Thursday, 14 June 2012

Dr Richard Alexander Scott given warning by General Medical Council

The General Medical Council has today on 14th June 2012 issued a warning to Dr Richard Alexander Scott. This decision will be welcomed by many people (religious and not religious) who are able to distinguish between the human rights of patients and human rights of medical practitioners.

A patient attended his surgery in National Health Service GP practice in United Kingdom and following this consultation a complaint was made by his mother to medical regulator that it distressed him and that there was inappropriate discussion of Christian faith during medical consultation. 

This case is important one because UK has failed to ensure separation of state and religion leading to many problems including loss of lives in other cases. While GMC regulation imposes obligations on medical practitioners to put patients first this has not always happened. European Convention on Human Rights does state the limitations on the rights to religious expression but there are many issues that UK has not sorted out and Dr Scott case illustrates a lot more than this determination.

Investigation Committee (Oral hearing)
Dr Richard Alexander SCOTT

11-14 June 2012

3 Hardman Street, Manchester, M3 3AW

Dr Scott:

At this hearing, the Investigation Committee has carefully considered all the material before it, including the submissions made by Mr Hurst on behalf of the General Medical Council (GMC) and Mr Diamond on your behalf. The Committee has noted and accepted the advice of the Legal Assessor.

The Committee is aware that it must have in mind the GMC’s duty to act in the public interest, which includes the protection of patients, the maintenance of public confidence in the profession, and declaring and upholding proper standards of conduct and behaviour. In deciding whether to issue a warning the Committee must apply the principle of proportionality and weigh the interests of the public with those of the practitioner.

This case arises from a complaint made to the GMC on 14 August 2010 by Patient A’s mother about your conduct when her son consulted you on 4 August 2010. The complainant alleged that you abused your position as a medical practitioner to push your religion upon a vulnerable patient. It was alleged that you had belittled Patient A’s religion (which was not Christianity) and emphasised the importance of Christianity, stating that Jesus Christ could cure him.

At the request of the GMC, Patient A provided a written statement, dated 20 October 2010, detailing his recollection of the consultation, on which the factual allegations against you were based.
On 28 February 2011, following the completion of their investigation, the GMC wrote to you in accordance with Rule 7 of the General Medical Council (Fitness to Practise) Rules 2004 and invited you to comment upon the allegations.
On 25 March 2011 RadcliffesLeBrasseur wrote to the GMC, on your behalf, confirming that you did not accept that all of the individual phrases or words attributed to you were used during the consultation.  It was stated that you had read the GMC’s guidance in Good Medical Practice and the supplementary guidance ‘Personal Beliefs and Medical Practice’ and aim to follow that guidance in your consultations. You rejected any notion that the views you expressed were not directly relevant to Patient A’s clinical care and that you would have brought the discussion about faith to an immediate end if Patient A had indicated that he wished the conversation to stop.

RadcliffesLeBrasseur submitted that there was no realistic prospect of a finding of impairment. A limited apology was provided stating that you were sorry, if on this occasion, the consultation had not gone well.
On 28 April 2011, the GMC wrote to you again in accordance with Rule 7 of the General Medical Council (Fitness to Practise) Rules 2004, and advised you that the Case Examiners had considered the allegations and the supporting information and decided that this was a case which they may conclude with a warning.
In a letter dated 20 May 2011 you wrote to the GMC confirming that you would not accept the warning therefore exercising your right under Rule 11 (3) of the Rules to an oral hearing before the Investigation Committee.
On 26 May 2011 the GMC received information from the National Secular Society which alleged that you had spoken on National media suggesting that your own faith had more to offer than that of Patient A. They provided the GMC with transcripts of two radio interviews in which you participated: The ‘Jeremy Vine Show’ aired on BBC Radio 2 on 23 May 2011 and BBC Radio 5 Live’s “Breakfast” show aired on 25 May 2011.
On 29 June 2011, the GMC wrote to you again in accordance with Rule 7 of the General Medical Council (Fitness to Practise) Rules 2004, and advised you that the Case Examiners had considered the additional evidence and confirmed that this remained a case that they may conclude with a warning.
In a letter dated 19 July 2011 you wrote to the GMC confirming that you wished to defend your position as a GP who cares for the whole patient, including the spiritual side, and therefore rejected the warning and wished to exercise your right to an oral hearing before the Investigation Committee.
At the opening of this hearing Mr Hurst, on behalf of the GMC, stated that this case did not constitute an attack on the Christian faith. GMC guidance acknowledges the role of faith issues in medical care and the right of doctors to raise such matters within the consultation provided that it is done with the patient’s consent and with sensitivity and respect for any faith they might have. Mr Hurst stated that on this occasion your behaviour in presenting your faith to Patient A had exceeded the boundaries set out in the guidance and, to use his words, “had gone too far.”
The Committee received oral testimony from you and Patient A. Patient A was permitted to give his evidence by telephone following the Committee’s earlier ruling. Patient A was supervised throughout his evidence by a GMC legal representative at the direction of the Committee. You were both subject to cross examination and were asked questions by the Committee. You each provided your own recollection of the consultation of 4 August 2010 and the Committee notes that there is a direct conflict of evidence between the accounts that you each gave of that consultation.
In providing oral evidence to the Committee you made a number of limited admissions during cross examination, but continued to assert that your actions were compliant with GMC guidance. You accepted that if you had acted in the way in which Patient A alleged this would be a significant departure from GMC guidance.

