The report of the review group examining the cases of Dr A, whose members were nominated by the Institute of Obstetricians and Gynaecologists, will have no formal legal standing. However, its conclusions will have enormous influence on the future of Dr A, as it will be seen as the judgment of a group of eminent fellow professionals.
The terms of reference for the review group were agreed recently between the health board and the doctor. The review process is expected to take four months.
This review, however, is quite separate from any Medical Council action. The Medical Council is empowered to censure, suspend or strike off medical practitioners in certain circumstances.
Part V of the Medical Practitioners Act (1978) deals with the issue of doctors' fitness to practise. It states: "The Medical Council or any individual may apply to the council's Fitness to Practise Committee for an inquiry into the conduct of a registered medical practitioner on the grounds of (a) his alleged professional misconduct (b) his fitness to engage in the practice of medicine by reason of physical or mental disability."
The Medical Council's recently published ethical guidelines define professional misconduct as "conduct which doctors of experience, competence and good repute upholding the fundamental aims of the profession consider disgraceful or dishonourable".
The Medical Council cannot, however, inquire into allegations of medical negligence. If a doctor makes a mistake, for example, the council cannot inquire into it unless there is also an allegation of misconduct or unfitness due to physical or mental factors.
When an application for an inquiry is made the 13-member Fitness to Practise Committee will first consider whether there is a prima facie case against the practitioner. The committee is currently chaired by Prof Patricia Casey and comprises nominees of the Minister for Health and members elected by doctors.
The committee writes to the doctor against whom a complaint is made, enclosing a copy of the complaint and seeking observations and comments. If it is decided that there is a case to be answered, the committee issues a notice of inquiry together with names of witnesses and details of the nature of the evidence. Medical Council hearings do not have to be held in private but invariably are.
The registrar of the Medical Council presents the evidence with a legal team. The doctor is usually represented by legal counsel as well. Witnesses are called and cross-examined. The standard of proof required varies depending on the seriousness of the case. Generally speaking the more serious the allegation the higher the standard of proof required.
The committee then produces a written report which is sent to the full Medical Council. If the complaint is proven, the council must then consider what sanction to impose.
It can strike off a medical practitioner, preventing him or her from working as a doctor again. It can impose a suspension, attach conditions to the individual's work (it could insist, if appropriate, on a doctor undergoing alcohol dependency treatment), censure, admonish or - the mildest sanction - advise the doctor as to future conduct.
The practitioner can then apply to the High Court within 21 days, seeking to have the decision set aside. The Medical Council must apply to the High Court for confirmation of its decision.
The findings of the Fitness to Practise Committee cannot be made public without the consent of the practitioner, unless he or she has been found guilty of misconduct or unfitness to practise.