High Court confirms Medical Council's decision to cancel doctor's registration due to UK attempted murder charge.

[APPROVED]

THE HIGH COURT

[2025] IEHC 742

(2025 522 MCA)

BETWEEN

MEDICAL COUNCIL

APPELLANT

AND

THOMAS KWAN

RESPONDENT

Ex tempore judgment of Mr. Justice David Barniville, President of the High Court, delivered on the 8th day of December 2025

1. INTRODUCTION

1. This is my judgment on an application by the Medical Council for orders pursuant to s. 76 of the Medical Practitioners Act 2007 (as amended) (the “2007 Act”) to confirm the decision of the Council to cancel the Respondent doctor’s registration on the register maintained by the Medical Council under s. 71 of the 2007 Act.

2. I should say that I determined at the outset of the hearing that the application should proceed today, and I gave a brief initial ruling explaining my reasons for that, having been satisfied that the Respondent was properly served with the papers and having been satisfied also that this is a very serious application brought by the Medical Council which, in any event, can be dealt with ex parte under s. 76 of the 2007 Act.

2. BACKGROUND

3. The background to this case, which, it has to be said, is one of the most unusual and serious cases to come before the Court on a confirmation application, is set out in the grounding affidavit sworn by Ms Maria O’Kane, the CEO of the Medical Council.

4. In her affidavit, Ms O’Kane explains that the Respondent doctor is registered in the Specialist Division of the Register of Medical Practitioners maintained by the Medical Council. She explains that the Respondent obtained his medical degree in the University of Newcastle-upon-Tyne in 1996. He was granted provisional registration in the UK in July 1996 and was fully registered in that jurisdiction in August 1997. He was first registered with the Medical Council here in Ireland in January 2022.

5. As Ms O’Kane explains, in or around mid-February 2024, the Medical Council was made aware through media reports that the Respondent had been charged with attempted murder in the UK. Amongst the reports that were available to the Council at the time was an online article published by Sky News on 7 February 2024 with the headline “Thomas Kwan: GP in court after being charged with attempted murder over suspected poisoning”.

6. Thereafter, the Medical Council sought to obtain information from the General Medical Council in the UK (the “GMC”) and from the relevant police authorities in the UK, the Northumbria Police. The Medical Council sought to obtain information as to what the background to the charges were, and any information available in connection with any investigation conducted either by the GMC or the UK police. Several attempts were made to obtain details of those matters, including the specifics of the allegations and offences which were being investigated, the current status of those investigations, and any other relevant information. The Medical Council was unsuccessful in obtaining information at that stage from the UK police, but it did obtain some information from the GMC. For example, in late February 2024, the GMC responded by email to the Medical Council confirming that it had become aware that the Respondent had been charged with attempted murder through press releases, and that the GMC itself held no further information, other than those press releases.

7. Later, in early March 2024, the GMC issued a notification to the Medical Council here that the Respondent doctor had been suspended from the register maintained by the GMC. At that time also, the Medical Council wrote to the GMC seeking information in connection with any investigation which the GMC had conducted, or was conducting, and similarly in relation to any investigation by the UK police. The GMC replied confirming that the position remained unchanged, that the UK police would not disclose any information to the GMC, and that the GMC did not hold any documentation other than the information contained in the press releases.

8. Further articles were published in early March 2024 by a number of other media sources, including ITVX, the Daily Mail, and The Standard media outlets. Those articles stated that the Respondent had been charged with making or using ricin, a chemical weapon, in addition to the existing charge of attempted murder, and they stated that he was to face trial in late July 2024. I should add here, however, that the Respondent doctor was not ultimately charged with using ricin, a chemical weapon, but he was charged with another offence, which I will come to later in this judgment, in addition to attempted murder.

9. Attempts were made by the Medical Council to obtain further information, including by writing to the Respondent himself, and no response was received from him at that time. Nonetheless, the CEO of the Medical Council decided in April 2024 to make a complaint against the Respondent under s. 57 of the 2007 Act, arising out of the issues of concern which had emerged from the Respondent’s arrest and the subsequent offences which the Respondent was charged with in the UK. The Respondent was informed of the complaint in June 2024. The Medical Council sought further updates from the GMC and the UK police in late May 2024. In June 2024, a police officer with Northumbria Police responded to the Medical Council confirming that the Respondent had been charged with attempted murder, that he was resident in HMP Hull, and that the trial, which had been fixed for late July 2024, had been adjourned to October 2024.

