High Court confirms Nursing Board's cancellation of nurse's registration as reasonable and proportionate.

THE HIGH COURT

[APPROVED] [2025] IEHC 557

(2025 326 MCA)

IN THE MATTER OF SECTION 74 OF THE NURSES AND MIDWIVES ACT 2011

(AS AMENDED) AND IN THE MATTER OF A NURSE AND IN THE

APPLICATION OF THE NURSING AND MIDWIFERY BOARD OF IRELAND

(BORD ALTRANAIS AGUS CNÁIMHSEACHAIS NA hÉIREANN)

BETWEEN

THE NURSING AND MIDWIFERY BOARD OF IRELAND

APPLICANT

AND

RONAN MARTIN BURKE

RESPONDENT

JUDGMENT of Mr Justice David Barniville, President of the High Court, delivered on the 23rd day of October 2025 Index

1. Introduction………………………………………………………………………………3

2. Overview and Summary of Decision……………………………………………………4

3. Hearing in Public………………………………………………………………………...5

4. The Parties………………………………………………………………………………..5

5. The Board’s Application………………………………………………………………...5

6. The Report of the Fitness to Practise Committee……………………………………..10

7. Board Meeting on 11 June 2025………………………………………………………..13

8. The Board’s Decision of 11 June 2025………………………………………………....16

9. Notification of Decision to Mr Burke………………………………………………..…18

10. The Board’s Confirmation Application………………………………………………18

11. The hearing on 21 July 2025…………………………………………………………..19

12. The hearing on 13 October 2025………………………………………………………20

13. Decision on the Board’s Confirmation Application………………………………….23

14. Orders to be made……………………………………………………………………...30

1. Introduction

1. At a meeting on 11 June 2025, the Nursing and Midwifery Board of Ireland (the “Board”) decided, pursuant to s. 69(1)(f) of the Nurses and Midwives Act 2011 (as amended) (the “2011 Act”), to impose the sanction of cancellation on the Respondent nurse, Ronan Burke, as recommended by the Fitness to Practise Committee of the Board (the “Committee”). The Board has now applied to the High Court pursuant to s. 74(1) of the 2011 Act for confirmation of its decision to impose that sanction.

2. The Board’s application to the court to confirm the decision first came before me on 21 July 2025. It was adjourned on that date to 13 October 2025 to enable Mr Burke to bring an application to extend the time to appeal against the decision to the court, should he so wish, with directions being given in the event that such an application was to be made. Mr Burke did not bring such an application. On the adjourned date, 13 October 2025, Mr Burke informed the Court that he was not seeking to appeal against the decision and reiterated the reasons for his decision not to do so which had previously been communicated to the Board in an email sent by Mr Burke on 5 September 2025. Amongst the reasons given by Mr Burke were that he could not afford the cost of engaging legal representation for the purposes of an appeal and that he had been let down by a person who he believed was a legal representative who could assist him. However, Mr Burke did oppose the Board’s confirmation application and sought to rely on (amongst other materials) a statement which he had sent to the Board by email on 10 October 2025 and on a document which set out grounds of appeal which he would have sought to advance had he decided to proceed with an appeal against the decision and which had previously been provided to the Board.

2. Overview and Summary of Decision

3. I heard the Board’s confirmation application on 13 October 2025. Mr Burke opposed the application. At the conclusion of the hearing, I indicated that I would consider the submissions of the parties and give my judgment later in the week (unfortunately, it has taken a few more days than anticipated due to court sittings and other commitments).

4. For the reasons set out in this judgment, I have decided that I must confirm the Board’s

decision. Section 74(3) of the 2011 Act requires the High Court, on a confirmation application such as this, to confirm the relevant decision unless it sees “good reason not to do so”. There is a well-established body of case law as to how that test, which is contained not just in the 2011 Act but in other similar legislation, is to be interpreted and applied. I will refer briefly to that case law later in this judgment.

5. There was clear uncontroverted expert evidence before the Committee and before the Board that Mr Burke suffers from a mental disorder, being a paranoid persecutory psychosis or a personality disorder, on the basis of which the Committee was satisfied beyond reasonable doubt that Mr Burke has a “relevant medical disability” within the meaning of that term in s. 2 of the 2011 Act. I am satisfied that, on the basis of this clear uncontroverted evidence and having carefully considered the submissions made on behalf of the Board and by Mr Burke in opposition to the Board’s application, I could not be satisfied that there is “good reason” not to confirm the Board’s decision. On the contrary, I am satisfied that the Board’s

decision was the correct one, and that any other decision by the Board would have been unreasonable and irrational. I am required, therefore, by s. 74(3) to confirm the Board’s

decision. I will, therefore, make the order sought by the Board confirming its decision that Mr Burke’s registration be cancelled.

3. Hearing in Public

6. Notwithstanding the expert evidence that Mr Burke suffers from a medical condition, Mr Burke did not seek any order under s. 27 of the Civil Law (Miscellaneous Provisions) Act 2008 (the “2008 Act”). This application was heard in public. I have, however, decided to adopt the approach taken in a number of the previous cases such as Medical Council v Anonymous [2019] IEHC 109 (Kelly P), and to direct that the members of staff who were the alleged victims of Mr Burke’s conduct and the name of the company in which Mr Burke and those members of staff were working at the time have their identities anonymised. That was the approach taken before the Committee and the Board. I am satisfied that that approach is consistent with the approach taken in previous cases and with the principles set out by the Supreme Court in Gilchrist and Rogers v Sunday Newspapers Ltd [2017] 2 IR 284.

4. The Parties

7. The Board was established pursuant to Part 2 of the Nurses Act 1985 and was continued in being by s. 6 of the 2011 Act. The Board established and maintains a register of nurses and midwives under that Act. Mr. Burke’s name appears on the register, and he is registered in the psychiatric nurse division of the register.

