Fitness to Practise Panel Hearing
New case of conduct heard under the Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules 1988
Session beginning on 16 May 2005
London

Dr Quentin Wynn Spender

Determination given: 12 October 2005

Dr Spender
At all material times you were a senior lecturer and Consultant in Child & Adolescent Psychiatry in an NHS Trust in Sussex, practising from The Child & Family Service for Mental Health, John Grenville House, Chichester and also at Orchard House, Chichester.

In July 1996 you saw Miss A in your capacity as Consultant Psychiatrist. Thereafter between July 1996 and August 1997 Miss A was under your care as regards her mental health. You have admitted that by 14 April 1997 you had formed the view that Miss A had been subjected to sexual abuse by some or all of the members of her family. The Panel found that you had insufficient information on which to draw that conclusion. In reaching that decision, the Panel noted that there was some evidence implicating members of Miss A’s family but it was satisfied that you had insufficient evidence to draw the conclusion that Miss A had been sexually abused by some or all members of her family.

The Panel also found that you failed to have any or any sufficient regard to other sources of information apart from the evidence emanating directly or indirectly from Miss A and failed to make the necessary enquiries to put yourself in a position from which you could safely draw such a conclusion. In reaching those findings, the Panel was satisfied that you should have kept an open mind about the possible causes of Miss A’s difficulties and that you should have had greater regard for other sources of information. The Panel noted the evidence of Dr McArdle, the GMC’s expert witness, who stated that a strong statement requires strong evidence. The Panel was satisfied that you did not adequately explore other sources of information or make appropriate enquiries before drawing the conclusion that you did and making what the Panel found to be a strong statement. The Panel was not assisted by the evidence of your own expert, Dr Bentovim, on this point.

You admitted that on 14 April 1997 you had a meeting with Dr and Mrs B at which you stated that you believed that Miss A had been sexually abused by some or all members of her family. In a letter dated 1 May 1997 written to Dr G, Miss A’s general practitioner, and copied to Ms LA, a senior social worker, Dr and Mrs B and Miss A, you wrote:

“Miss A’s parents and I had a major disagreement about the development of A’s current problems. I believe that this (is) at least in part due to sexual abuse by some or all family members.”

The Panel found that your conduct in making the assertions that you did orally on
14 April 1997 and in writing by letter dated 1 May 1997 was inappropriate, irresponsible and unprofessional. In reaching these findings, the Panel was satisfied that you should have foreseen the possible adverse consequences of the inappropriate wording you used in your letter dated 1 May 1997. The Panel considered that a responsible Consultant Child and Adolescent Psychiatrist would have been more circumspect in expressing the conclusions you had reached.

In about late 1998 and/or early 1999 there was an episode of bullying at a school in West Sussex (“the School”) in which a group of three boys bullied another boy, Master X. Among the group of bullies was Master Y (then aged 13).

In March 1999 Boy X made an allegation that Boy Y had sexually assaulted him in the toilets at the school. On 10 March 1999 the Headteacher, Mr W, excluded Boy Y from the school for 13 days and that period was subsequently extended,

Mr W called a meeting for ‘professionals’ on 10 May 1999 to review the decision to exclude Boy Y and to consider future arrangements for both Boys X and Y.

You attended the meeting of 10 May 1999. At that meeting you expressed inter alia broadly your opinion that Boy X was not only physically abused, but also sexually abused; that you assumed that the perpetrator of the sexual abuse as well as the physical bullying was Boy Y; that the probability was that Boy Y had himself been sexually abused and that the probability was high that without professional help
Boy Y would abuse another victim.

On 11 May 1999 Mr W decided to exclude Boy Y permanently from the school, because he believed, on the balance of probabilities, having listened to the various professional agencies, including yourself, that Boy X had been sexually abused by Boy Y.

In a letter dated 21 May 1999 to Mr W you set out your opinion that Boy X was not only physically abused, but also sexually abused; that you assumed that the perpetrator of the sexual abuse as well as the physical bullying was Boy Y; that the probability that Boy Y had himself been sexually abused was 75%; that the probability that he was the perpetrator of the abuse on Boy X was at least 95%; that the probability of Boy Y having been abused in some way was at least 90%; that the probability was very high indeed that without professional help Boy Y would abuse another victim.

The Panel found that in forming and expressing a view as to the likelihood that Boy Y had sexually abused Boy X, you had insufficient information before drawing that conclusion. In reaching this finding the Panel was satisfied that you had insufficient evidence upon which to express the likelihood that Boy Y had abused Boy X in terms of a specific percentage probability.

The Panel also found that you made assertions of fact which were based upon uncorroborated allegations. In considering this allegation, the Panel took the view that it dealt with a purely factual matter. While the allegations made by Boy X in relation to Boy Y were strong, they were nevertheless uncorroborated. This finding implied no criticism of you.