10. In early June 2024, having obtained that information, the Medical Council held a meeting and decided to apply to the High Court for an order suspending the Respondent doctor’s registration under s. 60 of the 2007 Act. That application was made to the High Court on 24 June 2024. The High Court (O’Higgins J) made an order on that day suspending his registration until further order of the Court. The Court directed that the matter would be listed again on 15 July 2024. On that occasion, the Respondent did appear remotely. Having heard submissions, O’Higgins J made s. 60 orders suspending the registration of the Respondent’s name on the register and prohibiting him from engaging in the practice of medicine until further order.

3. THE CRIMINAL TRIAL AND SENTENCING

11. The criminal trial in respect of the Respondent doctor commenced in the UK on 2 October 2024. The Respondent pleaded guilty to two offences, namely, attempted murder and the administration of poison with the intent to endanger life or to inflict grievous bodily harm. The sentencing of the Respondent was adjourned to 6 November 2024.

12. On that date, Mrs Justice Lambert, sitting in Newcastle Crown Court, delivered her sentencing remarks. In those sentencing remarks, Mrs Justice Lambert imposed a sentence of 31 years and 5 months on the Respondent doctor.

13. The circumstances in which the offences were committed, to which the Respondent ultimately pleaded guilty, are perhaps best explained by the description of the events in those sentencing remarks given by Mrs Justice Lambert:

“On 22 January 2024 you went to the home which your mother shared with her partner Patrick O’Hara in St Thomas Street in Newcastle. You were in disguise, wearing a hat, tinted glasses, and a surgical mask. You were masquerading as a community nurse attending to perform a routine health check upon Mr O’Hara. Your intention in visiting the home in this way was to administer a lethal injection of poison to Mr O’Hara on the pretence of administering a Covid booster. It was an audacious plan: to murder a man in plain sight. You very nearly succeeded in your objective. You were in the home, in the presence of Mr O’Hara, for around 40 minutes. For some part of that time your mother was also present, and you took her blood pressure. Extraordinary though it seems, so trusting were they, that neither recognised you under your disguise. The injection of poison which you administered caused Mr O’Hara immediate pain and he attended the local hospital where doctors were baffled at the cause of the inflammation and blistering around the injection site. Mr O’Hara went on to develop the condition called necrotising fasciitis which required him to undergo multiple surgical excisions of dead muscle tissue in the upper arm. Mr O’Hara remained seriously unwell for some weeks, and he required treatment in the intensive care unit. Fortunately, he survived although, as I learned from his evidence, he still suffers from the physical and psychological consequences of your attempt to kill him.” (p. 1 and 2 of sentencing remarks)

14. Mrs Justice Lambert then explained the Respondent’s background and the planning that went into his attempted murder of his mother’s partner. The judge found that the plan was “well underway” by November 2023, when the Respondent doctor:

“…sent the first of two forged letters to Mr O’Hara purporting to be from a registered general nurse called Mr Raj Patel of the Community Associated Nursing Team. Neither Mr Raj Patel nor the Community Associated Nursing Team existed. Both were inventions by [him]. In this first letter Mr O’Hara was informed that he was due to receive a community home visit for the purpose of health monitoring and seasonal vaccinations, including for Covid 19.” (p. 3 of sentencing remarks)

15. The judge found that the Respondent was at that time:

“…laying the foundations of [his] plan to get into the house at St Thomas Street and [to] perform the nursing assessment of Mr O’Hara under the cover of which [he] would administer the fatal injection. (p. 3 of sentencing remarks)

16. The judge said that the letter was:

“…a forgery of some sophistication. It featured the NHS logo which [he] had copied and pasted. There were hyperlinks. [He] used medical language.” [He] identified the various data privacy notices which typically appear on letters from organisations. It was, to Mr O’Hara, utterly convincing. [The Respondent doctor] sent a further forged letter on 3 January 2024. This letter provided the date and time of the proposed appointment of Monday 22 January between 9 and 1pm. The letter also contained the NHS logo, relevant hyperlinks, and this time, a QR code and link to a short health questionnaire to be completed by Mr O’Hara before the appointment.” (pp. 3 and 4 of sentencing remarks)

