Betrayal: the sex-hungry doctors who prey on patients

As Seen in the Guardian

To the television scriptwriters, it must have seemed just another torrid soap opera romance. And the tale of handsome young doctor Matt Parker's fling with his beautiful but unstable patient certainly kept Holby City viewers glued to the screen.

But when Kathy Haq, a nurse from Sunderland, saw it she was moved to fury. What horrified her was the dismayed reaction of some fans on the BBC drama's website when Parker ended the affair: 'They were saying, "Oh, he shouldn't have had to finish with her". The public have got to know that this is just not allowed.'

The story did not just offend Haq's professional sensibilities - a doctor can be struck off for sleeping with a patient because of the risk of exploitation. It also revived painful memories. She was a 19-year-old trainee nurse when, suffering from depression, she was referred to a psychiatrist called William Kerr.

In the privacy of the consulting room, she says, the doctor exposed himself to her, saying that 'this is what you need'. What is shocking about the abuse that she went on decades later to describe in court is that it was preventable.

A subsequent public inquiry into how Kerr and his colleague Michael Haslam got away for decades with indecently assaulting and seducing vulnerable patients established that the first complaint against Kerr was in 1965 - by a woman patient who reported being told that sex would cure her. By the Eighties, there had been nearly 30 separate complaints or concerns raised about Kerr's behaviour, but none was taken sufficiently seriously to prompt a full investigation. When a senior nurse at the Clifton Hospital raised the alarm after learning a patient had had an affair with Kerr, she was demoted.

'People used to say to me: "How do you keep going year after year?" and I'd say, "sheer anger",' says Haq, who now runs the Kerr/Haslam survivors' group. She says the effect on the victims' marriages, jobs and health was devastating. One girl whose father approached the group was sent to Kerr aged 16 after being sexually abused by an uncle, but claimed she was subsequently abused by Kerr. Another woman 'still thinks he is coming for her to take her children away, 25 years down the line. Those kids are grown up and married, and she still has dreams about this'.

The medical establishment insists that, in the nine years since Kerr was charged, medical regulation has been transformed rendering such a scandal far less likely now. But with rising numbers of ordinary Britons now seeing therapists and plans for a massive government-backed expansion of 'talking therapies', campaigners fear a whole new class of vulnerable patients is emerging.

While NHS psychiatrists like Kerr and Haslam were at least regulated by the General Medical Council, the growing army of counsellors, therapists, healers and alternative medicine practitioners are not. There is no register they can be struck off, no professional code to break, no way for the GMC to rule on their competence or ethics. Yet they have intimate access to vulnerable, distressed and damaged people. Campaigners says this gives rise to a grey area which serves neither patients nor reputable practioners. The case reported in The Observer today of alternative practitioner the Barefoot Doctor, who has been forced to defend himself on his website against allegations of inappropriate relationships, illustrates this.

The Department of Health will shortly unveil plans for a massive overhaul of medical regulation, including the long-term creation of a 'level playing field' for alternative practitioners. The move follows concerns that some psychiatrists subject to GMC investigation simply reinvent themselves as unregulated therapists, while patient groups argue that any unqualified individual can currently call themselves a counsellor.

Nearly half the complaints received by Witness, which represents patients alleging sexual abuse, involve unregulated practitioners. Director Jonathan Coe estimates there are 100,000 people offering so-called 'talking therapies' nationwide: 'Anyone can put a plaque on the door and start seeing vulnerable people. That has to change.'

Yet the recent history even of regulated professions suggests too often patients were betrayed. The public inquiry report into Kerr and Haslam is one of four sitting on the desk of Health Minister Andy Burnham, beside those into serial killer and GP Harold Shipman; the gynaecologist Clifford Ayling, who sexually assaulted patients for decades in Kent, and the surgeon Richard Neale, struck off in Canada following a patient's death but allowed to practise in his native Britain.

The four cases are very different, but what they have in common is the devastation visited on patients and families, the profound deafness of medical professionals to complaints about colleagues and the repression of NHS whistleblowers. What shines through is the ease with which the deep trust placed in doctors was breached.

For solicitor Sarah Harman, the sheer avoidability of the suffering is the worst thing. After nearly 30 years of complaints against Ayling, none of which were seriously pursued, the final indignity was the General Medical Council's decision to let him continue practising while under investigation for sexual misconduct. Seven women reported being assaulted during that time. 'I acted for women who had been abused many years ago. They felt angry that their complaints were not heeded. They couldn't believe so many women were making the same complaints,' Harman, the sister of Harriet Harman, the Constitutional Affairs Minister, says.

Perhaps the most startling failure to act, according to the independent inquiry into the Ayling case, came in 1980 when a nursing sister, Penny Moore, allegedly caught the gynaecologist masturbating over a patient. Moore banned him from the antenatal clinic at Thanet Hospital, Kent, and told the woman's consultant, who promised Ayling would be referred to a psychiatrist.

But the police were not involved and there is no evidence that anything was done. When, some time later, Moore discovered Ayling was to be allowed back on the ward and protested, she was told by a consultant 'not to question a fellow of the Royal College of Obstetricians and Gynaecologists'.