5. The Board’s Application

8. The Board brought this application to the High Court pursuant to s. 74(1) of the 2011 Act seeking confirmation of the decision made by it on 11 June 2025 that Mr Burke’s registration be cancelled. The evidence on foot of which the Board’s application is brought is set out in a number of affidavits sworn by Carolyn Donohoe, who is now the Chief Executive Officer of the Board. In her first affidavit which was sworn on 9 July 2025, at a time when she was the interim Chief Executive Officer of the Board, Ms Donohoe explained the background to the Board’s application. I will now summarise the relevant background to this application.

9. The Preliminary Proceedings Committee of the Board (the “PPC”) received a complaint in relation to Mr Burke from a director of a healthcare company that briefly employed Mr Burke (the “Company”) in November 2019. In the complaint, it was stated that Mr Burke was employed as a clinical lead and commenced employment with the Company on 11 November 2019. The complaint alleged that Mr Burke had given the Company “some serious grounds for concern” and noted that more than 40 communications had been received by members of the Company’s staff over a weekend (from Thursday 21 November to Monday 25 November 2019). The complaint asserted that Mr Burke might be a risk to himself, colleagues and patients. The Company was concerned to the point that it could not consider allowing Mr Burke to meet its clients or next of kin (something the Company said had not happened during Mr Burke’s nine days working for the Company). The complaint further asserted that Mr Burke’s behaviour gave rise to serious grounds of concern including potential issues of addiction or mental health. Amongst the communication from Mr Burke which was recorded in the complaint included a description of the CEO of the Company as being “Fenian” and that he [the CEO] might have him (Mr Burke) killed over the weekend. Other email communications contained a reference to the “unborn” of the Head of Nursing of the Company on several occasions and described the CEO as “money grabbing and without a soul”. The complaint also noted the use of profanities and threats by Mr Burke in multiple communications. Apart from the volume of communication, the complaint noted that the communications came at sporadic hours and often in batches of quick succession, sometimes with conflicting content which, on occasion, were followed by subsequent apologies from Mr Burke. The complaint stated that the HR Manager of the Company was in deep distress following a verbal assault from Mr Burke. It also noted a number of unfounded threats to report the Company to the HSE and other bodies, despite the fact the Mr Burke was allegedly not involved in any operational areas during his short induction phase with the Company.

10. Consideration was given at the time of receipt of the complaint to bringing an application for orders under s. 58 of the 2011 Act to suspend Mr Burke’s registration as a registered nurse. It was initially decided by the Board not to bring such an application. However, the Board did subsequently bring such an application in September 2023 following a meeting of the Board on 20 September 2023. Orders were made by the Court at that stage. Those orders were continued on various dates thereafter. It would not be appropriate for me in this judgment to refer in detail to the evidence and material relied on by the Board in the context of the s. 58 proceedings, since those proceedings were heard otherwise than in public as required by s. 58(2) of the 2011 Act. While the Applicant did not oppose the orders, he did send a multitude of communications to the Board and its solicitors (many of which were copied to the Professional Disciplinary List Registrar). Ultimately, the orders made by the Court from time to time in the s. 58 proceedings were superseded by the outcome of the fitness to practise process under Part 8 of the 2011 Act, which led to the

decision of the Board, of which confirmation is now sought. It is only fair to point out that Mr Burke became increasing frustrated with the length of time it was taking to finalise the fitness to practise process and re-entered the matter before the court in order to seek the court’s assistance in bringing that process to a conclusion.

11. I now turn to that fitness to practise process. The complaint made by the Company was considered by the PPC at a meeting on 27 May 2020. The PPC formed the opinion that there was a prima facie case for the holding of an inquiry in relation to Mr Burke’s conduct on the grounds of alleged professional misconduct, non-compliance with a code of professional conduct and relevant medical disability. The complaint was then referred to the Committee (i.e. the Fitness to Practise Committee of the Board) under Part 8 of the 2011 Act.

12. A Notice of Inquiry dated 27 October 2023 was prepared and served on Mr Burke. It contained factual allegations that Mr Burke, being a registered nurse, while employed at the Dublin office of the Company, engaged in certain conduct which may be summarised as follows:

(1) On 21 November 2019, Mr Burke met with members of staff working at the Company including [a specified member of staff] and asked him whether he had thought about committing suicide; and/or

(2) On 21 November 2019, Mr Burke shouted at [witness D], the Company’s HR Manager, causing her to be concerned about her safety; and/or

(3) On various dates between 21 November 2019 and 25 November 2019 inclusive, Mr. Burke sent a number of emails that were scheduled to the Notice of Inquiry to [witness E], the CEO of the Company (a) the number of which was inappropriate and/or (b) in one or more of which the content was inappropriate and/or disrespectful and/or abusive; and/or

(4) On various dates between 22 November 2019 and 25 November 2019 inclusive, Mr Burke sent further emails to [witness F], the clinical director of the company (a) the number of which was inappropriate and/or (b) in a number of which the content was inappropriate and/or disrespectful and/or abusive; and/or

(5) On various dates between 23 November 2019 and 29 November 2019 inclusive, Mr. Burke sent certain other emails to [witness A], a director of the Company (a) the number of which was inappropriate and/or (b) in a number of which the content was inappropriate and/or disrespectful and/or abusive; and/or

(6) On various dates between 1 April 2020 and 27 April 2020 inclusive, Mr. Burke sent certain emails to [witness B] and/or [witness A], both directors of the Company some of which (a) were inappropriate and/or (b) in respect of some of which the context was inappropriate and/or disrespectful and/or abusive.

13. The Notice of Inquiry alleged professional misconduct against Mr Burke, non-compliance with a code of professional conduct (being the “Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives” (December 2014)) published by the Board, and a relevant medical disability. The allegation in that respect was that Mr Burke suffers from a physical and/or mental disability which may impair his ability to practise nursing or a particular aspect thereof in that he: “(i) suffers from paranoid psychosis and/or paranoid personality disorder; and/or (ii) suffers from a history of psychosis and/or persecutory-type delusional disorder.”