17. Mrs Justice Lambert went on to say that:

“On 12 January 2024 [the Respondent doctor and his] wife stayed overnight at the Premier Inn in Newcastle. [He] had it in mind that this would be [the] base for operations, and I am sure that [his] purpose in staying at the hotel on this date was so that [he] could check out its suitability. [He] obviously found it to be a suitable base because on 15 January [he] booked another room in the hotel for Sunday 21 January 2024, this time however [he] booked under a false name and used a false address. On Sunday 21 January [he] sent Mr O’Hara a text message reminder to his mobile phone concerning the home visit appointment. [He] used an unregistered SIM card for that purpose, no doubt to cater for the possibility that Mr O’Hara might recognise [his] mobile number. [He] drove to Newcastle in the early hours of 22 January. [He] had sourced false plates for [his] car. The next day, after breakfast, [he] left [his] hotel room in [his] disguise. [He] wore a long coat and cap, blue surgical gloves and a clinical mask covering [his] face.” [He was] let into the house by Mr O’Hara [who] did not recognise [him] but, after all, he had no reason to suspect that [he was] not the nurse from the local community health team who had written to him on two occasions and texted him the day before. [He] disguised [his] voice by speaking in broken English with an Asian accent. [He] went through a medical questionnaire about his general health. [He] took [Mr O’Hara’s] blood pressure. [The Respondent doctor’s] mother came downstairs, and she too was duped. At her request [he] took her blood pressure. [He] then administered the injection of poison to Mr O’Hara telling him that it was a Covid booster. When [Mr O’Hara] complained of a severe stinging pain [the Respondent doctor] explained to him that he had had an allergic reaction, but Mr O’Hara sensed that [the Respondent doctor was] speeding up [his] exit from the house. As [the Respondent doctor] left, [his] mother came down the stairs and commented in passing that [he was] the same height as her son. It was only at this point that Mr O’Hara suspected that all was not quite right. [Mr O’Hara] hurried out of the house after [the Respondent doctor] but by this time [he] had gone” (pp. 4 and 5 of sentencing remarks).

18. The judge then outlined the circumstances of his arrest, and the subsequent search of his home and computer. That search revealed the Respondent’s obsessive interest in poisons and toxic chemical harm. The judge said that the Respondent’s:

“…home and garage contained liquid mercury, thallium, sulphuric acid, and arsenic. The garage contained the ingredients and materials needed to produce ricin, a highly toxic poison and scheduled chemical weapon and examination of [his] phone showed that [he] had made a number of internet searches using the word ricin between 6 and 21 January 2024. In order to obtain these poisons, [he] had set up a shell company in early 2023 in which [he] claimed to be a research officer within the research unit of the company… [His] home contained a library of material describing and giving instructions on the use of the various chemicals in killing human beings… … The police found a book which detailed the amount of each poison required to kill a person, the clinical effects and the time taken for the chemical to take effect…” (pp. 5 and 6 of sentencing remarks).

19. Mr O’Hara (the victim) was admitted to hospital immediately after the injection. Doctors were baffled at the cause of the inflammation and pain in his arm. Efforts were made to identify what it was that was causing the inflammation and pain. An expert, Dr Emmett, was fortunately close at hand. He was contacted and he formed the opinion that the most likely poison involved “…was iodomethane, a substance predominantly used as a fumigant pesticide.” The judge concluded that she was “…sure that this was the poison which [he] injected because a glass tube containing the poison was found in [his] home along with a hypodermic syringe and needle” (p. 6 of sentencing remarks).

20. The judge went on to say that:

“Additionally, [the Respondent doctor’s] phone showed that [he] had carried out internet searches for iodomethane on 97 occasions between 6 and 24 January; a video showing how to produce iodomethane was found on [his] computer; the expert concluded that the poison was highly reactive and on external contact with skin would lead to burns and blisters similar to those which affected Mr O’Hara” (p. 7 of sentencing remarks).

