Legal Advice Prompts Public Backlash at Billy Ralph Inquiry
The committee must be satisfied beyond reasonable doubt
Intro - this article is an in-depth look at the legal advice offered to the Irish Medical Council (IMC) Committee at Monday’s hearing. This advice prompted a visceral reaction among members of the public gathered in support of Dr Ralph, who is facing six allegations of professional misconduct for tweets posted on social media between Oct 2020 and June 2022.
In the final few minutes of Monday’s fitness to practise session something unusual happened. The time was 5.05pm. An elderly gentleman in the public gallery rose to his feet.
Closing submissions had concluded and the final contribution, from legal advisor to the IMC Committee, Senior Counsel Patricia Dillon, had been underway for more than 30 minutes.
“Excuse me, could you just stop, just stop,” a member of the public said.
Committee Chairman Paul Harkin asked the man to resume his seat.
“This is my job, my job is to advise the committee, and that’s the job I do, I am not here to advise the public,” Ms Dillon said.
The man at the back of the room addressed the chairman directly.
“Mr. Chairman, could I object? I am a citizen of --”
“No, you can’t object,” Mr Harkin said.
The man on his feet becoming visibly upset.
“That is all propaganda, that is out -- I have never heard anything like it in my life, this is disgraceful, I want that put on the record, it’s a disgrace.”
“I really don’t care what you think,” the Chairman responded.
Throughout the five day hearing, a stenographer was present, documenting everything that was heard at the inquiry. The transcript does not include the fact that at this point, multiple members the public gallery had risen from their seats, turned their chairs and were sitting with their backs to the top table.
Three aspects of legal advice offered by Ms Dillon appear to have prompted this quiet protest. These were examples of case law selected by Ms Dillon to illustrate gross professional misconduct.
One concerned the case of a doctor that had sexually abused his daughter. (A County Council v W and Others, England and Wales, 1996.)
Another was the case of a farmer who was a qualified vet (but not practising) that did not dispose of dead animals correctly. (Martin v. Royal College of Veterinary Surgeons, England, 1945)
A third example was that of an actuary accused of misconduct while managing the financial affairs of the estate of his deceased brother and mother. (E.G v Society of Actuaries in Ireland, 2017)
In outlining details of these cases, the legal assessor was using established case law regarding professional discipline and the legal threshold for professional misconduct.
The nature of the chosen examples prompted Dr Billy Ralph himself to object.
“Can I just make a point? I find those examples grossly insulting,” he said.
“I’m sorry, can I ..I didn’t…” Ms Dillon responded.
“Grossly insulting to me as a person,” Dr Ralph said.
“I’m very sorry, Chair… I’ll continue,” Ms Dillon said.
To this Chairman Harkin replied ‘yes please do.’
Addressing Dr Ralph he said:
“I am not sure why you should feel the evidence and law, case law is grossly insulting.”
“Financial impropriety, sexual abuse and dead animals,” Dr Ralph said.
“The purpose of these cases is to demonstrate to the Committee that professional misconduct is not confined to clinical practice and that it doesn’t necessarily involve patient harm,” Ms Dillon said.
She went on to outline two cases involving covid and freedom of expression. The first, Bielau v. Austria addressed the legal conflict surrounding the limits of online free speech in the context of medical professionals providing public information. It concerned Dr. Klaus Bielau, an Austrian GP and advocate of holistic medicine, who was subjected to disciplinary proceedings for publishing controversial statements about the ineffectiveness of vaccines on his website.
“This gentleman was a GP who had a website for holistic medicine and he published an article on his website concerning the ineffectiveness of vaccines and that bacteria and viruses don’t cause illnesses. He was disciplined by his disciplinary committee and fined 2,000 and suspended for a probationary period and he appealed to the ECHR, and the Court set out Article 10 and set out that there can be restrictions and said that there can be limitations or interference on your right for free speech where it is proportionate to a legitimate aim to do so, and the Court had to consider whether it was a legitimate aim,” Ms Dillon said.
Quoting the Austrian court ruling, she read out the reasons why the sanction against Dr Bielau was upheld. Readers might be particularly interested in this ruling excerpt in the context of Billy Ralph’s objection to the use of trial phase covid vaccines on children.