14. The inquiry under Part 8 of the 2011 Act was held before the Committee over the course of ten days (or parts of days) on 12 and 13 February 2024, 19 and 22 April 2024, 21 May 2024, 1 July 2024, 9 September 2024, 11 November 2024, 8 January 2025 and 2 April 2025. Mr Burke was present at the inquiry on all of those dates except 12 and 13 February 2024 and 2 April 2025. He was not legally represented on any of those dates. The Committee heard evidence from a number of witnesses, some of whom were cross examined by Mr Burke. I have been provided with copies of the transcripts of the evidence before the Committee as well as the documents exhibited in the course of the inquiry.

15. The Committee prepared a report following the inquiry on 1 April 2025 (the “Report”) and submitted the Report to the Board as it was required to do under s. 67(1) of the 2011 Act.

6. The Report of the Fitness to Practise Committee

16. In its Report, the Committee found that all seven of the factual allegations were proven as to fact beyond reasonable doubt. The Committee set out in detail in its report its reasons for so finding. The Committee then considered the allegation that Mr Burke is suffering from a relevant medical disability. The Committee noted in the report that that allegation was advanced on the basis of a report by Dr Paul O’Connell, consultant forensic psychiatrist, dated 30 August 2023 which was supplemented by an addendum report dated 9 May 2024. It is fair to record that Mr Burke was very critical of the circumstances in which both reports were prepared, and he repeated his criticism, particularly in relation to the addendum report, in his opposition to the Board’s confirmation application.

17. In the Report, the Committee noted that Mr Burke had been requested by the CEO of the Board to attend for psychiatric assessment. There were difficulties in relation to conducting such an assessment including by reason of conditions which Mr Burke sought to impose. Another difficulty was encountered when a different psychiatrist was identified to carry out the assessment, but that psychiatrist was of the view that a consultant forensic psychiatrist (rather than a general psychiatrist) was the appropriate expert to assess Mr Burke. Dr O’Connell was then engaged by the CEO of the Board. The Report notes that Mr Burke was offered an appointment to attend with Dr O’Connell in June 2023, but that he declined that appointment. The Committee noted that Dr O’Connell was required to carry out a desktop type exercise for the purposes of his first report. He describes that report as being preliminary, provisional and qualified. While noting that, the Committee considered Dr O’Connell’s first report to be “compelling”. For the reasons which were set out in detail in the Report, the Committee recorded Dr O’Connell’s opinion in his first report that, as of the date of the Report, Mr Burke was suffering from a relevant medical disability which might impair his ability to practise nursing or a particular aspect thereof. The report noted that based on the available evidence, Dr O’Connell was of the opinion that Mr Burke was suffering from a relevant medical disability, being “an untreated paranoid psychosis”. Dr O’Connell subsequently made clear that he had “no doubt” that Mr Burke suffered from a relevant medical disability. The Committee’s Report then set out the basis on which Dr O’Connell formed that opinion. The report notes that Mr Burke objected to Dr O’Connell addendum report as Dr O’Connell conducted his assessment of Mr Burke on the basis of observing him at the inquiry (for which Mr Burke had not provided his consent). However, the Committee decided in a reasoned decision dated 21 May 2024 that the CEO of the Board could rely on the addendum report.

18. The Committee concluded on the uncontroverted evidence of Dr O’Connell that there was no doubt in relation to the findings of that report, and that Mr Burke suffers from a mental disorder, being a paranoid persecutory psychosis or a personality disorder, and that this constitutes a relevant medical disability. The Committee was, therefore, satisfied beyond reasonable doubt that Mr Burke has a relevant medical disability, as defined in s. 2 of the 2011 Act being a paranoid psychosis and/or paranoid personality disorder and/or a history of psychosis and/or a persecutory type delusional disorder. The Committee was further satisfied that Mr Burke’s relevant medical disability continues to exist, on the basis of Dr O’Connell’s reports. It noted also the evidence that Mr Burke’s mental health difficulties go back as far as 2011, have featured in his workplace since then and were present in 2019 and 2020. The Report notes that the Committee was satisfied that the long-standing existence of these mental health issues, the recent report of Dr O’Connell, and the lack of any evidence that Mr Burke has sought or obtained any substantive treatment or counselling for his condition meant that the relevant medical disability continued to exist at the time of the Report.

19. The Committee then went on to consider the allegation of professional misconduct and a breach of the relevant code. The Committee was satisfied that Mr Burke’s relevant medical disability constituted a complete defence to the allegation of professional misconduct and a breach of the relevant code on the basis that the acts the subject of those allegations occurred at a time during which Mr Burke was actively labouring under a relevant medical disability. The Committee set out its reasoning to that effect in respect of the first six allegations. It similarly concluded that the conduct the subject of the seventh allegation did not constitute professional misconduct or a breach of the code.

20. The Committee then set out its recommendation to the Board in respect of sanction. The Committee recommended cancellation of Mr Burke’s registration from the register. It also recommended that certain conditions be attached to his registration. The Committee then set out its rationale for those sanctions. In that context, it noted that Mr Burke suffers from the relevant medical disability outlined earlier. It referred to Mr Burke’s history of depression and stress in the workplace and noted that he has a long history of mental health difficulties which have manifested themselves in the workplace in different contexts. The Committee noted that his condition is chronic, and that he is “vulnerable to experiencing an acute presentation”. It referred to the uncontroverted expert evidence noting that Mr Burke displays “flight of ideas” and characteristics of grandiose, paranoia and querulent thinking and processing and that he has displayed instances of anger and hostility and engaged in threatening behaviour. The Committee was of the view that his conduct is indicative of impaired judgement, and that he is liable to make poor decisions. The Committee further stated that there was no evidence of Mr Burke having undergone treatment for his mental health difficulties and that he had failed to engage properly with attempts to have him assessed for the purposes of the inquiry. The Committee felt that the evidence pointed not only to a lack of engagement or co-operation, but a lack of insight into his mental health issues. The Committee stated that those failures were culpable.

