Dr Robin Edward Lawrence v The General Medical Council
| Jurisdiction | England & Wales |
| Judge | THE HONOURABLE MR JUSTICE STADLEN |
| Judgment Date | 02 March 2012 |
| Neutral Citation | [2012] EWHC 464 (Admin) |
| Docket Number | Case No: CO/11086/2010 |
| Court | Queen's Bench Division (Administrative Court) |
| Date | 02 March 2012 |
The Honourable Mr Justice Stadlen
Case No: CO/11086/2010
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Royal Courts of Justice
Strand, London, WC2A 2LL
Ms Christina Lambert QC (instructed by Eastwoods Solicitors) for the Claimant
Ms Catherine Callaghan (instructed by General Medical Council Legal) for the Defendant
Hearing dates: 08/11/11 – 11/11/11
Dr Lawrence is a consultant psychiatrist practising from 96 Harley Street in London. In September 2010 a Fitness to Practise Panel ('the FTPP") of the General Medical Council ("the GMC") conducted a hearing into allegations that, in the course of his psychiatric and psychotherapeutic treatment of Patient B, a married woman in her late thirties/early forties, between December 2005 and June 2007 Dr Lawrence acted in various ways which were said to have been inappropriate, not in the best interests of his patient and an abuse of his professional position. The most serious allegations were that he attempted to pursue an emotional relationship with Patient B, encouraged her to believe that he wanted to pursue an emotional relationship with her, revealed to her sexual fantasies he had about her, told her she was attractive, spoke of meeting her socially and told her personal information about himself. It was alleged that his conduct was sexually motivated. It was also alleged that Dr. Lawrence should have heeded the advice of his supervisors to stop treating Patient B and, further, that when Patient B fell pregnant in the summer of 2006 and was considering a termination of pregnancy, he should have referred her to someone else for counselling.
Following a three week hearing the FTPP made a series of adverse findings of fact against Dr Lawrence, although not all the allegations were found proved. It found that his fitness to practise was impaired and by way of sanction directed that his name be erased from the Medical Register.
This is an appeal by Dr Lawrence under section 40 of the Medical Act 1983 against (a) certain procedural decisions made by the FTPP, (b) some of the FTPP's factual findings, (c) the FTPP's finding that Dr Lawrence's fitness to practise is impaired and (d) the FTPP's sanction of erasure. In view of the volume of material and complexity of issues raised in the appeals against (a) and (b), it was agreed at the hearing in front of me that those appeals should be argued and determined before consideration of the appeals against (c) and (d).
The allegations
The allegations against Dr Lawrence were set out in a Notice of Hearing dated 6 August 2010. They were as follows:
"That being registered under the Medical Act 1983,
1. You were at all times a consultant psychiatrist;
2. a. Between December 2005 and June 2007 Patient B was your private patient and you were responsible for her psychiatric care,
b. During those sessions,
i. you revealed sexual fantasies you had about Patient B to Patient B,
ii. you told Patient B personal information about yourself,
iii. you told Patient B that she was attractive,
iv. you spoke of meeting Patient B socially,
v. you attempted to pursue an emotional relationship with Patient B,
vi. you encouraged Patient B to believe that you wanted to pursue an emotional relationship with her,
c You continued with such sessions,
i. after you had become emotionally involved with Patient B,
ii. even though your supervisors had advised you to stop treating her,
d. i in September 2006 Patient B had a termination,
ii. you did not refer Patient B to another therapist for counselling about whether to undergo a termination;
3. In or around June 2007, when Patient B asked you for a referral to another therapist, you tried to persuade her to continue therapy with you;
4. Your acts and omissions as set out above at paragraphs 2.b.i. to vi., 2.c.i. and ii., 2.d. and/or 3. above were,
a. inappropriate,
b. not in the best interests of your patient, and/or,
c. an abuse of your professional position;
5. Your acts and omissions as set out above at paragraphs 2.b.i., 2.b.iii to vi., 2.c.i. and ii., and/or 3. above were sexually motivated;
"And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct"."
