PUBLIC RECORD. Record of Determinations. Medical Practitioner: Dates: 26/07/ /07/2018. GMC reference number: Tyne

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1 PUBLIC RECORD Dates: 26/07/ /07/2018 Medical Practitioner s name: Dr Neil Ineson GMC reference number: Primary medical qualification: Type of case New - Conviction / Caution MB BS 1978 University of Newcastle upon Tyne Outcome on impairment Impaired Summary of outcome Erasure Immediate order imposed Tribunal: Legally Qualified Chair Lay Tribunal Member: Medical Tribunal Member: Ms Marianne O'Kane Miss Susan Hurds Dr Bryn Davies Tribunal Clerk: Mr Michael Murphy Attendance and Representation: Medical Practitioner: GMC Representative: Not present and not represented Miss Leila Chaker, Counsel Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public. 1

2 Overarching Objective Throughout the decision making process the tribunal has borne in mind the statutory overarching objective as set out in s1 Medical Act 1983 (the 1983 Act) to protect, promote and maintain the health, safety and well-being of the public, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of that profession. Determination on Facts/Impairment - 27/07/ Dr Ineson qualified in 1978 and prior to the events which are the subject of this hearing, was a Colonel in the army and worked at a military Faculty of Public Health prior to transferring to the NHS in At the time of the index events, Dr Ineson was Director of Medicine at Frimley Park Hospital and Wrexham Park Hospital and a Consultant specialising in Cardiology, treating both military and civilian patients. 2. A referral was made to the GMC on 3 December 2014, following a local investigation which arose from an alleged sexual assault of a patient at a Cardiology Clinic at Frimley Park Hospital. This resulted in an extensive police investigation, which identified a number of other potential victims who made similar complaints regarding Dr Ineson s conduct during the period In total, seven men made allegations against Dr Ineson of sexual assault during the course of medical examinations by him. All were serving members of the military, and of varying ages, with one victim alleging that the conduct first arose when he was aged 16 years. 3. A prosecution ensued, leading to Dr Ineson s conviction at Guildford Crown Court on 4 April 2017 for 11 counts of sexual assault upon seven victims. Dr Ineson was convicted and sentenced to four years imprisonment, was required to register on the Sex Offenders Register for an indefinite period of time, and ordered to pay a Victim Surcharge in the sum of The Outcome of Applications Made during the Facts Stage 4. The Tribunal considered the GMC s application, made pursuant to Rule 40 of the General Medical Council (Fitness to Practise Rules) 2004 as amended ( the Rules ) that notice of this hearing has been properly served upon Dr Ineson. The Tribunal accepted this application, based on the evidence received. The Tribunal then considered whether to proceed in Dr Ineson s absence in accordance with Rule 31. It determined that it was in the public interest and in Dr Ineson s own interests to exercise its discretion to proceed with the case in his absence. A full determination, outlining the Tribunal s reasoning, can be found at Annex A. 2

3 The Allegation and the Doctor s Response 5. The Allegation against Dr Ineson is as follows: That being registered under the Medical Act 1983 (as amended): 1. On 4 April 2017 at Guildford Crown Court you were convicted of 11 counts of Sexual Assault on a Male No Penetration. To be determined 2. On 4 April 2017, you were sentenced to: a. Four years imprisonment to run concurrently in respect of counts 1, 7, 9, 12 and 13; To be determined b. Three years imprisonment to run concurrently in respect of counts, 2 4, 8, 10 and 11; To be determined c. remain on the Sex Offenders Register for an indefinite period; To be determined d. pay a victim surcharge in the sum of To be determined Documentary Evidence 6. The Tribunal had regard to the documentary evidence provided by the parties. This evidence included, but was not limited to: A police report summarising the key evidence available to police investigators; A copy Certificate of Conviction dated 4 April 2017 and Schedules; The Trial Judge s directions to the jury; The Trial Judge s sentencing remarks; Letters from the doctor s legal representative, dated 20 June 2018 and 25 June The Tribunal s Approach 7. In reaching its decision on facts, the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation. The standard of proof is that applicable to civil proceedings, namely the balance of probabilities, i.e. whether it is more likely than not that the events occurred. 3