21. It should be noted here that at the hearing of the confirmation application on 13 October 2025, Mr Burke rejected the finding that he had not displayed insight and referred to the fact that he had gone to his general practitioners in Cork and was on certified sick leave between August 2023 and October 2024.

22. While the Committee acknowledged that there had been no instance of concern for patient safety arising from Mr Burke’s relevant medical disability, his condition did go to public safety and the Committee had no confidence that Mr Burke could practise safely. While acknowledging that there was no culpability in a person suffering from a relevant medical disability, the Committee found that Mr Burke’s failure to attend for assessment or evaluation was culpable. Having considered the Board’s Guidance as to Sanction, the Committee was satisfied that the sanction it was recommending to the Board was appropriate and proportionate for the reasons set out at the conclusion of its Report.

23. The Committee’s Report was submitted to the Board as required by s. 67 of the 2011 Act. A copy was also sent to Mr Burke with a cover letter dated 2 April 2025.

7. Board Meeting on 11 June 2025

24. Mr. Burke was informed that the Board would meet to consider the Committee’s report pursuant to s. 69(1) of the 2011 Act on 11 June 2025. Mr Burke sent in a lengthy written submission to the Board which is dated 3 June 2025. Mr Burke did not attend and was not represented at the meeting. I have been provided with the transcript of the meeting and with the documents which were before the Board at that meeting, including Mr Burke’s submission of 3 June 2025 and the documentation attached to it, which I have carefully considered for the purposes of this judgment.

25. Of note, in addition to raising issues in relation to the procedures adopted by the Committee for the purposes of the inquiry, Mr Burke stated that he had made clear from the start of the process that he was not prepared to expend funds in registering with the Board having regard to the alleged deficiencies in the fitness to practise process outlined in his submission, including the delay of the completion of the process. On that basis, he submitted that the outcome of the inquiry was “less significant” to him, apart from “restoring [his] reputation” and “moving on” from what he described as “five years and seven months [of an] abusive situation”.

26. It is clear from the transcript of the meeting of the Board that the Board had been provided with Mr Burke’s written submission and the Board was advised by its legal assessor that it was required to consider those submissions in detail. It was also advised that no adverse inference should be drawn from the fact the Mr Burke was not present at the meeting.

27. The legal assessor, Ronan Kennedy SC, advised the Board, correctly in my view, that the Board’s role was not to revisit or review any of the findings of fact made by the Committee and that its role was confined solely to the discrete issue of sanction. Mr Kennedy SC advised the Board (as appears from the transcript) that in his submission, Mr Burke advanced extensive observations as to why the findings ought not to have been made by the Committee against him. Mr Burke made clear that he did not accept the findings made by the Committee and he did not accept that his ability to practise nursing was impaired by any alleged relevant medical disability. Mr Kennedy SC had further explained to the Board that Mr Burke’s position, as appeared from his submissions was that he was not (and is not) suffering from a relevant medical disability, that he had suffered from an occupational injury which was fully resolved through his prior attendance with his general practitioner, that he did not pose (and is not posing) any risk to the public and that he intended to appeal against the findings made by the Committee in due course. Mr Kennedy SC further advised the Board that it was a matter for the Board to determine, but that it was clear from the transcripts of the evidence before the Committee and from the Committee’s Report that it had given very careful consideration to the evidence and had adopted a “sympathetic approach” towards Mr Burke in determining that it would not be appropriate to make findings of professional misconduct or of a breach of a relevant professional code against Mr Burke. This was the case notwithstanding the existence of expert evidence which might have supported such findings. The Committee had adopted that approach on the basis that it was satisfied that Mr Burke had a relevant medical disability which constituted a complete defence to the allegations of professional misconduct and of breaches of the code.

28. Mr Kennedy SC advised the Board that it was not bound by the recommendation made by the Committee as it was the role of the Board to determine the appropriate sanction. He then advised the Board as to the relevant principles to be applied in determining the appropriate sanction. Mr Kennedy SC did, however, address a legal issue which arose from the recommendation of the Committee that, in addition to cancelling Mr Burke’s registration, the Board should also attach a number of conditions to his registration. He advised that that would not be legally appropriate in circumstances where, on cancellation, Mr Burke’s registration would be at an end. The question of conditions would only arise, he advised, if at a future point in time Mr Burke was to apply for restoration to the register. If he were to make such an application, the Board was advised, consideration could then be given by the Board as to whether or not conditions should be attached to his registration.

29. Having considered the advice of the legal assessor, the Board then heard a submission on behalf of the Board’s CEO. In her submission on behalf of the CEO, Ms Hackett agreed with the advice provided by Mr Kennedy SC in relation to the role of the Board at that stage of the statutory process. She stressed that the Board was not permitted to go beyond the findings made by the Committee, including its finding that Mr Burke was suffering from a relevant medical disability. Ms Hackett stressed the Board’s role was to decide on the appropriate sanction to be imposed in light of the findings made by the Committee. She contended that most of the matters set out in Mr Burke’s written submissions were not relevant to the issue which the Board had to decide, namely, the question of sanction. Ms Hackett did refer to some of the evidence given by Dr O’Connell, including the following evidence which Dr O’Connell gave on day 5 of the inquiry; “A paranoid delusion or a paranoid psychotic belief is one where a person believes that they are central to what they perceive to be threats against them, or miscommunication, or conspiracy and they will find confirmatory evidence to support this belief in material that may not appear to be relevant to other parties.”

30. A summary of that evidence was set out by the Committee in para. 14 on page 18 of 25 of its Report. Ms Hackett then put forward the CEO’s position in relation to the recommended sanction. She submitted that the approach taken by Mr Burke in his submissions provided to the Board was consistent with the Board’s finding that Mr Burke lacked insight into his condition. She noted that Mr Burke had given no indication that he planned to engage or undertake treatment for his relevant medical disability or to take any steps to address his practice and as to how he could return to safe practice. She submitted that cancellation of Mr Burke’s registration was the most appropriate sanction. She also agreed with the advice of the legal assessor in relation to the inappropriateness of conditions in the event that Mr Burke’s registration was to be cancelled.