Yet the evidence kept piling up. The same year a patient's husband complained of 'sadistic' treatment, saying Ayling appeared to enjoy giving the woman a rough internal examination. Hospital staff refused to be treated by him for their own pregnancies. There were repeated complaints of uncomfortable deliveries, lingering too long over intimate examinations, inappropriate sexual remarks and offering to sew patients up 'nice and tight' after episiotomies. He was eventually sacked in 1987 for injuring a baby during a Caesarean but got a job in Thanet's colposcopy clinic, which performs invasive tests on the vagina and uterus, instead.

A year later a woman escorting her teenage daughter to his clinic reported Ayling for rubbing himself up against the girl. His contract was not renewed, but no connection was made with the fact that Ayling had also worked as a GP since 1981. He continued to do so, triggering further complaints of unnecessary vaginal and breast examinations. Patients who queried him were told they could die of cancer if they did not submit and Harman argues he often treated women who had little other choice.

'He dealt with army wives who didn't know the area. He took on women who were not seen by other practices because they were drug users. He over-examined them and frightened them by saying that they needed tests every three months, which they didn't.'

A neighbouring GP, to whom some of Ayling's patients defected, was worried enough to raise the allegations with Ayling, who denied any wrongdoing. After similar complaints emerged at another hospital employing him, an inquiry began in 1993 but Ayling continued to do locum work. Finally in 1998 the health authority received a complaint of indecent assault and involved the GMC: he was arrested shortly afterwards.

Two decades after Penny Moore's challenge, Ayling was sentenced to four years for indecent assault. He was out of jail before the inquiry's findings were published, protesting his innocence. Nonetheless around 30 of Harman's clients successfully sued for compensation.

Meanwhile Moore, the unsung heroine of the inquiry, is said to remain distressed that she could not do more to help. It is a feeling Lin Bigwood would recognise. The former deputy sister at Clifton Hospital now lives quietly in the West Country, her career never having recovered from confronting Kerr.

In 1983 a psychiatric patient told Bigwood she had had an affair with Kerr, and that he had sex with others too. The nurse spent five years fighting for an inquiry into his behaviour. For her pains, she was demoted, while Kerr retired in 1988 with a glowing letter of thanks. The professionals had again closed ranks.

Haq says that, while attitudes now have changed dramatically from the 'old school tie' days of doctors arrogantly defending colleagues they trained with, the culture has not entirely disappeared. 'At the time a lot of them were public schoolboys, now we have got comprehensive school lads coming through. But there's still a tendency to protect your colleagues.'

She was one of 15 women who eventually went to court in 2000 - although Kerr, suffering from a degenerative brain disease, did not undergo a standard trial. He was found guilty on one of 19 counts of indecent assault, with the rest either ruled not proven or allowed to lie in record when the jury could not decide. Kerr was placed on the sex offenders' register and subsequently died. Haslam, charged after this trial ended, was sentenced to three years.

The subsequent inquiry found what it called an 'unhealthy' culture of professionals reluctant to act against each other, with patients routinely disbelieved. It recommended more collation of 'soft' evidence - concerns falling short of official complaints - and research into sexualised doctor-patient relationships. The Ayling report recommended offering chaperones for intimate examinations, and better co-ordination of separate complaints.

Both were investigating offences dating back to an era of old-fashioned deference to doctors. Yet the Kerr/Haslam inquiry concluded that, even by 2005, too little had changed: 'Substantial risks remain that patients or staff who raise concerns will not be heard... we are not persuaded that their concerns will even now be speedily and appropriately addressed.' Could it happen still?

Jonathan Coe argues it is. His organisation, Witness, receives around 100 direct reports of abuse annually, a caseload dominated by obstetricians and gynaecologists - whose consultations are uniquely intimate - and psychiatrists, whose power to section patients gives them an unusual hold over potential victims. 'I have met women who came forward and were encouraged not to say anything,' he says. 'They were told, "It won't be good for your mental health if you raise this".'

And even when patients persevere, it is usually their word against a doctor's. Which is why Witness has campaigned for a civil standard of proof in GMC cases - on the balance of probabilities - not the tougher criminal standard of beyond reasonable doubt. The change was backed by Dame Janet Smith's inquiry into Shipman, and by the government's Chief Medical Officer, Professor Sir Liam Donaldson.

But it is fiercely opposed by the British Medical Association, which argues it has compelling reasons for objecting: when Maria Marchese claimed the psychiatrist who treated her partner had raped her, she seemed to have cast-iron proof - traces of the doctor's DNA on her underwear. Dr Jan Falkowski was suspended and told he faced prosecution. He lost private patients and friends, while his relationship with his fiancee foundered under the strain of constant menacing text messages from his so-called victim.

But all was not as it seemed. Marchese was recently jailed for nine years after a court heard she bombarded the couple with death threats - including threatening to kill guests at their wedding. As for the supposed DNA evidence, she had fabricated it using a condom stolen from Falkowski's dustbin.

