The current process for managing sexual misconduct perpetrated by doctors in the UK requires major reform, say experts in The BMJ today.
Mei Nortley and colleagues argue that sanctioning of doctors is inconsistent and overly reliant on subjective evidence and they call for a dedicated, evidence driven approach "that treats sexual misconduct by doctors not as a regulatory outlier, but as the grave abuse of trust it truly is."
They point to several recent high profile cases that have fuelled concerns about the consistency and adequacy of the UK Medical Practitioners Tribunal Service (MPTS) sanctions against doctors found guilty of sexual misconduct.
The MPTS is an independent adjudicator that is funded by and accountable to the General Medical Council (GMC). Its primary role is to protect the public by ensuring doctors meet the required standards to practise medicine.
For example, an acute medicine consultant who was found to have committed rape by an MPTS tribunal was given only a 12 month suspension based on the tribunal's view of the incident as a "one-off event" and further justified by the time since the incident and testimonials of high clinical competence.
And a doctor who knowingly entered into a sexual relationship with a vulnerable patient whom he had pursued and groomed from the age of 14 was suspended for 12 months rather than erased from the register. The panel cited evidence of insight, remediation, and remorse.
The authors say these cases raise questions about the adequacy of protection for victims and the public and affect public confidence in the profession, and ask how can the process be improved?
They explain that MPTS guidance currently directs tribunal panels to balance aggravating factors (eg, lack of insight, abuse of position, discrimination) against mitigating ones such as insight, remediation efforts, positive character references (testimonials), and the time elapsed since the incident.
The aim is to promote consistency, fairness, and transparency in tribunal decisions, but they argue that many of these elements, particularly insight and remediation, are highly subjective, leaving them open to different interpretations.
Concurrently aggravating factors key to sexual misconduct such as grooming, manipulation, coercion and persistent behaviours are not recognised in MPTS sanctions guidance.
In addition to the procedural shortcomings, MPTS panel members lack the specialist training and tools required to deal with serious cases of sexual misconduct that include rape, sexual assault, and offences against children, they write.
They also point to a stark imbalance in support, where accused doctors often receive full legal support, including strategic guidance on presenting evidence and mitigating factors, but victims are ineligible for legal representation, support or guidance.
New research published in The Bulletin of the Royal College of Surgeons of England has found that in nearly one in four cases, the sanctions imposed by MPTS tribunals were more lenient than those proposed by the GMC. The Royal College of Surgeons of England (RCS England) is calling for urgent reform as these findings demonstrate that the current system of medical regulation - overseen by the MPTS and the GMC - is failing targets of misconduct.
Against this background, the authors suggest changes to the MPTS process that would improve its adjudication in sexual misconduct cases, such as specialist tribunal panels, reduced reliance on mitigating factors, better support for victims, and sexual misconduct training for all tribunal members.
"We need a dedicated, evidence driven approach that treats sexual misconduct by doctors not as a regulatory outlier, but as the grave abuse of trust it truly is," argue the authors. "Sanctions must be sufficiently severe to deter these behaviours, and vulnerable witnesses must be supported and protected."
"Without concerted effort to change, we risk preserving a system that is more skilled at facilitating abusers than protecting victims, and that continues to erode public trust," they conclude.
In a linked news article, Nortley and colleagues also point to a lack of fair treatment for victim witnesses in MPTS hearings. "Victims told us they experienced hostile cross examination and there were unexplained errors in the preparation of their evidence, such as large chunks of their evidence redacted without explanation and without consultation," they say.
This is borne out by a patient involved in a recent case who describes the MPTS tribunal process as "victim-hostile and utterly unfair" and says the tribunal "focused on protecting Dr Hughes's career, not the profound impact of his actions on me."
The MPTS is expected to issue updated guidance within weeks which will come into effect before the end of this year.
A spokesperson told The BMJ this would reflect the development of recent case law and build on good practice. "We recognise the impact of our work and decisions on the lives of the doctors. It is paramount that our decisions are fair and proportionate, and are seen to be so, and that we are open to informed scrutiny in this regard."
And since concerns about misconduct hearings cross the remit of both the MPTS and GMC, The BMJ also put the criticisms to the GMC.
A spokesperson said the Council took a zero-tolerance and proactive approach to all forms of sexual misconduct and at the heart of its efforts was the support it provided to victims and survivors. "We are actively listening and continuously seeking opportunities to play our part in ensuring that victims and survivors are supported and heard, and that cases of sexual misconduct are handled appropriately, with care and compassion."
In a linked editorial, Carrie Newlands and colleagues discuss the future role of the GMC and outline the case for a single healthcare regulator to address "serious inconsistencies" in the fitness to practise process.
They point out that the UK's Health and Care Professions Council regulates 15 different health professions, including paramedics and psychologists, at considerably lower cost than the GMC, while Australia has had a single professional health regulator for 15 years with responsibility for 16 health professions, including doctors, dentists, and nurses.
"As evidence continues to emerge on the damage caused to complainants, registrants under investigation and witnesses in the fitness to practise process, constructive multiprofessional dialogue in the UK should explore building a streamlined, evidence based, regulatory framework that puts patients first and holds everyone to the same ethical standard," they conclude.
