General Medical Council v Dr E [2013] EWHC 3425 (Admin)

Case No CO/13496/2013[2013] EWHC 3425 (Admin)
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
THE ADMINISTRATIVE COURT
Venue Manchester Civil Justice Centre
1 Bridge Street West
Venue Manchester, Greater ManchesterDate Thursday, 17th October 2013
M60 9DJ
B e f o r e:
HIS HONOUR JUDGE PELLING QC
(Sitting as a Judge of the High Court)
Between
GENERAL MEDICAL COUNCILClaimantv
Between
DR EDefendant
Digitial Audio Transcript ofWordWave International LimitedA Merrill Communications Company165 Fleet Street London EC4A 2AGTel No: 020 7404 1400 Fax No: 020 7831 8838(Official Shorthand Writers to the Court)
Mr Hurst appeared for ClaimantMr Atherton appeared for Defendant
J U D G M E N THIS HONOUR JUDGE PELLING QC :
[1]This is a claim by the claimant (hereafter the "GMC") for an order pursuant to section 41A of the Medical Act 1983 (as amended) for an order extending by 12 months, to 22nd October 2014, an interim order of conditions first imposed on the defendant by the Interim Orders Panel of the GMC on 23rd April 2012. As will be apparent from what I have said so far(a) the defendant has so far been subject to an interim order of conditions for some 18 months and(b) if I grant the order sought, will have been subject to such an order for two-and-a-half years by the time the proposed extension expires.[2]The conditions to which the claimant has been made subject have not differed materially over time. The condition which is material for present purposes is condition 5, which is to the following effect:
"(a) except in life threatening emergencies he must not undertake consultations with female patients without a chaperon present. The chaperon must be a fully registered medical practitioner or a fully registered nurse or midwife. (b) he must maintain a log detailing every case where he has undertaken a consultation with such a patient which must be signed by the chaperon. (c) he must maintain a log detailing every case where he has undertaken a consultation with such a patient in a life threatening emergency without a chaperon present. (d) He must provide these logs to the GMC prior to any review hearing of this Panel or alternatively, confirm there has been no such cases during that period."
The effect of this order is said by the defendant to be for all practical purposes the equivalent of suspension because he has worked for most of his professional life as a GP and out of hours general practitioner. As to the first he says that supervision by a registered medical practitioner makes it practically impossible to obtain employment because either he or the chaperon will be redundant and chaperoning by qualified nurse is almost as impractical. It is wholly impracticable for him to be chaperoned as an out-of-hours GP for reasons which are obvious. None of this is disputed or seriously disputed by the General Medical Council. In those circumstances the defendant resists the extension sought on the basis that it is contrary to his interest and is disproportionate in the circumstances both because of its practical effects and because of the delay that has occurred and will occur before the case against him can be placed before a Fitness to Practise Panel or abandoned[3]The principles that apply to applications of this sort are not in dispute between the parties. In so far as material section 41A provides as follows:
"(1)Where an Interim Orders Panel or a Fitness to Practise Panel are satisfied that it is necessary for the protection of members of the public or is otherwise in the public interest, or is in the interests of a fully registered person, for the registration of that person to be suspended or to be made subject to conditions, the Panel may make an order... (b)that his registration shall be conditional on his compliance, during such period not exceeding eighteen months as may be specified in the order, with such requirements so specified as the Panel think fit to impose (an 'order for interim conditional registration')... (3)Where ... an order for interim conditional registration has been made in relation to any person under any provision of this section ... an Interim Orders Panel or a Fitness to Practise Panel may... (a) revoke the order or revoke any condition imposed by the order; (b) vary any condition imposed by the order; (c) if satisfied that to do so is necessary for the protection of members of the public or is otherwise in the public interest, or is in the interests of the person concerned, replace an order for interim conditional registration with an interim suspension order having effect for the remainder of the term of the former; or (d) if satisfied that to do so is necessary for the protection of members of the public, or is otherwise in the public interest, or is in the interests of the person concerned, replace an interim suspension order with an order for interim conditional registration having effect for the remainder of the term of the former... (6) The General Council may apply to the relevant court for an order made by an Interim Orders Panel or a Fitness to Practise Panel under subsection (1) or (3) above to be extended, and may apply again for further extensions. (7) On such an application the relevant court may extend (or further extend) for up to 12 months the period for which the order has effect... (10)Where an order has effect under any provision of this section, the relevant court may— … (b) in the case of an order for interim conditional registration, revoke or vary any condition imposed by the order; (c) … substitute for the period specified in the order (or in the order extending it) some other period which could have been specified in the order when it was made (or in the order extending it), and the decision of the relevant court under any application under this subsection shall be final."