21. The judge described the Respondent’s planning and preparation of his attempt to murder Mr O’Hara as “detailed and extensive” and that he had also considered other ways of killing Mr O’Hara. The judge set out that:

“The police found a document created by [the Respondent doctor] purporting to be from an organisation called Northern England Men’s Sporting Association addressed to “Patrick.” It offered him free drinks and free ready meals because he had been identified as an eligible recipient due to his contribution to the North East throughout his working life. There was a further document, this time a compliments slip, purportedly from an organisation called Northern Wine and Drinks Tasting Gentlemen’s Club. [He] had clearly been pondering whether other better and, from [his] perspective, safer ways of poisoning Mr O’Hara by lacing food and drink with chemicals might be possible” (p. 7 of sentencing remarks).

22. The judge then considered the Respondent’s motivation and concluded that it was purely financial and that it was based on a perception that he had not received his just entitlements from his father’s estate and that, by reason of her relationship with Mr O’Hara, his mother too was not going to fulfil what the Respondent doctor believed were his just entitlements when she herself passed away. The judge concluded that she had “no doubt” that the reason the Respondent doctor attempted to murder Mr O’Hara was for “financial gain” and that, by killing Mr O’Hara, the Respondent “would have removed the obstacle which lay between [him] and [his] immediate recovery of [his] share in the property following [his] mother’s death in the event of her pre-deceasing [Mr O’Hara]” (p. 9 of sentencing remarks).

23. Mr Eoghan O’Sullivan BL, who appeared for the Medical Council on this application, brought me through the other sentencing remarks which detailed the reasons why the judge came to the sentence imposed on the Respondent of 31 years and 5 months. Those reasons included the degree of planning which had gone into the Respondent doctor’s attempted murder of Mr O’Hara by poisoning, the use of forged NHS letters and the various steps that had been taken by the Respondent doctor to carry out his plan. The judge said that the gaining of entry into the house by the Respondent doctor was in the “…the most calculated and callous of ways, under the guise of a trusted healthcare professional”, that he had “sought and obtained [Mr O’Hara’s] (and [his] mother’s) trust by abusing [his] knowledge of the healthcare system by faking letters purportedly from an NHS institution”. The judge said that the “wider impact of [his] offending [could not] be ignored” and that his masquerade “struck at the heart of public confidence in the healthcare profession” (p. 14 of sentencing remarks).

24. The reason that I have gone through those sentencing remarks in some detail is to convey the devious level to which the Respondent had stooped and to outline how he exploited the trust that Mr O’Hara and his mother had in the healthcare system.

4. PROCEEDINGS BEFORE THE MEDICAL COUNCIL

25. Following the sentencing hearing, the Medical Council in Ireland held a Preliminary Proceedings Committee (“PPC”) meeting. The PPC referred the matter to the Council itself under s. 57(5) of the 2007 Act. The Council informed the Respondent that it would hold a meeting on 27 June 2025 to consider the matter in accordance with s. 57(6) of the 2007 Act. This was an expedited way of dealing with the issue where particular statutory conditions are satisfied. It is quite clear to me that all of those conditions were satisfied, and I will deal with those later in this judgment.

26. The Respondent was invited to attend the Council meeting on 27 June 2025 and all of the material before the Council for the meeting was provided to him in hard copy through the administrative staff in HMP Hull and subsequently in HMP Frankland, where the Respondent doctor is currently serving his sentence. There was email correspondence with the prison services in the United Kingdom, and on 24 June 2025, the Medical Council’s solicitors were informed by prison staff that the Respondent doctor had been informed of the Council meeting that was due to take place on 27 June 2025 and that he had “no interest to participate in the meeting in any form”.

5. THE COUNCIL’S DECISION

27. The Council meeting ultimately took place on 27 June 2025. Having considered the matter, the Council was of the opinion that the statutory criteria in s. 57(6) of the 2007 Act were all satisfied. It decided at that meeting to impose the sanction of cancellation on the Respondent’s registration on the register maintained by the Medical Council in Ireland. Mr O’Sullivan BL has taken me through the Council’s reasons for its decision and he has cross-referenced those reasons with the statutory provisions set out in s. 57 of the 2007 Act. In particular, he set out the provisions of s. 57(1)(g), which provides for grounds of complaint to the PPC where a medical practitioner has been convicted in the State for an offence triable on indictment or where a medical practitioner has been convicted outside the State for an offence consisting of acts or omissions that if done or made in the State, would constitute an offence triable on indictment, and s. 57(6)(a)(ii), which deals with the circumstances in which the Council shall consider a complaint referred to it under s. 57(5) of the 2007 Act, and provides that, where a complaint falls within s. 57(1)(g), the PPC “…shall immediately refer the complaint to the Council”.

