General Medical Council v Stone, Court of Appeal - Administrative Court, October 13, 2017, [2017] EWHC 2534 (Admin)

Issuing Organization:Administrative Court
Actores:General Medical Council v Stone
Resolution Date:October 13, 2017

Case No: CO/4470/2016 and CO/4005/2017

Neutral Citation Number: [2017] EWHC 2534 (Admin)




Royal Courts of Justice

Strand, London, WC2A 2LL

Date: 13/10/2017



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Jenni Richards QC (instructed by GMC Legal) for the Appellant

Angus Moon QC and Claire Watson (instructed by MDDUS) for the Respondent

Hearing date: 6th October 2017

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1. This is the appeal of the General Medical Council (``the GMC'') brought under section 40A of the Medical Act 1983 against a determination of a Medical Practitioners Tribunal (``MPT'') given on 4th August 2016 suspending the registration of Dr Robert Stone (``the doctor'') for a period of 12 months and ordering a review hearing.

2. The GMC's essential argument is that the sanction imposed by the MPT was insufficient to protect the public, and that the doctor should have been erased from the medical register.

3. The GMC also appeals against the determination given by the MPT at the review hearing on 10th August 2017 that the doctor's fitness to practise was no longer impaired because of the remedial steps he had taken. The destiny of this second appeal is entirely dependent on the outcome of the first.

4. At the outset of the hearing I made a reporting restriction in relation to the doctor's health condition. This has meant that two versions of this Judgment have been prepared: a full version for the parties and their legal advisors, and a redacted version to be placed in the public domain. This is the redacted version.

Essential Factual Background

5. The doctor is a GP who qualified in 1977. Following an investigation, it was alleged by the GMC that the doctor had engaged in an improper sexual and emotional relationship with one of his patients, a vulnerable woman who has been designated at all material times as Patient A (her identity is protected by a further reporting restriction). The relationship lasted between November 2011 and July 2014, and during its course the doctor continued to act as Patient A's GP. In around March 2014, perhaps coinciding with the beginning of the breakdown in the relationship, Patient A's health deteriorated and there were three occasions in March and April 2014 when she attempted to take her own life. When the relationship ended, the doctor informed the partners at his practice and self-reported to the GMC.

6. The hearing before the MPT commenced on 27th July 2016. The doctor did not admit all of the allegations and gave oral evidence before the MPT. Patient A's witness statement was admitted in evidence as hearsay; she was now deceased. The doctor admitted that he visited Patient A at her home in order to engage in sexual activity with her; that he sent her text messages which were of a sexual and personal nature; that on one occasion he had Patient A to stay at his house in order to pursue his sexual relationship with her; that on numerous occasions he engaged in sexual activity with Patient A in a consulting room at the GP practice; that on numerous occasions during this period he treated Patient A clinically as a patient; and, that he knew her to be vulnerable. The nature of Patient A's vulnerability was apparent from the medical records which the GMC relied on before the MPT, and which the doctor knew or ought to have known about as her treating GP. In short, Patient A had a history of depression; she exhibited suicidal ideation with a recorded suicide attempt; she had problems with alcohol abuse and dependency; and she had relationship difficulties. All these matters were admitted by the doctor.

7. Apart from certain matters of detail which were not critical to the overall gravity of his misconduct, the doctor disputed one important head of charge, namely that he had been dishonest in relation to providing two supportive letters (one being to the Asset Letting Agency) regarding Patient A on or about 1st October 2012 and 17th May 2013, in relation to her claim for benefit support. The dishonesty concerned his failure to disclose his sexual relationship with her. At paragraphs 48-51 of its Findings of Fact, the MPT upheld the GMC's case and characterised the seriousness of the doctor's dishonesty in these terms:

``49. The tribunal finds that an ordinary informed member of the public would consider the production of these letters, in the circumstances, to be deceitful and dishonest. This would be the case even though the contents of the letters are true and accurate. The recipients of these letters would not have accepted them as valid if they knew of your relationship with Patient A because the nature of your relationship with her undermines your independence and the reliability of their contents. You were well aware that you were involved in an affair with Patient A at the time and were actively concealing this from your family and partners. The tribunal determined that if you had reflected even for a moment at that time, you would have realised that your actions were dishonest and it is unlikely that you would have written the letters.


