings
1. Witness evidence must address the real issues
A witness statement should do more than provide a general denial. It should identify the relevant events, explain the doctor’s position clearly and respond to the specific factual issues likely to determine the case.
Where the doctor cannot remember an event, that should be stated honestly. A carefully explained account of what the doctor’s usual practice was may be relevant, but it should not be presented as a substitute for evidence about the particular occasion.
2. Expert evidence must be properly tested and presented
In clinical allegations, expert evidence may be decisive. The defence should identify:
- The precise opinion relied upon by the regulator;
- The factual assumptions underlying that opinion;
- Any alternative clinical explanations;
- Whether the expert has addressed the doctor’s evidence; and
- Whether the expert’s conclusion changes when the factual assumptions change.
It is also important to ensure that the tribunal is directed to the parts of the expert evidence that support the defence case, not only the regulator’s conclusions.
3. The defence case must be visible in the determination
At the conclusion of a hearing, a doctor should be able to understand why the tribunal accepted or rejected the central parts of the defence.
This does not mean that every submission must be repeated. It does mean that the determination should address the material issues: conflicting accounts, important documents, expert disagreements, chronology, credibility and any alternative explanation advanced by the doctor.
If the tribunal’s reasons do not engage with the defence case, that may be relevant to an appeal.
4. Appeal analysis must focus on identifiable error
A disappointing result is not necessarily an appealable result. The question is whether the decision was wrong or unjust because of a serious procedural or other irregularity.
A prompt review of the determination, hearing transcript, expert reports and written submissions is essential. Potential errors should be analysed precisely, with attention to whether they affected the outcome.
What does the judgment mean for doctors?
Shokouh-Amiri is not authority for the proposition that a tribunal must accept expert evidence or that every factual mistake will invalidate a determination.
Its importance lies in the limits it places on tribunal reasoning. An MPTS tribunal must assess the evidence fairly, avoid circular reasoning, correctly understand the factual record and address central expert evidence. Where it does not, the High Court may intervene: even though appellate courts generally respect the specialist role of the tribunal.
For doctors facing a GMC investigation, hearing or appeal, the case underlines the importance of early preparation and specialist representation. Advice from experienced GMC defense solicitors and medical license defense solicitors can help protect your position, test the evidence and identify whether an MPTS decision is legally challengeable.
Contact Tyndel Solicitors’ doctors’ defence team for advice about GMC fitness to practise proceedings, MPTS hearings and appeals.
This article is for general information only and does not constitute legal advice. The law and procedural requirements may change, and advice should be obtained on the facts of the individual case.