31. Following a short adjournment, the Board returned and announced its decision. The decision is recorded in the transcript and was subsequently recorded in the typed minutes of the meeting.

8. The Board’s Decision of 11 June 2025

32. The Board decided, having considered all the documentation in the case, the advice of its legal assessor and Mr Burke’s written submission, to impose the sanction of cancellation of Mr Burke’s registration, as recommended by the Committee pursuant to s. 69(1)(f) of the 2011 Act. The Board noted that, in light of the advice received from its legal assessor, it did not consider it appropriate to impose the additional conditions recommended by the Committee in circumstances where it was deciding to cancel Mr Burke’s registration. The Board stated that the necessity or otherwise for conditions would fall to be considered at a future point in time, in the event that an application was made by Mr Burke for registration or for restoration to the register.

33. In reaching that decision, the Board stated that it was adopting in full the reasoning provided by the Committee in its Report. The Board stated that it had had “very careful regard” to the additional written submission received from Mr Burke. It observed that the majority of the submission addressed the issue of why the findings ought not to have been made by the Committee as opposed to the issue of sanction. However, having afforded those submissions as much weight as it could, the Board stated that it was firmly of the view that cancellation was necessary, appropriate and proportionate having regard to the risk to the public, particularly in light of what it saw as Mr Burke’s persistent and ongoing lack of insight into his medical condition and the lack of evidence that Mr Burke had received or was receiving treatment in respect to his relevant medical disability.

34. The Board went on to deal with the question of publication and concluded that there would be no publication on the Board’s eZine (the Board’s monthly newsletter) or on its website regarding the matter. In light of the fact that the case involved the finding of a relevant medical disability, it decided that publication was not in the public interest. However, it decided that notification would be given to the relevant bodies under s. 82 of the 2011 Act. The Board also agreed that the transcript would not be published as it was not in the public interest to do so. It further decided that it would not make a notification to the National Vetting Bureau (pursuant to s. 19 of the National Vetting Bureau (Children and Vulnerable Persons) Act 2012) in respect of Mr Burke as it did not have a bona fide concern that Mr Burke presented a risk of harm to children or vulnerable adults and was not satisfied that the relevant statutory criteria set out in that section had been met in this case.

9. Notification of Decision to Mr Burke

35. Mr Burke was informed of the Board’s decision in a letter sent by Ms Donohoe on 13 June 2025. That letter quoted the Board’s decision and the reasons for it. It also advised Mr Burke that he could bring an appeal from the decision under s. 73(1) of the 2011 Act “not later than

21 days after receipt of the notice of decision” and that, once the appeal period had lapsed without any appeal being brought, an application would be made by the Board to the High Court to confirm the Board’s decision to impose the sanction of cancellation. Mr Burke was furnished with a copy of the transcript of the Board meeting.

10. The Board’s Confirmation Application

36. Mr Burke did not bring an appeal to the High Court against the Board’s decision within the 21- day period referred to in s. 73(1) of the 2011 Act, or at all. The Board issued its confirmation application on 10 July 2025 with a return date of 21 July 2025. As noted earlier, the Board’s confirmation application was grounded on the affidavit sworn by Ms Donohoe on 9 July 2025. Mr Burke did not swear any replying affidavit in response to the Board’s application. He did, however, send numerous communications by email to the Board following the Board’s

decision. Many of the emails were copied to the Board’s solicitors and to the Professional Disciplinary List Registrar. I do not consider it necessary to outline the full extent of that correspondence, some of which was rather bizarre. It is important to record, however, that in a letter dated 23 June 2025, the Board provided further information to Mr Burke in relation to the appeals process. It outlined the document necessary to bring an appeal, provided him with the relevant contact details for the Central Office, informed him that the 21-day appeal period would expire on 4 July 2025, and stated that if an appeal was not brought within that period, the Board would bring a confirmation application at the earliest opportunity. No appeal was brought by Mr Burke. However, he did continue to correspond with the Board and with various other parties in which he provided updated information on his interaction with various third parties. In an email sent on 9 July 2025, Mr Burke informed the Board, its solicitors and the Registrar that following discussion with his family he had decided not to appeal against the Board’s decision “due to the current stressors” which he outlined in other communications.

11. The hearing on 21 July 2025

37. On the return date of the Board’s confirmation application on 21 July 2025, it was unclear as to what Mr Burke’s position was in relation to a possible appeal against the Board’s decision. Mr Burke provided to the Court a document dated 4 July 2025. That document was stated to constitute Mr Burke’s appeal and set out grounds for appeal. I will return to that document later. It was not suggested that the document was provided to the Registrar on 4 July 2025. From the review of the emails sent by Mr Burke, it appears that the document was sent by email by Mr Burke to a number of addressees including the Board and the Registrar on 18 July 2025. In that email, having referred to the involvement of An Garda Síochána as a result of matters he had referred to in a previous email, Mr Burke stated that he was attaching the grounds of an appeal he would have brought were it not for various recent incidents of which he had previously informed the Board. It would appear from that document that Mr Burke was not providing it as part of any appeal, but was referring to it as the document he would have relied on if he was appealing against the Board’s decision. In any event, the document was made available to the Court on the return date of the confirmation application on 21 July 2025.

38. On that date, the Board wished to proceed with its confirmation application. However, it was not entirely clear as to whether Mr Burke did or did not wish to appeal against the Board’s

decision. While noting that the statutory time period for doing so had expired, I afforded Mr Burke the opportunity of bringing an application to extend the time to appeal against the

decision, should he wish to do so, while noting that I was not to be taken as deciding that it would be open to the Court to extend the time at all. I gave directions in relation to any such application by Mr Burke, which I directed would have to be issued no later than 5 September 2025. I then adjourned the Board’s confirmation application to 13 October 2025.

