The accused
Public exposure from complaints and claims can cause doctors to face a trial by media. In 2011, a UK GP was accused of sexually motivated conduct when he examined a patient’s chest – he shares his experience with Sara Dawson
It seemed like a normal surgery day a couple of years ago. As I was signing scripts, my practice manager knocked on my door and brought in a brown envelope marked private and confidential. I opened it and read it – the contents were highly distressing.
The letter contained details of allegations made by a female patient (Mrs B) that, two months previously, I had conducted a sexually motivated consultation. I remember seeing Mrs B in early spring complaining of chest and stomach pain. Initially I offered her a chaperone, as it is practice policy; she declined, so I performed a thorough chest examination and referred her for surgery.
Her complaint was that during the chest examination I squeezed her breast, and behaved sexually while breathing heavily. She thought my front, back and side examination was inappropriate and not what she’d expected.
I was devastated to hear about the serious nature of the complaint, as it would have ramifications for me, as a doctor, and as a husband and a father, and as an upstanding member of society. My surgery staff were highly distressed and took it very seriously; I immediately contacted MPS.
Investigation
We asked the patient to give consent so that we could send the complaint to be investigated thoroughly and in an unbiased way by the PCT (Primary Care Trust).1 After a delay the records were shared and I gave my witness statement. The local PCT determined that I should have a chaperone for every female consultation while the investigation was underway.
In spite of numerous attempts, Mrs B failed to engage with the PCT to give her version of events. The PCT felt they had no choice but to refer the case to the General Medical Council (GMC). The GMC held an interim order panel meeting. Accompanied by an MPS solicitor, the panel listened to our case. They applied conditions to my registration that I was to have a chaperone for every intimate female examination, and to log each examination. The GMC’s investigation took more than a year to complete and a hearing date was set, 18 months after the initial allegation.
The hearing
The first day of the hearing didn’t go to plan. I arrived all geared up to defend my corner, but Mrs B did not turn up, so it was adjourned until the following day. When the hearing did commence Mrs B gave a witness statement, and there was a submission from my MPS-instructed barrister, then the panel went away to decide the next course of action.
The next day the panel gave their decision that they found the allegation untrustworthy and uncorroborated, and the case was concluded.
Personal impact
The experience of having a patient make an unfounded allegation against you is devastating; I would not wish it on my worst enemy. The insecurity you feel day in and day out is worse than physical pain. There were days where I could not see any light at the end of the tunnel, like my head was under a guillotine. My mind was fractured; I kept thinking ‘why me, why did this happen to me?’
As a doctor this experience was earth-shattering: it’s the worst thing to be accused of – an allegation of sexual motivation; how can you prove you were acting appropriately? It’s their word against yours. If the GMC had found in Mrs B’s favour, my license, my livelihood, my marriage, my social standing would have been demolished just like that.
During the investigation I went to work as normal. Every day I had to face the stigma around me of what I had allegedly done.
Impact on the practice
It was particularly hard on the practice, having to have a chaperone from beginning to end. We were not just employing a GP, but two healthcare professionals at the same time. This had huge financial and logistical implications for the practice. Not being a big practice we don’t have many nurses or staff, so it was difficult. We had to consider the future of the business: if I were to be found guilty and forced to leave, how would the practice cope?
We had to consider the future of the business: if I were to be found guilty and forced to leave, how would the practice cope?
Media coverage
Handling the media was not something I’d really considered. I’d definitely never thought about being on the front page of a national newspaper. We were all worried about it: what would patients do? The stories were angled in a certain way that assumed I was guilty – it would have been nice to be captioned in a different way.
I remember, during the hearing, getting messages from friends asking if I was ok, as they’d seen the coverage. Even abroad, it was all over the internet. The pressure was huge and so upsetting. My name was exposed, I’d lost my anonymity – I was breakfast gossip. There was a sense of bias – why was I stripped of my anonymity when the person who made the allegations enjoyed full anonymity? The media coverage added salt to my wounds.