In forming and expressing a view as to the likelihood that Boy Y had himself been abused and/or sexually abused you had insufficient information to make those assertions. In reaching this finding, the Panel was satisfied that the research on which you relied could not substantiate the specific probability of 90% that you asserted.

The Panel found that your conduct in making the assertions that you did at a meeting on 10 May 1999 and in a letter dated 21 May 1999 was inappropriate, irresponsible and unprofessional. In reaching these findings the Panel took account of the admissions that you made in respect of what you said at the meeting on 10 May 1999 and the content of your letter dated 21 May 1999 and its own determination that you had insufficient information in drawing your conclusion about the likelihood that Boy Y had sexually abused Boy X. It also took account of its finding that you had insufficient evidence on which to make those assertions. Further, the Panel is satisfied that you were irresponsible in not considering the potential repercussions of your actions when you went beyond the terms of reference of the request for a report from the Headmaster of the school in framing the letter of 21 May 1999. The Panel considered that there were more appropriate and professional methods of bringing your concern for Boy Y to the attention of the appropriate authorities. In reaching its decision the Panel also noted that Boy Y was not your patient and that you had not seen him.

The Panel has considered all the evidence, including the expert and character evidence provided by eminent professionals working in the field of Paediatrics and Child and Adolescent Psychiatry. It acknowledges that the area of medicine in which you practice is complex and has noted the evidence in your support that the nature of your work brings with it a high risk of complaint by some parties. Nevertheless, the Panel is concerned that in forming your opinion on these cases, in the case of Miss A, you failed to explore other avenues of inquiry and in both cases you had insufficient information before drawing your conclusions. The Panel is also concerned that, in expressing your views as you did both orally and in writing in both cases, you did not take account of the possible effect of your assertions on the recipients and the families of Miss A and Boy Y.

A doctor has a position of trust in society and the Panel considers that it is essential that any letters or reports prepared by a medical practitioner, especially by a consultant, should be constructed carefully and with proper consideration for the subject matter and its possible effect on the reader. As regards your letter dated
21 May 1999 in relation to Boy Y, you should have realised that because your opinion could influence the decision taken by the group of professionals receiving your report, you had a duty to be precise in expressing your concern and any views about Boy Y. The Panel has noted that paragraph 41 of the October 1995 edition of ‘Good Medical Practice’ and paragraph 55 of the July 1998 edition, which were in effect at the respective times of the two incidents, both state that registered medical practitioners must take reasonable steps to verify any statement before signing a document. The Panel considers that on the basis of the way in which you arrived at and expressed your assertions about Miss A and Boy Y, both orally and in your two letters, your conduct fell seriously short of this standard. Further, at no time in these proceedings have you acknowledged that there may have been failings in your conduct.

Taking all of the above matters into account, and noting that there have been two separate incidents, the Panel is satisfied that your conduct amounts to a serious departure from the standards expected of a registered medical practitioner and finds you guilty of serious professional misconduct.

In considering whether to take action in relation to your registration, the Panel has considered the issue of proportionality and has balanced the interests of the public against your own. The Panel has given careful consideration to the submissions made on your behalf by Mr Finucane, those made on behalf of the GMC by Mr Kark and the advice given by the Legal Assessor. It has also considered carefully the GMC’s Indicative Sanctions Guidance, dated May 2004.

The Panel has read the large number of testimonials and character references from your professional colleagues as well as those from patients and their parents, and there is no doubt that you are regarded as a committed, caring and very hardworking doctor and that the eminent professional colleagues who have provided testimonials hold you in high esteem.

In determining the appropriate sanction in your case, the Panel first considered whether it would be sufficient to conclude your case with a reprimand. The Panel is conscious of its duty to protect the interests of patients and the public interest. Based upon all the material it has considered during this hearing, the Panel is satisfied that there is no risk to patient safety. Accordingly, the Panel is satisfied that it would be both appropriate and proportionate to conclude this case with a reprimand.

The Panel might have gone on to consider a more serious sanction but in reaching its decision paid particular regard to the length of the delay in bringing this case to a hearing, which has taken place eight and a half and six and a half years after the events. The Panel has taken into account the fact that you have continued in the same area of clinical practice and that there has been no evidence of any repetition of the conduct that has brought you before it. Nevertheless, in these two cases you demonstrated a high-handed and blinkered approach to your work. In the case of Miss A, you gave your conclusion in unnecessarily blunt terms to Miss A’s parents. In the case of Boy Y you showed a lack of professional judgement in not simply providing Mr W with the information he required to support the decision that he proposed to take, and separately bringing your concerns with regard to Boy Y to the appropriate authorities in measured terms. The Panel considered that you failed to have due consideration for the families concerned or the likely impact upon them of the information that you were imparting.

The case is now concluded.