12. The hearing on 13 October 2025

39. In advance of the hearing of the Board’s confirmation application on 13 October 2025, Ms Donohoe swore a supplemental affidavit on 6 October 2025. She exhibited the further communications between the Board and Mr Burke together with some additional material which was before the Court on 21 July 2025, but which had not been put on affidavit at that stage. In addition to the material exhibited to Ms Donohoe’s affidavit, Mr Burke sent in a further submission to the Board and asked that it would be read out to the Court in the event that he was not in a position to attend the hearing.

40. As explained by Ms Donohoe in her supplemental affidavit, Mr Burke had indicated in correspondence with the Board that he was not bringing an application to extend the time for appealing against the Board’s decision and was not appealing against that decision. His reasons were essentially due to illness and an inability to pay the fees associated with the bringing of an appeal. In an email sent to the Board on 24 August 2025 entitled “ill health”, Mr Burke stated that he was due to return to sick leave that week as certain recent stressors which he outlined previously were taking a toll on his wellbeing. He intended to seek support from his general practitioner. At that point his position was that, should his ill health continue, he “may not be able to appeal as planned”. He also referred to his “limited finances due to [his] health issues over the last two years of [the] process and indeed incidents occurring in [his] private life linked to this process”. He attached a medical certificate dated 4 November 2024 from a general practitioner in Co. Cork. In the certificate, that doctor stated that he had not seen Mr Burke in one year and that he had “offered multiple appointments to assess him” but that Mr Burke had not been able to attend. The doctor stated that Mr Burke told him that “he feels fit to return to work” as of the date of the certificate.

41. In a further email sent to the Board on 5 September 2025 headed “Appeal”, Mr Burke informed the Board that he was “unable to appeal the NMBI decision” for a number of reasons, including his lack of income since he had been required to cease practice and he could not therefore afford the costs of bringing an appeal. He noted that he had previously outlined the “legal points” which he would have made previously to the Board and to the Court and was reserving his position in relation to those points. He confirmed “reluctantly” that he was unable to appeal the decision and also indicated that he would be asking for a change of judge as I had also dealt with the Board’s application to suspend Mr Burke’s registration under s. 58 of the 2011 Act pending the outcome of the fitness to practise process.

42. Mr Burke sent further correspondence to the Board and copied others including the Registrar between then and the hearing date, some of which was exhibited by Ms Donohoe to her affidavit. Later, further communications were sent by Mr Burke to the Board and copied to the Registrar. The statement which Mr Burke asked the Board to read out in the event that he was not in a position to attend the hearing was sent to the Board and copied to the Registrar on 10 October 2025.

43. At the outset of hearing on 13 October 2025, Mr Burke confirmed that he was not pursuing any request that I recuse myself from dealing with the Board’s confirmation application. He also confirmed that he had decided not to appeal the Board’s decision for the reasons mentioned in his correspondence.

44. Ms Caoimhe Daly BL then opened the Board’s application and brought me through the relevant documents. Mr Burke responded to the application. He read out the statement that he had sent to the Board and to the Registrar on 10 October 2025. The statement reiterated criticisms which Mr Burke had previously made about the approach taken by the Board before the fitness to practise inquiry and the Board’s reliance on the two reports from Dr O’Connell. He was critical of the manner in which the reports were sourced and was particularly critical of the circumstances in which Dr O’Connell’s addendum report was prepared. He disputed the contention that he was (or is) suffering from a relevant medical disability and was critical of the length of time that the entire process had taken. He noted that he had attended a new general practitioner last week and remained fit to work at that time. He maintained that he did not pose any risk to the public.

45. Mr Burke also took the Court through the document provided by him that bears the date 4 July 2025 (a copy of which was sent to the Registrar on 18 July 2025 and was provided to the Court on 21 July 2025). Mr Burke was reminded by the Court that the issue before it was whether there was “good reason” not to confirm the Board’s decision. In response, Mr Burke contended that the matters set out in that document together with the other material on which he relied amounted to “good reason” for the Court not to confirm the Board’s decision. The 4 July document contained a series of criticisms of the approach taken by the Board’s CEO before the Committee and the approach taken by the Committee itself. Mr Burke criticised the manner in which the medical reports were obtained (including those from Dr O’Connell) and the manner in which the witness statements were procured. He criticised the protracted nature of the process before the Committee and the fact that the Committee had discounted his evidence and certain other evidence during the inquiry. He further criticised the number of hearing days over which the inquiry was conducted spanning an eleven-month period. I have not set out each and every point made by Mr Burke in his statement of 10 October 2025 or in the document which bears the date 4 July 2025. However, I have very carefully considered those documents, and the other material put before the Court.

46. As I noted at the outset of this judgment, I reserved my judgment so that I could consider further the submissions made on behalf of the Board and by Mr Burke. Since I reserved my judgment, Mr Burke sent some further emails to the Registrar. In one of those emails (sent on

14 October 2025), Mr Burke sought to make a further submission by way of criticism of the circumstances in which the CEO of the Board obtained expert medical evidence and reiterated his submission in relation to the circumstances in which the addendum report was prepared by Dr O’Connell. He noted that he had objected to the CEO’s reliance on that report. His objection was, however, rejected by the Committee. In a further email sent on 17 October 2025, Mr Burke informed the Registrar that he had omitted to make a request for access to the Digital Audio Recording (the “DAR”) for the hearing on 13 October 2025.

13. Decision on Board’s Confirmation Application

47. Once the Board’s decision was provided to Mr Burke, it was open to him to appeal against the

decision to the High Court under s. 73 of the 2011 Act “not later than” 21 days after he received notice of the decision. The last day on which Mr Burke could have appealed within that 21-day period was 4 July 2025. If Mr. Burke had appealed and if he wished to contest not only the sanction which the Board decided to impose on him, but also the underlying findings of relevant medical disability made by the Committee, he could have done so and the burden would have rested on the Board to prove that he was suffering from a relevant medical disability and that the sanction which the Board imposed upon him was correct (see, for example, In re M., (A Doctor) [1984] IR 479, per Finlay P at p. 483). The range of options which would have been open to the Court on the hearing of an appeal are set out in s. 73(3) of the 2011 Act. However, as outlined earlier, for various reasons, Mr Burke ultimately decided not to appeal against the Board’s decision.