Mr Hurst submitted that it was both appropriate and proportionate to issue you with a warning. He stated that it was in the public interest to issue you with a warning, and that a warning would serve an important role in maintaining public confidence and high standards in the profession. He submitted also that a warning would act as a deterrent, reminding you that your behaviour had fallen below the standards expected and that repetition would likely result in a finding of impaired fitness to practise.

Mr Hurst submitted that your conduct amounted to a significant departure from the principles of Good Medical Practice and associated guidance; in particular paragraphs 33 of ‘Good Medical Practice’ and paragraph 19 of ‘Personal Beliefs and Medical Practice’ – supplementary guidance for doctors. He also submitted that your conduct ought to be marked by the issuing of a warning, to lay down a marker as to expected standards and to maintain public confidence in the profession.

Mr Diamond submitted on your behalf that your actions were appropriate in that you had acted at all times within these Guidelines; the issue was sensitively discussed and ceased upon request. He submitted further that a degree of deference should be given to an experienced GP who is embedded into the local community, particularly one who has a reputation for the care he provides to his patients.  

Mr Diamond drew the Committee’s attention to a considerable number of letters of support, testimonials and supportive recollections by your patients of occasions when matters of faith had been discussed to positive effect. The Committee noted also two witness statements that spoke of the help that had been received following discussions of faith with you and the regard in which you are held.

Mr Diamond submitted that a warning was neither appropriate nor proportionate.

In considering the facts of this case, the Committee noted that the GMC’s guidance confirms that discussing personal beliefs may, when approached sensitively, help to work in partnership with patients and allow doctors to address a patient’s treatment needs. As such the discussion of religion within consultations is not prohibited and this case relates to the manner in which religion was approached during the consultation with Patient A.

The Committee notes that there is clearly a conflict of recollection of what occurred in the consultation between the participants. In the Committee’s view both witnesses were honest and not trying to deceive. The Committee concluded that the differences were likely to be due to their differing perceptions.
Having made due allowance for the fact that Patient A gave his evidence by telephone and not in person, the Committee considers that it was able to obtain a sufficient impression of his truthfulness from the manner in which he gave his evidence and his response to questions. The Committee consider that Patient A gave credible evidence, direct answers and made all due allowances in your favour.

The Committee considered that while you sought to answer questions truthfully a number of your responses were in conflict with the evidence. Specifically, the Committee noted that it is unlikely that the very full record of the consultation which you made would have omitted mention of the treatment plan if it had been discussed – since this would have happened before the discussion about religion. The Committee regards it as unlikely that the discussion of your faith lasted only two and a half minutes as you contended, bearing in mind the breadth of material covered during your discussion. Furthermore, regrettably, at times you appeared to be evasive when answering questions.

The Committee went on to consider each of the allegations in turn. The Committee notes that you admitted paragraphs 1 to 3, at the outset of your cross-examination, and therefore commenced its consideration at paragraph 4.