[4]The legal test that I am required to apply was considered by the Court of Appeal in the well-known decision of GMC v Hiew [2007] EWCA Civ 369 [2007] 1 WLR 2007. The relevant paragraphs for present purposes are paragraphs 27-28 and 31-33. Paragraph 27 identifies that under section 41A(7), the court has power to determine that there should be no extension or the extension sought by the GMC or some lesser extension. Thus, it is that the court is not confined to deciding whether or not the application made by the GMC should simply be granted or refused but has power to grant a lesser extension and to vary the terms of any conditions which have been imposed.[5]At paragraph 28 of the judgment the point is made that the criteria which the court applies in deciding applications of this sort are the same as those that have to be applied by the original Interim Orders Panel under section 41A(1). Thus the court can take into account such matters as the gravity of the allegations, the nature of the evidence, the seriousness of the risk of harm to patients, the reasons why the case has not been concluded and prejudice to the practitioner.[6]At paragraph 31 Arden LJ said this:
"The statutory scheme thus makes it clear that it is not the function of the judge under section 41A(7) to make the findings of primary fact about the events that have led to the suspension or to consider the merits of the case for suspension. There is, moreover, no express threshold test to be satisfied before the court can exercise its power under section 41A(7), such as a condition that the court should be satisfied that there is evidence showing that there is a case to answer in respect of misconduct or any other matter. On the other hand, if the judge can clearly see that the case has little merit, he may take that factor into account in weighing his decision on the application. But this is to be done as part of the ordinary task of making a judicial decision, and a case where a statutory body makes an application on obviously wholly unsupportable grounds is likely to be rare."
The function of the court is to :
"...ascertain whether the allegations made against the medical practitioner, rather than their truth or falsity, justify the prolongation of the suspension. In general, it need not look beyond the allegations."
Arden LJ added that it was for the court to decide what weight to give to the opinion of the GMC in its Interim Orders Panel decisions emphasising that the court was not bound to follow them but that full weight had to be given to the opinion of a body which had special statutory responsibilities, relevant experience and expertise in relation to medical practice. The only gloss on the principles identified by Arden LJ in Hiew, that I need note at this stage in these proceedings is that the court is entitled to discount evidence that is manifestly unreliable - see in this regard Perry v NMC [2013] EWCA Civ 145.[7]The allegations faced by the defendant in this case are apparently some of the most serious that could be faced by a registered medical practitioner. They are summarised in paragraphs 12 to 14 of the statement of Miss Stephanie Pollett, the head of national investigations of the GMC, filed in support of this claim in the following terms:
"12.The claimant was made aware of concerns relating to the defendant by way of an email chain dated 24th November 2011 from DC Meadows of Derbyshire Police ('the police') DC Meadows contacted the claimant in relation to an ongoing criminal investigation concerning an allegation that the defendant had raped one of his patients, KA. Within this correspondence the claimant confirmed that a previous investigation had been undertaken into an allegation that the defendant had conducted an inappropriate relationship with KA. The complaint had been referred to the claimant by Dr John Chesworth Medical Director of NHS North Staffordshire in February 2010. KA had been identified as a vulnerable adult and so the claimant did not approach her to obtain a witness statement in relation to the allegations. The case concluded with no further action and there was insufficient evidence to suggest the relationship had occurred while the defendant was KA's GP. The defendant was informed of this outcome by way of letter dated 22nd December 2010. Further correspondence was received from DC Meadows by way of an e-mail dated 20th December 2011. DC Meadows confirmed that the defendant had been arrested on 19th December 2011 on suspicion of the rape of KA over a period of 3 years, from January 2008 to November 2011. DC Meadows also stated that the defendant was the father of KA's 2 year old child. The defendant had been bailed conditionally from the police station to return on the 18th March 2012. On the 7th February 2012 the claimant received further e-mail correspondence from DC Meadows in which he stated that the police will be taking no further action in relation to the allegations as the evidential threshold test was not met ..."