48. In those circumstances, the Board was obliged under s. 74 of the 2011 Act to bring the confirmation application and did so in compliance with that obligation.

49. The approach which the Court is required to adopt on such a confirmation application is set out in s. 74 (3) of the 2011 Act. It provides: “The Court shall, on the hearing of an application under subsection (1), confirm the

decision under section 69 the subject of the application unless the Court sees good reason not to do so and direct how the costs of the application are to be borne.”

50. Therefore, I am required under s. 74(3) of the 2011 Act to confirm the Board’s decision to impose the sanction of cancellation on Mr Burke unless I see “good reason not to do so”.

51. The statutory formulation of the test which the High Court is required apply on a confirmation application brought by the Board where the court is required to confirm the decision of the Board unless it sees “good reason” not to do so appears in a number of similar statutes regulating registered professionals. It has been the subject of prior consideration by the High Court and the correct interpretation of that and similar statutory phrases is clear and wellestablished. The phrase was first considered, in the context of s. 76(3) of the Medical Practitioners Act 2007 (as amended), in Medical Council v. M.A.G.A. [2016] IEHC 779. At para. 30 of his judgment in that case, Kelly P accepted the argument made on behalf of the Medical Council that the jurisdiction conferred under s. 76(3) of the 2007 Act is not “an unfettered one” and it does not constitute the High Court as an appeal tribunal on the merits of the case when hearing a confirmation application. Kelly P stated: “Rather, the obligation of the court is to deal with the issues of the type identified, such as adherence to correct procedural norms, adherence to the requirements of natural and constitutional justice and the making of the decision by the Medical Council which is a reasonable one or to put it another way is one which cannot be said to be one which no reasonable council would come to. By the use of that expression, I am importing concepts of reasonableness which are well known to legal practitioners on the judicial review side of the court, namely ‘Wednesbury unreasonableness’ or ‘Stardust’ type unreasonableness. (Associated Provincial Picture Houses Ltd. v. Wednesbury Corporation [1948] 1 KB 223; State (Keegan and Lysaght) v Stardust Victim’s Compensation Tribunal [1986] IR 642).”

52. Kelly P continued (at para 31):

31. “The question that arises for consideration here, therefore, is can it be said that the

decision of the Medical Council was one which was arrived at by a reasonable council behaving in a reasonable fashion? The fact that I might take a different view as to sanction does not at all enter into consideration. That is because I am not exercising an appellate jurisdiction on the merits. The questions I have to ask myself is has there been any procedural impropriety here and there clearly has not. Has there been any failure to adhere to the rules of natural and constitutional justice and clearly there has not. The third question, and this is the only pertinent one, is can it be said that the

decision arrived at here is so unreasonable as to warrant the intervention of the court. If the court comes to the conclusion that the decision here is so unreasonable as to warrant its intervention then there is ‘good reason’ to depart from it.”

53. Having considered the relevant material before the Court, Kelly P was unable to come to the

conclusion that the Medical Council in that case had come to such an unreasonable conclusion as to amount to a “good reason” for the Court to disturb it.

54. Kelly P subsequently confirmed that that was the approach to be adopted on an application such as this in Medical Council v Lohan-Mannion [2017] IEHC 401. Both parties in that case agreed that the interpretation which the Court had given to the provision of s. 76(3) of the 2007 Act in M.A.G.A. was the correct one. Kelly P stated:

49. “The ability of the court to refused to confirm the decision of the Medical Council is limited to circumstances where it can identify ‘good reason’ not to do so…the only basis upon which the court can refuse an order under s.76 is that outlined in M.A.G.A. Thus, the court would have to be satisfied of either a procedural impropriety, a lapse from the norms of constitutional and natural justice or a decision on the part of the Medical Council which is one which no reasonable Council could come to.” (para. 49)

55. Kelly P held that, in that case, there was no question of any procedural impropriety or any failure to observe the standard of natural and constitutional justice. Nor was the decision one which no reasonable Medical Council could have reached. He stated (at para. 63): “…The threshold which needs to be achieved to demonstrate such unreasonableness is similar to that required to quash the decision of any administrative body on judicial review. It is a high threshold and has not been achieved here.”

56. That approach was followed by Faherty J in the High Court Teaching Council of Ireland v S.R. [2018] IEHC 582 in the context of an application to confirm a decision of the Teaching Council under s. 44(5) of the Teaching Council Act 2001 (as amended). Under that provision, the Court, on the hearing of a confirmation application, was required to confirm the decision of the Teaching Council “unless it sees good reason to the contrary”. Citing the earlier judgments of Kelly P in M.A.G.A. and Lohan-Mannion, Faherty J confirmed that the approach to be taken was that set out in those earlier judgments. She considered that there was no question of any procedural impropriety or lack of natural or constitutional justice. Nor was the decision of the Teaching Council so unreasonable as to warrant the Court refusing to confirm its decision.

57. The High Court (Irvine P) subsequently endorsed that approach where in the case of a confirmation application the court is required to confirm the decision unless it sees good reason to the contrary or good reason not to do so. She contrasted that approach with a statutory provision such as the one at issue before her, namely, s. 80(5) of the Veterinary Practice Act 2005 (as amended) where the court is not subject to such constraints and is empowered to make “any other order that it considers appropriate” (see Veterinary Council of Ireland v Brennan [2020] IEHC 655, per Irvine P at paras. 13-16).

58. The principles set out in these cases have been consistently applied by the High Court, including by myself, in countless confirmation applications brought by statutory regulatory bodies such as the Board and the Medical Council and I am satisfied that they are the principles which must be applied in determining the Board’s confirmation application in this case.