“...the special duties by doctors, including the special relationship of medical practitioners with patients based on trust, confidentiality and confidence that the medical practitioners will use all available knowledge and means for ensuring the well-being of their patients, implying also a need to preserve solidarity among members of the profession, and the doctors’ obligation to provide their patients with an objective view of their state of health and treatment.”
The second covid era case used by Ms Dillon to advise the committee was Avagyan v. Russia, a European Court of Human Rights case in which a beautician in southwestern Russia was charged by with ‘disseminating untrue information’ by local police in May 2020. She had posted the following statement on her Instagram account which had 2,600 followers.
“There have been no reported cases of coronavirus in Krasnodar or its surrounding region, and no patients with a coronavirus diagnosis have received test results confirming it. Think about why our government would need this.”
In a reply to that comment, she posted the following:
“People are afraid to speak up about it because they fear for their jobs or even lives. Everyone knows that there is money to be had for reporting coronavirus as the cause of death on official death certificates.”
The ECHR found in her favour, citing inappropriate interference with her Article 10 rights.
The difference between the two cases, Ms Dillon said, was that because Bileau was a GP his opinion was likely to engender more credence than the Russian beautician’s.
“The Court said that because she was a hand therapist, because she was not a doctor, that the principles that they had set out didn’t apply. In other words people would not place as much reliance on what she had to say as they would have placed on when a doctor says something and that’s an important point for the Committee to remember.”
Ms Dillon was outlining a third case, that of Adil V the General Medical Council (2022) in the UK, when the elderly objector rose to his feet just after 5pm at the Talbot Hotel in Stillorgan, Dublin.
The case was an appeal brought by Mr Adil pursuant to section 40 of the Medical Act 1983, against a Medical Practitioners Tribunal’s decision of 29 June 2022 that his registration be suspended for six months. The Tribunal had sanctioned Mr Adil because, between April and October 2020, he appeared in a number of YouTube videos stating words to the effect that:
Covid-19 did not exist, it was a conspiracy brought by the UK, Israel and America, that it was a multibillion scam for the benefit of various persons, organisations and companies, that it was being used to impose a new world order, was made as part of a wider global conspiracy and that Bill Gates infected the world with Covid-19 in order to sell vaccines.
As to Covid-19 vaccines, they would be given to everyone, by force if necessary and that they could potentially contain microchips that affect the human body and further the 5G mobile phone technology agenda, the vaccine will transform human 3 psychology and beliefs and could be used to control and/or reduce the world’s population.
Mr Adil had given assurance that he would remove the videos, but failed to do so, and instead uploaded further videos.
Ms Dillon then drew the committee’s attention to the following words issued in the court ruling against Mr Adil.
“It might be a lawful exercise of freedom of expression for a member of the public to deny the existence of the virus or disease. But for a doctor to do so invoking his medical experience and expertise brings into play different considerations, in a disciplinary context, when considering the effect it may have in trust and confidence in the profession and on public health. People will take medical views from doctors on trust and may reasonably take them as representing the views of the profession more widely.”
And she selected the following paragraph:
“The views expressed by the appellant were not dangerous because they contradicted public health messages on restrictions, as such, but because they undermined the public health messages about the existence, and virulence of the virus.”
Readers will be aware that Billy Ralph did not argue the existence of ‘covid’, but did argue the virulence of it, advocating for the use of treatments instead of isolation measures. The IMC itself heard, in its case against Dr Marcus de Brun at Kings Inns last September, that former IMC president Dr Rita Doyle admitted in relation to a HSE document on hydroxychloroquin that it had beneficial effects on covid.
Dr de Brun asked again if this amounted to the withholding of medication that had been identified by the HSE as beneficial in the treatment of covid.
“I think this is just a general advice, not everybody can have what they want when they want it, when you have a limited supply....” Dr Doyle replied.
Returning to Monday’s proceedings, Ms Dillon told the committee that the details of the ruling against Mr Adil were ‘something that I should remind the Committee about.’
The objector that rose to his feet to interrupt had been growing quietly more concerned with the legal assessor’s advice. This Substack can identify the man as Paddy Kehoe, a farmer from Enniscorthy, the husband of a retired Chief Superintendant and a man of faith. He had been listening closely. And what he heard had caused him to become frustrated to the point of addressing the committee directly.
Here is the full interaction:
Paddy Kehoe (PK): Excuse me, could you just stop, just stop.
Chairman Paul Harkin (PH): Sorry, can I just ask you to resume your seat please.
