Professional Standards Authority for Health and Social Care v Health and Care Professions Council & Wood [2019] EWHC 2819 (Admin)
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Professional Standards Authority for Health and Social Care v Health and Care Professions Council & Wood [2019] EWHC 2819 (Admin) concerned an appeal by the Professional Standards Authority against the sanction imposed by a Conduct and Competence Committee of the Health and Care Professions Council on Mr Christopher Wood, a registered paramedic. Mr Justice Pushpinder Saini allowed the appeal, quashed the decision and remitted the case for fresh determination.
Mr Wood had been suspended for six months following admitted misconduct. On 7 May 2017, he attended Patient A’s home in response to an emergency call. Patient A was a highly vulnerable young woman with multiple conditions including Hypermobility Syndrome, ME/CFS, severe depression, high anxiety, Non-Epileptic Attack Disorder and split personality disorder. Patient A stated she had provided Mr Wood with a pdf document detailing her medical history and vulnerabilities, though Mr Wood denied receiving it. During the consultation, Mr Wood conducted a 12-lead ECG (requiring Patient A to undress) and asked questions about her periods, relationships and contraception. Patient A described him as “flirty”. Within 10 to 15 minutes of leaving, Mr Wood texted Patient A, having obtained her number without her express provision. He asked her to keep the contact secret. Over the following weeks he sent numerous sexually explicit messages seeking to arrange a meeting for sex. The contact came to light when another paramedic attended Patient A during a seizure on 17 June 2017.
Mr Wood was dismissed for gross misconduct by his employer. In initial interviews with the Trust on 29 June 2017, he gave a misleading account, suggesting Patient A had initiated the contact and that his messages were supportive and platonic, and that he had tried to make excuses when she invited him over. He said he was unaware of the extent of her vulnerability and denied considering her a vulnerable adult. The text messages themselves showed persistent sexually motivated contact initiated and driven by Mr Wood.
The Committee received limited charges focused only on obtaining Patient A’s telephone number and sending inappropriate text messages of a sexual nature between 7 May and 16 June 2017. Mr Wood admitted the factual allegations and misconduct but denied current impairment. The Committee found the facts proved and that Mr Wood had abused a vulnerable patient for his own sexual gratification. It found his fitness to practise impaired on public protection grounds and to maintain public confidence, noting his insight was “impressive in some regards” but lacking in that he had not considered the impact on Patient A and had “approached remediation in a linear way; demonstrating no empathy for his victim”. The Committee imposed a six-month suspension with review. Following the review on 5 July 2019, Mr Wood was restored to the register.
The Authority appealed under section 29 of the National Health Service Reform and Health Care Professions Act 2002, arguing serious procedural irregularities meant it was not possible to determine whether the sanction was unduly lenient. The first respondent accepted the appeal and did not oppose it. Mr Wood, whilst formally adopting a neutral position, advanced detailed submissions challenging the grounds.
The court held that the case had been fundamentally under-charged. The charges should have covered Mr Wood’s conduct during the consultation itself, including whether he knew Patient A was vulnerable (particularly if he had received the pdf document), whether he behaved inappropriately or in a sexually motivated manner during the consultation, whether his “flirty” comments constituted misconduct, and whether his reference to professionals being struck off for relationships with patients was part of a pattern of grooming behaviour. The judge emphasised that where a patient is particularly vulnerable, there is a greater duty on the healthcare professional to safeguard them, and that using a professional position to pursue a sexual or improper emotional relationship with a vulnerable patient is a significant aggravating factor.
The court rejected Mr Wood’s submission that the Committee had nonetheless had the full picture before it in the trial bundle. Mr Justice Saini held that the drawing of a line between events at the consultation and post-consultation events was a significant error. The prosecutor had missed the main point: this was never a case which should have been confined to the text messages. By charging the case so narrowly, Mr Wood was never required to explain why or how the pressures in his life led him to pursue this particular patient, or why it would take “moral courage” or “protective factors” to avoid exploiting a vulnerable patient in future. Those answers seemed to miss the point and did not provide reassurance.
The court also upheld the ground concerning Mr Wood’s initial dishonest account to his employer. The way in which a healthcare professional reacts to discovery of misconduct is an important part of assessing their attitude, insight and the sanction necessary in the public interest. A lack of candour might call into question fitness to hold a position of trust. Mr Wood’s initial account had sought to minimise his contact and place responsibility on Patient A as instigator, which was not credible upon review of the messages. Without charges directed to this misleading account, the Committee was deprived of the ability to properly assess aggravating factors, future risk and steps required to protect the public interest. Worse still, the Committee had been led into giving Mr Wood credit for “early” admissions when in fact he had given misleading answers.
The court did not pursue the ground concerning failure to obtain expert evidence, as shortly before the hearing the first respondent received a draft report from an experienced consultant paramedic confirming that both the 12-lead ECG and the personal questions asked were clinically justified.
The court rejected the ground concerning insight, holding that the Committee could not be criticised for failing to assess Mr Wood’s insight into predatory behaviour when those aspects had not formed part of the case put before it. That failure was itself a reason for allowing the appeal on other grounds.
The court upheld the ground concerning inadequacy of reasons. Even limiting the case to the text messages, the Committee had not adequately explained why it concluded Mr Wood’s name could remain on the register without threatening public confidence in the profession, nor had it provided adequate explanation of its conclusions on aggravating and mitigating factors. The nature and extent of the evidence required more elaborate reasons to explain the six-month suspension.
The judge declined to treat the subsequent review decision restoring Mr Wood to the register as relevant, since it had been based on an assessment of progress in addressing matters arising from the original decision, which was itself based principally on the text messages. The true extent of Mr Wood’s potential misconduct had not been before the panel conducting the review.
In short, the appeal succeeded because serious under-charging and other procedural irregularities meant the Committee never addressed the potential predatory dimension of Mr Wood’s conduct toward a highly vulnerable patient during the clinical consultation itself, such that it was impossible to determine whether the sanction imposed was sufficient for public protection.
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