59. I have carefully considered all of the material before the Court and I have read and re-read the submission and documents relied on by Mr Burke in his opposition to the Board’s confirmation application. It is important to re-iterate that I am not dealing with an appeal by Mr Burke under which the Court would have a much wider powers and, depending on the scope of the appeal brought, the burden of proving matters such as a relevant medical disability on the part of Mr Burke and the appropriateness of the sanctions sought to be imposed on him would rest on the Board. I am constrained, therefore, in considering the Board’s confirmation application by the provisions of s.74(3) of the 2011 Act, and the statutory test contained in that subsection under which I am required to confirm the Board’s

decision unless I see “good reason not to do so”.

60. I am required, therefore, to determine whether Mr Burke has established that there was any procedural impropriety or failure to observe the standards of natural or constitutional justice in the proceedings before the Committee or the Board or whether he has established that the

decision by the Board to impose the sanction of cancellation following the finding by the Committee at the inquiry is one which no reasonable Board could make.

61. I can discern no procedural impropriety or any failure to observe the standards of natural and constitutional justice in the proceedings before the Committee during the inquiry or before the Board when it decided to impose the sanction of cancellation on Mr Burke. While the process did take a very long period of time before the Committee, (extending over 10 day or parts of days of hearings), Mr Burke was afforded every opportunity to defend his position. He was entitled to obtain representation but was unable to obtain such representation. He was entitled to attend and fully participate in the inquiry (having been provided with the relevant documentation). Apart from two days, he did attend throughout the inquiry. The Committee was, in my view, entitled to proceed with the inquiry on the dates on which Mr Burke did not attend. Mr Burke was entitled to cross examine and did cross examine the witnesses called by the CEO. He gave evidence himself during the course of the inquiry and was cross examined by counsel on behalf of the CEO. He had the opportunity of making and responding to closing submissions made on behalf of the CEO. I accept that the entire process was extremely protracted, due in no small part, I have to say, to the lengthy submissions and interventions of Mr Burke during the course of the hearing. I make that observation based on my review of the transcripts of the hearing before the Committee.

62. I am absolutely satisfied that there was no question of any procedural impropriety or any failure to observe the standards of natural and constitutional justice in the course of the inquiry before the Committee. Nor was there any procedural impropriety or breach of natural or constitutional justice in relation to the meeting of the Board on 11 June 2025 at which the Board took its decision. Mr Burke was provided with the relevant documentation in advance of the meeting of the Board and chose to make a written submission to the Board rather than attending the meeting himself. That was his entitlement.

63. I am acutely conscious of the limited jurisdiction which is vested in the court on a confirmation application and that, in considering this application, I am not acting as an appeal tribunal on the merits of the case made against Mr Burke before the Committee or at the meeting of the Board on 11 June 2025. In my view, the points which Mr Burke has sought to advance in the various written and oral submissions he has sought to rely on in response to the Board’s confirmation application go well beyond what the Court would be entitled to consider in the context of a confirmation application and would, in effect, seek to constitute the Court as an appellate tribunal from the findings made by the Committee in its report and from the Board’s decision to impose the sanction of cancellation on Mr Burke. Those comments apply particularly to Mr Burke’s attempt to criticise the expert psychiatric evidence obtained by the CEO at the inquiry and the circumstances in which the Board ultimately engaged Dr O’Connell, the consultant forensic psychiatrist (having been advised by Professor Colin O’Gara to engage such a psychiatrist).

64. In any event, I am not satisfied that Mr Burke has established any procedural impropriety in relation to the expert evidence adduced before the Committee in the course of the inquiry. Nor has Mr Burke established any such impropriety in relation to the procedure adopted by the Board. Nor, as I have already indicated, has he established any breach of the required standards of natural and constitutional justice.

65. I now turn to the final matter which I must consider on this application. Having concluded that there was no procedural impropriety or breach of natural or constitutional justice, in order to refuse to confirm the Board’s decision, I would have to be satisfied that the decision of the Board was one which no reasonable Board could reach. As the case law discussed earlier establishes, the threshold which has to be met in order to demonstrate such unreasonableness is a high one and is similar to that required in order to quash a decision of an administrative body on judicial review. Faced with the Committee’s Report and the findings which it made on the basis of the evidence considered by the Committee at the inquiry and with the submissions and material received by the Board from Mr Burke, not only am I not satisfied that the decision of the Board was so unreasonable that no reasonable Board could have reached the decision, on the contrary, I am satisfied that the decision of the Board to impose a sanction of cancellation of Mr. Burke’s registration was entirely correct. I will go so far as to say (although it is unnecessary for me to do so) that a decision by the Board to impose any lesser sanction would arguably have been a decision which no reasonable Board could have taken in these circumstances. The sanction of cancellation was, in my view, an entirely appropriate sanction and proportionate in the circumstances, although all I must be satisfied of in order to confirm the Board’s decision is that the decision was not so unreasonable that no Board could have reached it. I should also make clear that I have been unable to find any error in the approach which the Board adopted in determining the sanction to be imposed on Mr Burke.

66. In those circumstances, I do not see a “good reason” not to confirm the Board’s decision. I am, therefore, required under s. 74(3) of the 2011 Act to confirm that decision, and I will make an order to that effect.

14. Orders to be made

67. For the reasons set out in this judgment, I intend to make an order in terms of para. 1 of the Originating Notice of Motion issued by the Board on 11 July 2025, namely, an order pursuant to s. 74(1) of the 2011 Act confirming the decision of the Board made on 11 June 2025 that, pursuant to s. 69(1)(f) of the 2011 Act, Mr Burke’s registration be cancelled.

68. At the request of Mr Burke (made subsequent to the hearing of the application on 13 October 2025), I will make an order under Order 123, Rule 9 of the Rules of the Superior Courts directing that Mr Burke be provided with a copy of the transcript of the DAR of the hearing on 13 October 2025 between approximately 14:45 and 16:00 and that the Board discharge the cost of obtaining that transcript.

69. I will list the matter for the purpose of making these orders and any further order as may be required (including, but not limited to, any orders for costs) at 10:15am on Friday, 24 October 2025.