Ms Dillon: This is my job, my job is to advise the Committee, and that’s the job I do, I am not here to advise the public.
PK: Mr. Chairman, could I object? I am a citizen of --
PH: No, you can’t object.
PK: That is all propaganda, that is out -- I have never heard anything like it in my life, this is disgraceful, I want that put on the record, it’s a disgrace.
PH: I really don’t care what you think.
PK: I am speaking for myself, and I am saying that’s disgraceful. I am sorry I didn’t say it sooner.
PH: Sit down with your disgrace
PK: It’s a disgrace.
PH: That’s fine, you are a member of the public, you are entitled to hold any view you like.
PK: Is this propaganda or is it science or is it a hearing, what is it?
PK: It is propaganda.
PH: It’s not, it’s not, so please don’t interrupt the proceedings. It is challenging enough for us to have a Fitness to Practise Inquiry, and we want to make sure that we are as fair as possible to Dr. Ralph --
PK: It is not an Inquiry.
PH: It is an Inquiry --
PK: It is not an Inquiry.
PH: That’s your opinion, but please --
PK: That’s right.
PH: -- just keep it to yourself, because you are a member of the public, you are not a participant of this Inquiry process. And if --
PK: -- criminal activities such as sexual abuse and theft, how are they appropriate?
PH: You can continue to interrupt and disrupt this Inquiry if you wish --
PK: Are you going to stand over everything that was said here? Is this all loaded, everything that was said --
PH: I don’t know who you are --
PK: This is disgraceful.
PH: I don’t know who you are and I don’t really care, you are not a participant --
PK: I don’t care if you don’t know who I am, I am a citizen of the State, and I object to what is going on here today.
PH: You are entitled to object.
Ms Dillon: If I can finish in relation to the piece, I found the document now in relation to that. All of those cases that I have quoted are cases that are real and can be found in any of the textbooks on this area. It is my job not to advise the public, it is my job to advise the Committee, that is what my job is, and if I didn’t draw the Committee’s attention to those cases I would be derelict in my duty. And all the shouting and roaring in the world will not deflect me now.
It is not an easy thing to stand, interrupt proceedings and express one’s opinion in this manner. It is akin to interrupting proceedings in a courtroom. This Substack was curious about the man’s motivations so I followed up and conducted an interview with him. He is from Co Wexford but he is not a patient of Billy Ralph’s. In the interest of clarity for readers (to separate the reporting of official proceedings), I will publish his interview seperately.
I can reveal that Mr Kehoe’s frustration had not arisen with the citing of case law that involved sexual abuse or dead animals, though certainly this had caused him much grievance. It was earlier comments from the Ms Dillon, that had caused him to question her legal advice for the Committee.
Here is what she said:
“The first thing to remind the Committee about is that an Inquiry, which is what this is, is not a criminal trial and it is not a criminal process, and the Courts have regularly held that the standard of proof is equivalent to the criminal standard of proof but that does not mean that an Inquiry such as this is a replica of a criminal process. While the standard of proof in both processes are the same, that is beyond reasonable doubt, matters that would offend a criminal trial can and have taken place here today. For example the introduction of the video evidence wouldn’t be allowed in The Four Courts, it certainly wouldn’t be allowed in a criminal trial without all the appropriate notification. The late production of witnesses is also something that mightn’t be allowed,” Ms Dillon said.
“But none of that is to take away from the fundamental thing that it is important to remember, which is that the standard of proof in these cases is beyond a reasonable doubt, and the obligation to prove the case to that standard, which is a very high standard, rests at all times on the shoulders of the CEO.”
Ms Dillon selected another English case, often cited in Irish law, Miller v. Minister for Pensions [1947] to illustrate ‘beyond reasonable doubt.’
She said:
“And beyond a reasonable doubt means in a very old case called Miller v. Minister for Pensions, the criminal courts said:
“'Proof beyond reasonable doubt does not mean beyond a shadow of a doubt. The law would fail to protect the community if it admitted fanciful possibilities to deflect the course of justice. If the evidence is so strong against a man as to leave only a remote possibility in his favour, this can be dismissed with the sentence ‘Of course it is possible but not in the least probable’, and the case is thereby proven beyond reasonable doubt.”