51. The tribunal finds that you knew you were making a misrepresentation of your position in providing these letters but you justified your actions by stating that you were writing them solely from a GP perspective and not a personal one. The tribunal finds that it is unlikely that you could wholly separate the two and so considers that your justification was self-deceiving.''

8. At Stage 2 of the proceedings (sc. misconduct and impairment, per Cranston J in Cheatle v GMC [2009] EWHC 645 (Admin)), the GMC received evidence from Dr John Hook, MRCPsych, a Medical Consultant Psychotherapist. He had previously practised in the NHS as a Consultant Psychiatrist. The MPT ``considered [that] Dr Hook gave detailed, comprehensive evidence'' which it accepted. In the circumstances, it has been necessary to examine this evidence with some care. I have read Dr Hook's lengthy report at least three times.

9. The doctor's account to Dr Hook was that although Patient A initiated the relationship he considered his own conduct to be ``criminal ... massively wrong, hurtful, and destructive''. The doctor described his mother as being domineering and controlling. At the time the doctor's relationship with Patient A started his wife's career was taking off, and she was working long hours. Dr Hook conducted a mental state examination of the doctor and various questionnaires, inventories and other standardised assessment tools were applied. Dr Hook's formal diagnosis was [REDACTED].

10. Dr Hook summarised the position in his report in these terms:

``He has engaged in an inappropriate sexual relationship with a patient. Whilst on the face of it, it appears that the relationship with Patient A was sexually motivated I am of the opinion that there is an alternative explanation based in his character pathology and personal circumstances for these behaviours. In my view the combination of the above factors created a perfect storm in which he was confused by his own feelings and behaviours to a degree which interfered with and overrode his professional judgement. She represented aspects of his mother - dominating and demanding but with a more obvious vulnerability which he responded to in the hope of rescuing her from her unhappy situation. His psychological needs become predominant and caused internal conflict with his professional ethical code. He was not able to sufficiently prioritise his patient's needs over his own. I do not think that his behaviour was sexually predatory.

He is suffering from [REDACTED]. This is the main source of vulnerability and risk. The features in relation to the allegations are his social inhibition, non-assertiveness, being overly accommodating self-sacrificing and self-deprecating which created a propensity to become involved with a troublesome relationship which could only be self-destructive and damaging to the patient.''

11. Dr Hook's oral evidence to the MPT included the following:

``The behaviour following on from whatever is going on in his mind. I am suggesting that in these perfect storms the drives are so strong that normal judgement, sane judgement, professional judgement, is easily overridden to an extent, and this relates to what I was saying early on, that it is almost impossible to put oneself in that position because it is qualitatively different state of mind, one that we, for the reason which you are asking the question, find ourselves - it is incredibly difficult to get one's head round what it is like to be in a state of mind to be driven to do something that another part of your mind, the sane part of your mind, tells you is going to be a disaster.


I think what I suggested earlier on is that the perfect storm had already begun by the time sex occurs; that actually there is a moment, as I said earlier, and I can only place it - I cannot tell you exactly when that moment was but I suspect that moment right at the beginning when she leans forward and strokes his arm is the beginning of the storm and there is virtually no way back from that point on. There are lots of points from a rational point of view that we would all say ``Of course there were points that you should not have done this''; what I am saying is the psychological drivers are sufficiently strong to override all those judgements. To come to your other point, that the rest of my report falls away, what I said to you I think a few moments ago is that it does not fall away. These are not mutually exclusive ideas. What I am saying is that the psychological driver for me, my understanding, is the prime driver.


What I am saying about will is it gets overridden by the unconscious processes of drivers that drove Dr Stone at that moment. But to answer the other...

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