[8]The first investigation referred to in this evidence had originally been completed and a decision taken that no action was required for reasons set out in a letter from the GMC to the defendant dated 22nd December 2010. In so far as it is material for present purposes the letter was to this effect:
"KA was reported to have a complex medical history and family background and it was alleged she fell pregnant with a child of her GP, Dr E. According to the account of the CPN Dr E was fully aware of KA's background. The child of KA was born on 7th July 2009 and the birth certificate names Dr E as the father. Dr E has responded to the GMC rule 7 letter and denies the relationship with KA was established or pursued while Dr E was her GP. Patient KA said to be a vulnerable adult and has not been approached directly to assist the GMC investigation... The allegations made against Dr E are serious and if proven constitute breaches of good medical practice. The case examiners are asked to consider all the evidence in this case and to establish that there was a realistic prospect of proving that Dr E's fitness to practise is impaired to a degree that justify action being taken on his registration status ... the case examiners have carefully considered all the evidence in this case including the anonymised patient records. The fact that Dr E admits that he is the father of KA's child and is named on the child's birth certificate does not of itself prove any wrongdoing on his part. It is noted that despite considerable efforts it has not been establish that Dr E used his professional position to establish or pursue a sexual or improper emotional relationship with patient KA or that the relationship commenced while Dr E remained KA's GP."
[9]There are very substantial grounds for thinking that KA's evidence is incredible in a number of respects. First, her initial statement to the GMC includes a number of inherently improbable assertions. These include:(a) an allegation that the defendant took the claimant to the Medical Protection Society, where she claims she was coerced into agreeing to say that the relationship between the defendant and her started in 2007 after KA had ceased to be a patient at the practice which the defendant was then a partner when in fact it started much earlier.(b) an allegation that after KA became pregnant by the defendant for the second time "as of result of one of the occasions when Dr E forced himself upon me … I was made to have a termination. Dr E took me to a private clinic in Birmingham. He did not want anyone to know he had paid £600 in cash. I am also devastated as I am against abortion." This is inherently unlikely because of the legal requirement that an abortion must be approved by two medical practitioners before it can be lawfully carried out and also because I was told that KA is not able to identify even approximately the location or any other details relevant to the clinic said to be concerned; and(c) in relation to the defendant's role in looking after the child of the relationship, who I refer in this judgment as "A", KA says:
"Dr E now looks after A to which I have genuine concerns. As throughout the time Dr E stayed with me he administered A aged two-and-a-half years 6 plus Mediced despite him not needing it. He would use it in order to settle A off at bed times so that he did not awake while Dr E was abusing me."
This last allegation is potentially extremely serious one but is apparently incredible because it is not in dispute that there have been proceedings concerning the care of A that have been determined in the Chesterfield County Court as the appropriate Family Court for resolving those issues. In those proceedings the Family Court made first an interim residence order in favour of the defendant and then a final residence order. These facts are not in dispute. The documentation relating to these proceedings are not available to me. In order for those materials to become available an application would have to be made to the Family Court for their release. Such an application would have to be made either by the defendant or possibly by the GMC. Counsel for the GMC did not disagree when I suggested that it was to be inferred that these allegations of rape and abuse of A must have been made and rejected in the child care proceedings or alternatively must not have been made at all by or on behalf of KA. In either event that significantly damages the reliability of KA's evidence.[10]The credibility to be attached to KA's evidence would appear to be to have been a major consideration in the police deciding not to proceed further with the allegations made by her. I emphasise in this regard that this was not a case of the police seeking the advice of the CPS. This was a decision that the police took at a very early stage in their enquiries.[11]The disclosure by the police to the GMC shows why this decision might have been taken. It includes notes of enquiries made by the police concerning KA. These notes include a statement from KA's mother who was recorded as having described KA as a "compulsive liar" and that KA abuses alcohol to a very serious level and has suffered from a history of mental illness going back some years. Her father describes her more diplomatically as "prone to drinking and exaggeration". This material also suggests strongly that the relationship between the defendant and KA was a consensual one. It records also a threat by KA to destroy the defendant because she wanted her child back. This is all the more a telling point because it was said to have emerged in the course of a telephone call that took place between KA and the defendant's former wife initiated by KA.[12]It is not the function of this court to reach judgments as to whether the factual allegations relied upon by the GMC have been proved - see the summary of the applicable legal principles set out above. However, the factors to which I have referred suggest that the central allegation that the defendant has raped KA on a large number of occasions over a number of years is an unsustainable allegation because it depends exclusively on evidence that is manifestly unreliable.[13]This is significant because the GMC's case at each Interim Orders Panel to which the case against the defendant has been presented has been presented exclusively by reference to this allegation. The last occasion that this case was placed before an Interim Orders Panel was 19th July 2013. The case was opened to the Interim Orders Panel in these terms:
"Dr E was referred to GMC by Detective Constable Jane Meadows of Derbyshire Constabulary on 24th November 2011. DC Meadows informed the Council that an allegation of rape had been made against Dr E which was in early stages of investigation. Although no further police action was subsequently taken against Dr E the investigating officers were of the view the case raised serious concerns with regard to Dr E's judgment and cast doubt on his ability to work with vulnerable adults. DC Meadows added that the complainant KA, with whom Dr E had previously entered into a relationship was quite clearly a person with mental health issues and the judgment of Dr E and the relationship appeared extremely flawed given his position of trust. In March 2012 KA made an online complaint in which she made a number of serious allegations against Dr E."