In her legal advice to the committee Ms Dillon continued:
“It is often in criminal cases a jury is directed about what is meant by beyond a reasonable doubt by saying the level of certainty you would have when you were making a very serious life decision. Some people would say buying a house, other people might say getting married. It is just something where you can’t say certain because that’s not possible but it is to the higher level. Balance of probabilities is 51% wins the case on the balance of probabilities.
The Committee has to decide this case to that satisfaction. They have to be satisfied before they can make a finding against Dr. Ralph that the case or part of it has been proven against him beyond a reasonable doubt.”
In fitness to practise inquiries, the standard applied is the same that applies in criminal law, ‘beyond reasonable doubt’. The highest standard of proof is required for a finding of guilt to be applied. It means the prosecution must present evidence so conclusive that a judge or jury has no logical or probable alternative explanation other than the accused's guilt. It requires near certainty of an accepted legal threshold of 96% or higher.
The balance of probabilities is an entirely separate standard of proof.
The committee made up of Chairman Paul Harkin, Ms Jill Long and Dr Liam Conroy (a medical practitioner) must be satisfied beyond reasonable doubt of the allegations against Dr Ralph before making a negative finding.
Patricia Dillon SC is a highly experienced senior counsel, she served as a core member of the Mahon Tribunal. Financial disclosures highlighted her as the highest-paid barrister on the Tribunal's 35-person legal team, earning approximately €5.59 million in legal fees for her extensive work.
This Substack finds that there appears to be a subtle anomaly in her legal advice, a certain lack of clarity in differentiating between two legal standards - beyond reasonable doubt and balance of probabilities.
Was this deliberate?
Why mention the 51% rate required for balance of probabilities without mentioning the accept legal standard of 96% for beyond reasonable doubt which is the standard required for a finding of guilt in an Irish Medical Council inquiry?
Ms Dillon points out that the standard of proof required to prove the IMC’s case against Dr Ralph ‘is equivalent to the criminal standard of proof’ but she went on to point out that the inquiry is not ‘a replica of a criminal process’ citing the introduction of video evidence and late production of witnesses (Dr Clare Craig and Dr Angus Dalgelish.)
Is there a very subtle inflection here, that because the video and the witnesses were allowed by the inquiry, that the burden of proof drops to the balance of probabilities?
Would it be more useful to cite an Irish example of case law and discuss this in the context of the Irish Constitution? We know that in Ireland, the right to free expression is bound to state oversight, being ‘subject to public order and morality.’
Certainly, the concepts of public order and morality apply to the public health guidance that Billy Ralph was critical of in his series of tweets posted on X.
But why no mention of the Proportionality Test, the primary legal tool used by Irish courts to decide if a law that restricts a constitutional right (such as freedom of speech) is legally permissible?
The Billy Ralph case presented a unique opportunity to do so, particularly because of the passage of time since the entire country’s constitutional rights were waived for public order purposes.
But what of morality?
I asked AI to define morality in the context of the Irish Constitution. It states that ‘morality’ in this context in not static, it is fluid and evolving. And in relation to the case against Billy Ralph, if he is found guilty of professional misconduct, we must ask, in what direction is public morality evolving?
Something in Ms Dillon’s delivery hit a nerve with those assembled in the public gallery. I will explore this further in my next article.
The Fitness to Practise Committee has set a date of June 5th to return their findings.
For today I will leave the last word to Dr Billy Ralph, who (representing himself) offered this analysis of the concept of professional misconduct.
“Professional misconduct is not established by reference to whether views are easy or difficult for others to manage, or whether they align with the expectation of colleagues, it is established by reference to a defined standard of conduct, that standard has not been identified.”
“Once the concepts are properly separated, the position becomes clear. What is established at its height is disagreement, criticism and the possibility of influence. What is not established is a principled basis, upon which those matters amount to professional misconduct. Without a clear distinction between these concepts, the analysis cannot safely proceed, because the boundary between legitimate professional expression and regulatory breach has not been drawn. And without that boundary the threshold cannot be met.”
Below are the two reports of Monday’s proceedings in Irish newspapers, the Irish Independent and the Irish Daily Mail. There was a freelance reporter in attendance for the Irish Times but his work was not published.
Thanks to those that support and share this work - much appreciated.
Previously:
Spike protein injectable products: unsafe, ineffective; physical distancing and mask-wearing: damaging and useless; lockdowns: mentally, physically, socially and economically damaging.
Just whose professional misconduct requires interrogation here?
Thank you for your sterling work in recording this, Louise.