28. The reasons given by the Council for its decision can be summarised as follows. First, the Council considered and noted the guilty plea by the Respondent to the charges of attempted murder and the administration of a toxic substance with the intent to endanger life or to inflict grievous bodily harm. Second, the Council was satisfied that the conviction against the Respondent in the UK was for attempted murder and/or poisoning and that that constituted an act or omission, that if done in the State, would constitute an offence triable on indictment. Third, the Council considered the nature of the offences the subject of the conviction and considered them to be most serious. The Council considered the circumstances in which the offences were committed, and they included those set out in the sentencing remarks of the judge in the UK. The Council was satisfied that the Respondent:

(a) used his status as a doctor the plan and commit the crime;

(b) that the acts the subject of the conviction were carried out with forethought and were planned in advance;

(c) that the acts the subject of the conviction were carried out for financial gain;

(d) those acts were carried out using trickery in circumstances where the Respondent relied on the vulnerability of his victim in the context of the COVID-19 pandemic;

(e) that the acts the subject of the conviction were carried out and that the Respondent doctor left his victim knowing him to have had an adverse reaction to the poison and;

(f) that the acts the subject of the conviction caused permanent physical and psychological harm to his victim.

Fourth, in those circumstances and with reference to the statutory requirements, the Council was satisfied that the acts the subject of the conviction rendered the Respondent a person who had permanently ceased to be a fit and proper person to continue to practise medicine. Fifth, the Council considered that it was in the public interest to act immediately under the provisions of s. 57(6)(a) of the 2007 Act.

29. While noting that the Respondent doctor was already the subject of a suspension order by the High Court and was incarcerated in the United Kingdom, the Council was of the opinion that it remained essential that the registration of the Respondent doctor be cancelled to prevent him from engaging in any further deception by using his status as a registered doctor, which could ultimately cause harm to the public. The Council explained that, in any event, and even in the absence of such risk, the Council was satisfied that it remained in the public interest as “…acting now goes to the reputation of the medical profession, which might otherwise be damaged if the public did not have confidence in the profession and the regulation of the profession”. The Council was satisfied further that if it did not take immediate action under the statutory provisions, the matter would have to be referred back to the CEO of the Council, and the complaint would have to be investigated and that that would all add “…unnecessary delay and expense and would effectively prevent the matter being disposed of in the most economical, expeditious and efficient manner.”

30. The Council felt that there was no unfairness caused to the Respondent in circumstances where he had made clear that he did not wish the engage with the Medical Council’s complaints and investigation process.

31. The Respondent did not participate in the Council hearing, and he did not seek any adjournment of that hearing.

32. In those circumstances, the Council was satisfied that cancellation was the most appropriate sanction arising from the criminal conviction. The Council decided that the imposition of this sanction would highlight the seriousness of the Respondent’s conduct. The Council was of the opinion also that the sanction of cancellation would highlight to other members of the profession the seriousness of the conduct, thereby maintaining the reputation of the profession and public confidence in the regulatory process. The Council noted also that the imposition of the sanction of cancellation went to public safety, including public safety in the long term. Lastly, the Council regarded as significant the sentence imposed on the Respondent doctor of 31 years and 5 months in the criminal proceedings. The Council also took his guilty plea into account.

33. The Respondent was informed of the decision of the Council in correspondence sent on

11 July 2025. In a letter received by the Council from the Respondent on 30 June 2025 (although the letter is dated 24 June 2025), the Respondent commented on a statement made in an earlier piece of correspondence sent by the Council on 6 June 2025. He pointed out that the conviction stated by the Council in its letter was wrong. He said that the Council’s letter of that date stated that, as well as on the charge of attempted murder, he had been convicted of “…the production and use of a chemical weapon”.

The Respondent doctor contended that “…this is absolutely incorrect. I was never charged or convicted of this conviction”. That letter was the only engagement by the doctor in the Medical Council’s complaints and investigation process, and it was the only piece of correspondence sent by the Respondent in relation to this entire matter. It seems to me that that letter is irrelevant to the issue that I have to decide on this application, bearing in mind the very serious offences for which the Respondent was convicted and sentenced (having pleaded guilty to the offences at the start of the criminal trial).