[14]Before me an attempt has been made by the GMC to broaden the allegations made to include an allegation concerning probity and also to justify the continued imposition of conditions on the basis that even if the rape allegations are discounted as incredible or nearly so, there is nonetheless evidence that the defendant entered into a relationship with a vulnerable adult patient or ex-patient and that should be regarded as at least as serious.[15]The defendant is not alleged to have any previous findings of misconduct made against him. This is significant given that the defendant qualified in the very early 1980s and thus has been qualified as a medical practitioner for not less than 20 years. It is not alleged against the defendant that he has assaulted any patient in the course of any examination or that he has formed a relationship with any other patient, whether vulnerable or otherwise, apart from KA.[16]It is also right to note that each of the organisations by whom the defendant was employed each professed themselves happy to employ the defendant on an unrestricted basis. In particular the defendant was employed by North Staffordshire Urgent Care as an out-of-hours locum out of hours GP. It wished to retain the services of the defendant but were unable to do so because of the requirements of condition by 5(a) which the GMC declined to relax. Staffordshire Primary Care Trust retained the defendant on its Performers List following the disclosure of the allegations and notwithstanding the imposition of the interim conditions be the Interim Orders Panels that I have referred to.[17]I reserved judgment in this case overnight because I wished to reread all the material available to me. I have come to the conclusion that on the material available to me the evidence of KA appears to be sufficiently unreliable that it must be discounted, save where it is agreed or is supported by other evidence from an otherwise unimpeachable source. Thus the evidence available establishes that the defendant entered into a relationship with KA, that he had a child by her, who now lives with him by order of the Family Court. No finding of misconduct has ever been made against the defendant in some 20 years of medical practice and no allegations of misconduct other than that investigated by the GMC in 2010, in respect of which no action was taken has ever been made.[18]Critically in my judgment the allegation that the relationship started while KA was a patient of the defendant is denied and was not supported by KA in a statement she gave at the time of the first investigation. This statement is the one that she now claims she was coerced into providing at a meeting at the Medical Protection Society. The GMC maintains that medical records which are now available support inferentially the allegation that the relationship started while the defendant was KA's GP. Whilst it is true to say that those records suggest much longer consultations than were the norm for the GP's practice at which the defendant was then a partner and took place at times which meant that they continued outside otherwise normal surgery hours, the length and frequency of the consultations may be explained by the fact that these consultations were in the nature of counselling sessions associated with KA's mental health condition. It would I think be difficult to infer an improper relationship on the basis of this evidence alone.[19]The issue that I confess to finding a little more difficult concerns the probity of the defendant. This is not an issue that has been considered by an Interim Orders Panel. It is said to have surfaced only following the receipt of a witness statement from Dr Julie Oxtoby, the GP principal at the surgery where the defendant was a partner until he was required to resign in March 2010. In summary the issue is that Dr Oxtoby asked the defendant whether the former patient who he disclosed he was in a relationship with was KA. The defendant refused to give the name of the patient or former patient concerned. In my judgment that was not a helpful response, but did not lack probity because it did not involve any false representation. However, Dr E did tell his partners that the patient or former patient concerned was not, in his view, a vulnerable adult. It is difficult to see how that could be regarded as an honest answer in the particular circumstances of this case. It is that which is said to give rise to the probity issue in this case.[20]Whilst I do not consider the probity allegation to be so serious that it ought to lead to suspension rather an interim conditions order, it does of course have an impact on the submissions made on behalf of the defendant concerning the relaxation of the conditions which have been imposed upon him by the GMC.[21]Before turning to my conclusions it is necessary that I consider the delay that has occurred in the conduct of the GMC's investigation. It is to be borne in mind that the investigation the GMC had to carry out did not involve considering multiple numbers of patients or multiple numbers of allegations concerning different patients , nor did it involve considering technically difficult medical science issues, much less ones that necessitated instructing expects. There was a single albeit very serious allegation of a serial rape over a period of years that had to be considered. Counsel for the GMC recognised that a significant amount of time had passed but in accordance with the evidence filed in support of the claim sought to explain the delay that had occurred by reference to the fact that KA is vulnerable and thus obtaining evidence from her has proved, for entirely reasonable reasons, to be particularly difficult. Indeed, counsel informed me in the course of his submissions that even now a signed witness statement had yet to be obtained from KA. He did not suggest to me that it was thought she lacked capacity to give evidence at any material time during the period that has elapsed.[22]I accept the submissions on behalf of the defendant that not all the delay that has occurred can be explained by reference to KA's vulnerability. On the contrary, large parts of it can be explained only by inactivity on the part of the GMC for prolonged periods. The defendant's counsel summarised these periods of delay in paragraph 9 of his written submissions in these terms:
"The GMC cannot lay all the responsibility for the delay on the fact that KA is vulnerable as the following chronology show - the GMC took 6 months from March 2012 to September 2012 to seek Dr E's employer details In an email to the Court, Mr Hurst, counsel for the Defendant informed me that this reference was “not accurate”. Although it was extracted from the evidence field on behalf of the Claimant, in fact the GMC sought Dr E’s employment twice so that whilst it is correct to say that the GMC sought employment details 6 months after the initial complaint, that was not the first time they had been sought. I have not altered the text of the judgment because it reflects the judgment that I gave at the time. However, I record that I do not consider this issue to be material to the conclusions that I reached. . - the GMC took 9 months to obtain KA's medical records - the GMC took nearly 3 months to follow up with the police to obtain more information • the GMC took 15 months to request the trust investigation file • the trust and other management agency material remains outstanding 18 months after KA's complaint - the GMC took 13 months before attempting to take a witness statement from KA. • 18 months after the complaint was made the GMC does not still have even a finished first draft witness statement for consideration and signature • the GMC took 14 months from the complaint to begin to witnesses despite the witnesses being identified and the police material received on 2nd April 2012."
This was not in substance disputed by the GMC or rather GMC's counsel in the course of submissions.[23]It is true to say that the unwillingness of KA to provide a statement has contributed to the delay that has occurred. I recognise that KA is vulnerable. I recognise also that the GMC as a responsible regulator must be careful not to disadvantage such vulnerable persons by applying undue pressure to deliver witness statements within unduly pressured time limits. The GMC must be particularly astute to protect the interests of vulnerable people. Thus I reject the defendant’s submission that KA cannot be allowed to dictate the speed of the investigations if by that it is contended that the speed of the investigation can have no regard to the vulnerabilities of KA. However, I accept the point made on behalf of the defendant that there will come a point where, if there is no evidence from KA to support her complaints, the process must be brought to a conclusion on the basis that she cannot or will not provide a statement that supports the allegations that she has made.[24]It was submitted on behalf of the defendant that condition 5(a) should be discharged and replaced with conditions that entitled him to practise as a GP without a chaperone unless one was requested in the ordinary course by the female patient concerned and that he should instead be required to keep a log in relation to each female patient seen, recording when and where the patient was seen, what examinations were performed and why.[25]The GMC says that I should simply continue the existing conditions and in support of that contention relies in particular upon an exchange that took place at one of the Interim Order Panels between the medical member concerned and the solicitor then appearing for the defendant in which an application to relax the terms of paragraph condition 5(a) was sought and the medical member challenged the desirability of that course. I have of course read that exchange more than once and take it into account in arriving at the conclusions that I have reached.[26]In my judgment, neither of the submissions made by the respective parties in this case are ones that I can accept.[27]As I have said, on the material available I regard the uncorroborated evidence of KA that she was repeatedly raped over a number of years and became pregnant twice as a result is so inherently unreliable that it would be unsafe and unsound to proceed by reference to that allegation. It remains the case however that the claimant commenced a relationship with someone who was, on his own case, a former patient and who he knew or must have known was a vulnerable adult by reason of her mental health issues. It also remains the case that the defendant is credibly alleged to have actively misled his former partners on the question of whether the former patient he admitted having a relationship with was a vulnerable person. Whilst I would regard it as unsafe and unsound to extrapolate from that isolated allegation, which concerns conduct which arose in circumstances that must on any view have been highly pressured, a conclusion that the defendant is so untrustworthy that he ought not to be permitted to practise at all. However, simply looking at the allegations that are made rather than arriving at any judgments concerning their truth or accuracy, it does mean that there is a risk that he might attempt to develop a relationship with a vulnerable patient and, if the only control was a log, that he would seek to disguise or conceal such an occurrence. By the same token, whilst I consider that interim conditions are necessary for the protection of both patients and the defendant, it is necessary to consider very carefully whether condition 5(a) is proportionate in the circumstances.[28]As was accepted by counsel for the GMC, conditions that are proportionate when they are first imposed can become disproportionate with the passage of time and thus delay is a material consideration in deciding whether it would be proportionate to continue the interim conditions order or relax it in whole or part. There has been significant delay here. The delay that has occurred is not something that I alone have been critical about. The IOP that considered the conditions again in March 2013 was critical of the delay that had occurred too, for it said as follows:
"The Panel has had regard to length of time that the GMC investigation has taken and was disappointed at the apparent lack of progress...."