Support
Throughout the process I worked closely with the local medical committee, my MPS legal team, and the PCT. Without the understanding and professionalism of these people it would have been a much more difficult time. I drew strength from the fact that I knew I was professional and hadn’t done anything wrong – I believed the truth would come out in the end. I’m most proud of the way the practice dealt with the whole thing – we pulled together like a family.
From the first day, I was honest about the allegation and discussed it with my staff, my patients, my family and my colleagues; from then on I informed them of all the developments. I could not have survived the experience if they hadn’t supported me. I always wanted to be a professional GP, dedicated to my practice and patients, and to be involved in the community as a doctor.
Eighteen months have been wiped from my life and I will never get answers to why Mrs B did what she did, but I take some comfort in that justice has been done and I was vindicated – life goes on and I have learnt from it.
Legal opinion
By Dr Jo Galvin, MPS medicolegal adviser, who handled the case.
Unfortunately this case is not an isolated one. Mrs B came to the practice specifically asking for her chest to be examined thoroughly. During the examination she perceived that the actions of the GP in question, whom I shall refer to as Dr Z, were sexually motivated.
Dr Z said that when he examined her, he explained what he was going to do and explained the depth and pattern of the breathing. His situation was compounded when he locked the door to preserve her confidentiality, as the door had recently accidentally opened into the adjacent waiting room. Mrs B misconstrued this again to be sexually motivated.
Credibility
The credibility of Mrs B was undermined when she did not turn up for the first day of the hearing – she claimed that her father was in hospital. MPS requested full disclosure of the reasons for her absence. It came to light that she had sent the text message explaining her absence from her sister’s house, and her father was not in fact in hospital.
It is unlikely that you would come back voluntarily and visit your GP again if you perceived him to have acted inappropriately. This raised questions around Mrs B’s recollection of the events
Chaperones
Doctors are alive to the fact that they need to use a chaperone when performing intimate examinations, but they aren’t always alive to the dangers of some examinations; for example, an accidental brush of the chest can get doctors into difficulty. An important point to make is that Mrs B’s consultation was not an intimate examination – it was a chest examination – but Dr Z still offered Mrs B a chaperone.
MPS conducted an audit of Dr Z’s previous consultations, and were able to prove that it was his consistent practice to offer a chaperone and document it. He’d documented contemporaneously in the notes that he had offered a chaperone to Mrs B and that she had declined – this helped his defence.
Good record-keeping
There were several important factors that further undermined Mrs B’s version of events. During the consultation Dr Z also referred Mrs B to hospital to be treated for a different condition; Mrs B had no recollection of this or of visiting Dr Z a couple of weeks later about a different matter. It is unlikely that you would come back voluntarily and visit your GP again if you perceived him to have acted inappropriately. This raised questions around Mrs B’s recollection of the events. In contrast, Dr Z had documented everything contemporaneously.
When there is a factual dispute, the credibility of a complainant is important. In this case there was a factual dispute and the weight of evidence was in Dr Z’s favour. His notes were further backed up by a GMC-obtained expert report about the correct standard of chest examinations; this proved that Dr Z’s standard of chest examinations was appropriate.
Professional challenges
The situation presented professional challenges because Mrs B remained a patient at the practice. It is hard to justify removing a patient simply because they have made a complaint. Good practice management meant that Dr Z did not see Mrs B.
Advice
Dr Z was unlucky, but his contemporaneous note-keeping and good practice helped prove that he had not done anything wrong. He did everything he could to give himself the best protection.
Learning points
- Always use chaperones for examinations that are perceived to be intimate examinations
- Good record-keeping is essential
- Communicate effectively with your practice team
- Develop good working relationships with your staff and patients
- Expert evidence is helpful in disputes around standard practice.
For further information about chaperones and maintaining boundaries please see our factsheets >>
Names have been withheld to protect the confidentiality of those involved.
References
1. Note for readers outside England: Primary Care Trusts were administrative bodies within the National Health Service (NHS), responsible for commissioning primary, community and secondary health services from providers, and for providing funding to GPs. They were abolished in 2013.