34. The Respondent doctor was served with the Council’s decision in two ways, by email on 15 July 2025 and by post on 16 July 2025. In the Council’s letter, the Respondent doctor was informed that he had 21 days within which to appeal the decision or to reply to this Court to set aside the Council’s decision. He did not do so. That is consistent with an expressed desire on the part of the Respondent doctor not to participate in any way in the process. The Respondent has not participated in the process thus far, and he has not participated in the hearing this afternoon.

6. CONFIRMATION OF COUNCIL’S DECISION

35. On this application, I am asked to confirm the decision of the Council. The test for confirmation of a decision of the Council such as the one at issue here is set out in s. 76(3) of the 2007 Act which provides that:

“The Court shall, on the hearing of an application under subsection (1), confirm the decision under section 71 the subject of the application unless the Court sees good reason not to do so.”

36. In considering whether there is “good reason” not to confirm the decision of the Council, I have considered whether the statutory requirements of s. 57 of the 2007 Act have been complied with. As I have indicated in the course of this judgment, I am satisfied that the provisions of s. 57 of the Act have been complied with.

37. Under s. 57(1)(g) of the Act, it is provided that:

“(1) A person (including the Council) may make a complaint to the Preliminary Proceedings Committee concerning a registered medical practitioner on one or more than one of the grounds of…

(g) a conviction in the State for an offence triable on indictment or a conviction outside the State for an offence consisting of acts or omissions that, if done or made in the State, would constitute an offence triable on indictment.”

Clearly, the shocking and macabre facts of this case fall within the statutory provision in s. 57(1)(g). The Council was entitled the make a complaint to the PPC, and it was entitled to deal with the matter under s. 57 of the Act.

38. Under s. 57(5) of the 2007 Act: “Where a complaint falls within subsection (1)(g), the Preliminary Proceedings Committee shall immediately refer the complaint to the Council.” The Council followed the steps specified in that subsection in dealing with this complaint.

39. Under s. 57(6)(a) of the 2007 Act,

(6) The Council shall consider a complaint referred to it under subsection (5)

and—

(a) if it is of the opinion that—

(i) the nature of the offence that is the subject of the complaint or the circumstances in which the offence was committed render the practitioner permanently unfit to continue to practise medicine, and

(ii) it is in the public interest that it take action immediately under this paragraph, the Council shall decide under section 71 to impose on the practitioner the sanction referred to in section 71 (f) as if the complaint were a report referred to in section 69 (1) of the Fitness to Practise Committee in relation to the complaint, and the other provisions of Part 9 (except section 72 (2)) shall apply to that decision accordingly…”

That is precisely what the Council did in this case as it was satisfied that the nature of the offence and the circumstances surrounding it were such that the Respondent doctor had permanently ceased to be a fit and proper person to continue to practice medicine. The Council was satisfied also that it was in the public interest to take action immediately.

40. In my view, and as I have indicated earlier, the Council complied fully with the relevant provisions of s. 57 of the 2007 Act and, therefore, absent any infringement or breach of those provisions, and absent any breach of fair procedures or the making of a decision that was manifestly unreasonable, there exists no “good reason” not to impose the sanction of cancellation decided by the Council. The legal principles applicable to confirmation applications such as this are well established. There is no need to reproduce them here. They were recently summarised by me in my judgment in Nursing and Midwifery Board v Burke [2025] IEHC 557 at para. 51. In my view, and in applying those principles, I must confirm the Council’s decision. The relevant procedures were applied impeccably by the Council, in my view, and the decision was so far from being unreasonable as it is impossible to envisage any other sanction other than cancellation which would be appropriate in the circumstances here. In fact, a decision to impose a more lenient sanction would have been manifestly unreasonable, in my view.

7. CONCLUSIONS AND ORDERS

41. In all those circumstances and for the reasons I have given in this judgment, it is very clear that I must confirm the decision of the Medical Council to cancel the Respondent doctor’s registration on the Register. I will, therefore, make an order in the terms set out at para. 1 of the Originating Notice of Motion. Mr O’Sullivan BL has informed me that the Council will not be seeking its costs on this application, and that seems to me a practical and pragmatic approach given that the Respondent doctor is currently incarcerated in the UK, and is likely to be incarcerated for a long time. I will, therefore, make no order as to costs.