Paragraph 4:
    During the consultation of 4 August 2010, you:

Paragraph 4(a):
    “continuously asked Patient A about his religion”
Has not been found proved

During oral testimony it was neither asserted by you nor Patient A that you had continuously asked Patient A about his religion. The evidence presented suggested that the contrary was true and that very little time had been spent on Patient A’s own religion.

Paragraph 4(b) During the consultation, you told Patient A that (or words to the effect that):

Paragraph 4(b)(i):
    “you were not going to offer him any medical help or tests or advice”
Has been found proved

The Committee notes that there is a direct conflict in recollection between yourself and Patient A on this matter. While you stated in your own evidence that you did not tell Patient A that you were not going to offer him any medical help, the Committee considers that Patient A’s account is more probable, since there is no mention in the notes of the medical treatment which you say that you offered.

Paragraph 4(b)(ii):
“you had something to offer Patient A which would cure him for good and that this was his one and only hope in recovery.”
Has been found proved in part

You acceded to the first half of this paragraph during your oral testimony, accepting that you had informed Patient A that you had something to offer which would cure him. The Committee has not found proved that you said that what you had to offer was his one an only hope of recovery as this was not borne out in your testimony or that of Patient A.

Paragraph 4(b)(iii):
“if Patient A did not turn towards Jesus and hand Jesus his suffering, then Patient A would suffer for the rest of his life.”
Has been found proved

The Committee considered that whilst you may not have said the exact words as stated within this paragraph, you did say words to that effect. It was confirmed in both your own testimony and that of Patient A that you had used phrasing similar to that in the allegations.

Paragraph 4(b)(iv):
“his own religion could not offer him any protection and that no other religion in the world could offer Patient A what Jesus could offer him.”
Has been found proved

The Committee considered that whilst you may not have said the exact words as stated within this paragraph, you did say words to that effect. During your testimony you conceded that you had said “you may find that Christianity can offer you something that your current faith can’t” and that you had told Patient A that his faith was not helping him. While you tried to justify your comments by saying that Patient A had walked away from his own religion, the Committee is satisfied that your words were sufficiently similar to find this paragraph proven.

Paragraph 4(b)(v):
“until he was ready to turn to Jesus that he would eternally suffer.”
Has not been found proved

You agreed in cross examination that you told Patient A that he would continue to suffer for a long time if he did not turn to Jesus, but did not talk about eternal suffering. Patient A did not make this claim in his oral evidence. The Committee does not consider that suffering for a long time is sufficiently similar to ‘eternal suffering’ to be able to find this paragraph proven.

Paragraph 4(b)(vi):
“the devil haunts people who do not turn to Jesus and hand him their suffering.”
Has been found proved

During your testimony you accepted that you had made reference to the Devil during the consultation. Whilst you do not accept using the term ‘haunt’ the Committee considers that your words were sufficiently similar to find this paragraph proven.

Paragraph 4(b)(vii):
“when pointing to a large picture frame on the wall, all the happy people he could see in those pictures all used to be addicts like Patient A until they turned to Jesus and now they are cured.”
Has been found proved

Whilst agreeing to the substance of this paragraph you stated that you had not referred to Patient A as an addict, as you do not consider him to be one. The Committee considers that your words were sufficiently similar to find this paragraph proven.

Paragraph 4(c):
“were told by Patient A that he had not come to a doctor to talk about religion and that he had come to the Practice because he was unwell and desperately needed help, or words to that effect.”
Has been found proved

You agreed, during your oral testimony, that Patient A did say this towards the end of the consultation.

Paragraph 4(d):
“told Patient A that you were not offering him anything else because there is no other answer and that he will keep suffering until he is ready to hand his suffering to Jesus.”
Has been found proved

The Committee considered that whilst you may not have said the exact words as stated within this paragraph, you did say words to that effect. You confirmed in your oral testimony that you had said that Patient A’s condition was not amenable to standard medical treatment. This is supported by Patient A’s own testimony.

Paragraph 5:
“You knew or ought to have been aware that your views expressed at 4(b) and 4(d) above:”

Paragraph 5(a):
“were not directly relevant to Patient A's clinical care.”
Has been found proved.