At the outset of the hearing Mr Booth who appeared for Dr Lawrence admitted on his behalf the allegations in paragraphs 1, 2.a., 2.b.ii., 2.b.iii., 2.c.ii., 2.d.i. and 2.d.ii. Thus he admitted telling Patient B personal information about himself and telling her that she was attractive, that he continued treating her even though his supervisors had advised him to stop doing so and that he did not refer Patient B to another therapist for counselling about whether to undergo a termination. It was not admitted and indeed was denied that any of those acts and omissions was inappropriate, not in the best interests of his patient, an abuse of his professional position or sexually motivated as alleged in paragraphs 4 and 5. Indeed Dr Lawrence denied any sexual motivation and denied that he attempted to pursue an emotional relationship with Patient B or that he encouraged her to believe that he wanted to pursue such a relationship.
Factual Background
Patient B was referred to Dr Lawrence by Mr Guy Thorpe-Beeston, a consultant obstetrician and gynaecologist in December 2005 after she had suffered a miscarriage in traumatic circumstances. Dr Lawrence first saw her on 30 December 2005. He treated her with medication for her depression and one to one psychotherapy. He also recommended her for group therapy sessions which she attended on a regular basis. Those group sessions were facilitated by a combination of Sue Sutcliffe, Dr Lawrence and, in the early days, Kay Dowd. Ms Sutcliffe and Ms Dowd were colleagues of Dr Lawrence who practised at 96 Harley Street.
At some point in 2006 it is common ground that Patient B became aware that she was becoming attracted to Dr Lawrence. He asked her about it and she revealed her attraction to him. It is also common ground that, as described by Dr Kennedy, the GMC's expert, this is a well recognised and not uncommon phenomenon in psychotherapy known as "erotic transference".
In early July 2006 Patient B discovered that she was pregnant. She was ambivalent about whether or not to go through with the pregnancy. She revealed her ambivalence in both group therapy sessions and one to one sessions with Dr Lawrence. She did not ask to be referred elsewhere. She rejected Dr Lawrence's suggestion that she might want to see Sue Sutcliffe instead of him. However Dr Lawrence did not tell Patient B that he would no longer be able to see her for one to one sessions and he did not refer her to another therapist for counselling about whether to undergo a termination. On 6 September 2006 Patient B underwent a termination of pregnancy performed by Mr Thorpe-Beeston, Dr Lawrence, in his capacity as Patient B's psychiatrist, having previously signed what is known as the "pink form" to state that in his opinion the procedure was clinically indicated.
On 11 September 2006 Patient B sent Dr Lawrence an email. This email was discovered by Dr Lawrence only after the hearing was well under way and Patient B had already given evidence. He relied on it as corroborating his evidence that he had not, as alleged by Patient B, reciprocated her expressions of attraction to him but had rather sought to make her realise that there was no realistic possibility of a relationship between them. Patient B was recalled to answer questions about the email.
Throughout the time that Dr Lawrence was treating Patient B, he participated in a peer supervision group at 96 Harley Street which included Ms Sutcliffe and Ms Dowd as core members. He presented Patient B's case in supervision on a regular basis. His supervisors expressed concern for his vulnerability in the light of the reported persistence of Patient B's erotic transference and her reported unwillingness to recognise it as such and they therefore advised him that he should stop treating her. Dr Lawrence explained to them why he felt that it would be preferable for him to continue treating Patient B and his supervisors accepted that reasoning.
On a date which was not found as a fact by the FTPP but was sometime between December 2006 and April 2007 Patient B raised with Dr Lawrence the fact that she had done a Google search on him and had found media reports of his previous involvement with the GMC in relation to his having had sex with a patient. It was not disputed by Dr Lawrence that in January 2000 he was found guilty of serious professional misconduct by a Professional Conduct Committee ("PCC") of the GMC. The PCC found that he pursued an emotional and sexual relationship with a vulnerable female patient and on three separate occasions had sexual intercourse with her at her home. This was found to have been a gross abuse of trust. The PCC also expressed concern about Dr Lawrence's failure to maintain any or any adequate records of his large number of consultations with the patient from December 1996 to April 1998, having seen only one piece of paper which recorded two consultations. As a result Dr Lawrence's registration was suspended for twelve months.
In April 2001 the suspension was extended for a further period of twelve months. The PCC on that occasion expressed serious concern at evidence that Dr Lawrence's breach of trust had been a calculated and deliberate course of conduct in respect of a vulnerable patient. However it also heard that he...
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