I accept the evidence of the defendant that he has been deprived of most of his income as a result of the conditions imposed. I accept that this has seriously affected his ability to provide for his children, including A. However, if the imposition of condition 5(a) was proportionate, that is to say that it represents the minimum interference with the defendant's ability to practise medicine that is necessary to achieve the statutory objective set out in section 41A, then these consequences should not lead the court to refuse to continue to the order.[29]As I have said, there are credible allegations made against the defendant that he formed a relationship with a vulnerable patient. In those circumstances I consider that conditions can be formulated, that will eliminate that risk without having the effect of practical suspension. I have of course taken into account, as I have said, the remarks made by the medical member of the Interim Orders Panel when this issue was considered in the context of an application to relax the effect of condition 5(a). With respect however, I conclude that whilst condition 5(a) would undoubtedly be an appropriate one to impose where the allegations made were of physical assaults in the course of medical examinations, it may not be appropriate to adopt that approach where as here the medical practitioner is alleged to have groomed a single vulnerable patient over time, with a view to cultivating a relationship which became physical in consequence.[30]In those circumstances, I conclude that in substance condition 5(a) should be replaced with conditions broadly to the effect that I am about to describe. These are conditions which will require some consideration so far as formulation is concerned and therefore the summary I am about to give is of the substance rather than the final formulation of the conditions that must be imposed. In summary however, I consider the appropriate course would be to substitute for condition(a) the following conditions: (a) not to treat or have any personal contact with any female patient other than in a consultation fixed by prior appointment by the patient concerned to a GP's surgery or other NHS unit.(b) not to have telephone contact with any female patient other than in response to calls from such patients to the surgery or other NHS unit at which the claimant is employed(c) not to make any contact with any patient by e-mail or other electronic means other than to respond to emails received from a female patient sent to the surgery or other NHS unit of which the claimant is employed.(d) except in life threatening emergencies not to treat or undertake a consultation with any female patient more than three times in any three month period.(e) save to the extent provided by (a) to (c) above, not to make contact with any female patient or visit or meet with such patients.(f) on every occasion when he treats or conducts a consultation with a female patient, he must offer that patient a chaperon.[31]These conditions ought to enable the claimant to practice as a locum GP during normal surgery hours but at the same time eliminates to the maximum possible extent the opportunities for developing inappropriate relationships with female patients in the way that is alleged by the GMC in this case. In my judgment this is a proportionate response to the allegations that currently are available to the GMC - that is the defendant formed an inappropriate relationship with KA while she was or after she ceased to be a patient and to the isolated allegation of a lack of probity.[32]The final question that I have to consider is the length of the extension. I am prepared to extend the conditions as varied in the way I have described for a further period of 6 months. By then the defendant will have been subjected to an interim order of conditions for 2 years. By then the claimant will have or ought reasonably to have decided whether it wishes to proceed and, if so, on what basis. If KA gives a statement and if that necessitates further enquiries which require additional time then there will have to be a further application. Had the GMC not delayed in the way I have described I would have expected that this case could have been much more advanced and possibly even concluded by now.[33]In those circumstances and to that extent, I am prepared to accede to the claim that is made.

Cited in 1 later judgment