The Committee does not consider that matters of faith are irrelevant to clinical care, and accepts that there are many circumstances in which spiritual assistance is valuable. The Committee noted that you were not Patient A’s GP, that you had not previously met him and that the appointment had been made at the request of Patient A’s mother to consider her urgent concerns about Patient A. The Committee considers that you must have been aware that the manner in which your views were expressed during the consultation were not directly relevant to Patient A’s clinical care at that time.

Paragraph 5(b):
“could potentially cause distress to Patient A.”
Has been found proved.

The Committee notes your oral evidence in this regard, specifically that you accept that you were taking a risk in raising religion in the way that you did. Whilst you perceived that it was you who were bearing the risk, in that the GMC may receive a complaint about your actions, the Committee considers that the true risk of your actions would be that Patient A may be distressed.

Paragraph 6:
Following the consultation of 4 August 2010, you did not arrange any further referral to the local psychiatric services for Patient A.
Has not been found proved.

The Committee accept that you had already referred Patient A to the local psychiatric service on 2 August 2010 and therefore a further referral was not required.

Paragraph 7:
“Your actions and/ or omissions at 4(a), 4(b), 4(d), 5 and 6 above were:

  1. inappropriate
  2. clinically not in Patient A’s best interests”

The Committee consider that your actions in relation to those elements found proved within 4b, 4d and 5 were both inappropriate and clinically not in the Patient A’s best interest. The Committee consider that you went beyond the limit of such spiritual guidance as would have been appropriate. Your actions caused some distress to Patient A, which was foreseeable. He said that he felt abused. This is plainly inappropriate and not in his best interests.

Paragraph 8:
“On 24 May 2011, you stated on national radio that during the consultation at 2 above you had told Patient A that he may find Christianity offers him something more than his current faith does in his current situation, or words to that effect.”
Has been found proved.

The Committee notes that during cross examination you admitted making the comments, as alleged.

Having made its determination on the facts the Committee went on to consider whether your actions constituted a significant departure from Good Medical Practice and supplemental guidance. Given your own admission that a significant departure would have occurred if Patient A’s recollection was correct, and in exercising its own judgement, the Committee considers your actions do constitute a significant departure.

Furthermore, based on the facts found proved, your actions meet the threshold set out in paragraph 13 of the GMC’s Guidance on Warnings. In the Committee’s view, having taken all the circumstances into consideration, your actions did fall just below the threshold for a finding of impaired fitness to practise.

In the absence of insight and given your strongly expressed views during this hearing the Committee is not satisfied that repetition of the concerns is unlikely. It notes that although this was a single incident, if there had been more the case would undoubtedly have been referred to a Fitness to Practise panel.

We have noted the excellent testimonials presented on your behalf, which speak of the esteem in which you are held and the dedicated care you offer to your patients. Some of them say you did not press your faith on them when they resisted. There have been no previous complaints about you to the GMC.

This case however is different, because on this occasion you caused the patient distress which you should have foreseen. While the allegations relate to what occurred on a single occasion your actions nevertheless constitute a significant departure from the principles in Good Medical Practice. The Committee considers that it is appropriate, proportionate and in the public interest for the protection of the reputation of the profession to issue you with a warning.

The Committee directs that the following warning be attached to your registration:

“During a consultation with a patient in August 2010 you expressed your religious beliefs in a way that distressed your patient.

You subsequently confirmed, via National media, that you had sought to suggest your own faith had more to offer than that of the patient.

In this way you sought to impose your own beliefs on your patient. You thereby caused the patient distress through insensitive expression of your religious beliefs.

Your actions were in direct conflict with the GMC’s supplementary guidance: Personal Beliefs and Medical Practice. This states in paragraph 19 that:

‘You must not impose your beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views’.

Your actions also contravened Paragraph 33 of Good Medical Practice:

‘You must not express to your patients your personal beliefs including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.’

Your actions do not meet with the standards required of a doctor. You are hereby formally warned as to your future conduct. Further serious or persistent failure to follow GMC guidance will put your registration at risk.”

This warning will be published on the List of Registered Medical Practitioners (LRMP) for five years and will be disclosed to any person enquiring about your fitness to practise history during that period. After five years, the warning will cease to be published on the LRMP. However, it will be kept on record and disclosed to employers on request, indefinitely.

You will be notified in writing of this decision in the next two working days. That concludes the determination of the Investigation Committee in this case.

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