The case illustrates the risks for some doctors working with disturbed women. Although Coe argues that the false accusation rate is only about 2 per cent, undeniably some practitioners face malicious complaints threatening their livelihoods and liberty. The BMA argues that lowering the burden of proof would mean dangerous miscarriages of justice.

Caught in the middle of this passionate debate is Finlay Scott, the softly spoken chief executive of the GMC. He gave evidence to all four inquiries, and says quietly that their stories stayed with him: 'Talking to the victims of Kerr and Haslam was a profoundly moving and distressing experience. It is undeniable they were let down by the system - not narrowly by the GMC, but by the whole regulatory system.'

For, as Scott points out, in too many cases doctors and local health authorities did not bother contacting the GMC even as the complaints stacked up. It was repeatedly involved only at the eleventh hour, something Donaldson wants to change by putting GMC affiliates into local NHS organisations.

The vast majority of doctors, Scott argues, are competent and caring, but nonetheless he backs a shift in the burden of proof, although he thinks this should vary according to the gravity of the crime. 'If you are contemplating taking away a doctor's livelihood, then you have to be sure of your facts. On the other hand if you are proposing restrictions on a doctor's practice - that they will not undertake a particular kind of procedure - you can be more flexible.'

The GMC has already moved to defuse criticism by publishing proposals for reform, including appointing an equal number of lay and medical members to investigative panels and a tougher code of conduct. That appears to be enough to avert threats to abolish the GMC. But it still faces criticism over past failings especially in cases such as that of Richard Neale, a British doctor struck off in Canada in 1985 after a pregnant woman whose birth he had induced died. Neale returned to England and a consultant job in Northallerton, Yorkshire: although a subsequent inquiry found the GMC was informed of the Canadian conviction in 1985. In 1988 it was uncovered during routine checks after Neale applied to become a police surgeon, yet the GMC did nothing to stop him practising.

As Donaldson concluded in a review last July, Neale was shown an 'inexplicable degree of leniency'. He was only exposed when newspapers heard of the Canadian death.

Better patient protection in future, Scott argues, may lie in tying regulation to risk. If it knew where rogue doctors were most likely to emerge, the GMC could concentrate its efforts. The other priority is encouraging patients to stand up for themselves. Haq is helping the Committee for Health Regulatory Excellence to compile advice for patients on what constitutes doctors overstepping the mark. While she does not believe abuse could now happen on the scale it did in Yorkshire, she says it will always continue. 'There are rogue doctors and rogue nurses out there. Hopefully the work we are doing will make people aware that this is not acceptable.'

More sensitive handling of victims could also, Coe argues, encourage them to come forward. One woman Witness recently supported through a GMC case was left alone in a room during the hearing, where the accused doctor approached her to her terror. Harman, however, sounds a note of genuine optimism. Last year she represented a group of women sueing neurologist Dr Brian Phillips over claims he groped them during routine examinations. Although he was acquitted in court, the GMC struck him off for indecency.

The contrast between the cases of Ayling and Phillips convinced her that the GMC has genuinely changed, she says. 'They realised the way they dealt with Ayling was not approriate, and all credit to Ayling's former patients for that. I do feel positive.'

When ministers publish their conclusions shortly, women nationwide will see whether that hope is justified.

The accused men

William Kerr and Michael Haslam

A 2005 government inquiry found the two NHS consultants sexually assaulted at least 77 of their patients over a 20-year period. According to the inquiry, Kerr had raped or molested at least 67 women between 1965 and 1988. Thirty-eight of the women complained to nurses and 11 GPs but were dismissed as 'fantasists'.

Michael Haslam was jailed for three years in 2003, after being found guilty of four charges of indecent assault on three patients between 1981 and 1988. William Kerr was deemed unfit to stand trial for health reasons.

Clifford Ayling

The Kent GP molested dozens of victims over 30 years. Concerns were first raised in 1975, but he continued working until 2000. He was jailed for four years in 2000 after being convicted of 13 counts of indecent assault on patients between 1991 and 1998.

Richard Neale

Consultant gynaecologist Neale botched operations on women that left them in constant pain, incontinent or unable to bear children. He was struck off the medical register in Canada in 1985, following the deaths of two patients, but was allowed to work in the UK until 1999. He was struck off the UK medical register in 2000. He was arrested and then bailed in 2006, as part of an ongoing police inquiry.

Which doctors might turn rogue?

Some doctors present a far higher risk than others of turning rogue, according to the anecdotal evidence of the head of the General Medical Council's Fitness to Practise Panel.

Defendants are significantly more likely to be male than female. Although half of junior doctors and a majority of medical students are now female, chief executive Finlay Scott said the caseload is disproportionately male.

Doctors who trained and qualified abroad also face proportionately more complaints, although it is not clear whether foreign doctors are less competent, or just less likely to be protected by any old boys' network. 'We do not have a complete answer,' said Scott.

Cases are disproportionately likely to involve doctors working in obstetrics and gynaecology, general practice and certain specialist branches of surgery.

The GMC, which handles about 150 cases a year, regulates on behalf of patients, maintains a register of trained doctors and is largely funded by their professional fees. Nurses and midwives have their own body, the United Kingdom Central Council for Nursing.