4 The Tribunal s Analysis of the Evidence and Findings 8. The Tribunal has considered each paragraph of the Allegation separately and has carefully evaluated the evidence in order to make its findings on the facts. 9. In particular, the Tribunal had regard to the copy Certificate of Conviction purporting to relate to Dr Ineson, dated 4 April 2017 and the Schedules. The Tribunal also had regard to Rules 34(3) and 34(7) of the Rules, which state: (3) Production of a certificate purporting to be under the hand of a competent officer of a Court in the United Kingdom or overseas that a person has been convicted of a criminal offence or, in Scotland, an extract conviction, shall be conclusive evidence of the offence committed. (7) A copy of a document of which the original is admissible may be received by the Committee or a Tribunal without strict proof. 10. The Tribunal noted the letter of 20 June 2018, from Dr Ineson s legal representative in which he states Dr Ineson does not accept that the jury s verdicts were correct. Nevertheless, they are now a matter of record and until the convictions are set aside, Dr Ineson understands that the Panel will be invited to accept the verdicts as conclusive. 11. The Tribunal was aware that it must not seek to go behind the conviction, however it must satisfy itself that the person named on the Certificate of Conviction is the doctor who is the subject of this hearing. The Tribunal has placed reliance on the Certificate of Conviction produced. In the absence of any submission from Dr Ineson that he is not the subject of these convictions, and through the content of his representative s letter of 20 June 2018 and his engagement with these proceedings, the Tribunal can be satisfied that the person named in the Certificate of Conviction is one and the same as Dr Ineson, who is the subject of these proceedings. 12. The Tribunal has determined that each paragraph of the Allegation is found proved. The Tribunal s Overall Determination on the Facts 13. The Tribunal has determined the facts as follows: That being registered under the Medical Act 1983 (as amended): 1. On 4 April 2017 at Guildford Crown Court you were convicted of 11 counts of Sexual Assault on a Male No Penetration. Determined and found proved 4

5 2. On 4 April 2017, you were sentenced to: Impairment a. Four years imprisonment to run concurrently in respect of counts 1, 7, 9, 12 and 13; Determined and found proved b. Three years imprisonment to run concurrently in respect of counts, 2 4, 8, 10 and 11; Determined and found proved c. remain on the Sex Offenders Register for an indefinite period; Determined and found proved d. pay a victim surcharge in the sum of Determined and found proved 14. The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether, on the basis of the facts which it has found proved, Dr Ineson s fitness to practise is impaired by reason of his conviction. The Evidence 15. The Tribunal has taken into account all of the evidence received during the facts stage of the hearing. Submissions 16. On behalf of the GMC, Ms Chaker reminded the Tribunal that Dr Ineson has indicated, through his solicitor, that he does not accept the findings made by Guildford Crown Court on 4 April She submitted that no evidence has been presented to demonstrate regret, remorse, remediation or insight into his wrongdoing. 17. Ms Chaker summarised the evidence which formed the basis of the convictions and highlighted the position of trust that Dr Ineson occupied both by virtue of being a doctor but also by virtue of his status as a former army officer of rank. She was careful to draw the Tribunal s attention to positive attributes which had been highlighted during the trial, namely that Dr Ineson was a doctor of distinction who held a very high reputation within the profession, as attested to by numerous colleagues. She repeated the trial Judge's remarks that this special position also created the opportunity to offend and his conduct constituted a very grave breach of trust. 18. She referred the Tribunal to the remarks of Dame Janet Smith in the fifth report to the Shipman Inquiry which are summarised at paragraph 23 below, and indicated that limbs (a) (c) are engaged in this case. Ms Chaker submitted that there is a high risk of 5

6 repetition of his offending and that the public interest would be undermined if a finding of impairment were not made. 19. Ms Chaker submitted that it is clear that Dr Ineson s fitness to practise is impaired by reason of his conviction and invited the Tribunal to so find. The Relevant Legal Principles 20. The Tribunal reminded itself that at this stage of proceedings, there is no burden or standard of proof and the decision on impairment is a matter for the Tribunal s judgment alone. 21. The Tribunal must determine whether Dr Ineson s fitness to practise is impaired today, taking into account the nature and extent of his convictions and any relevant factors since then, such as whether the facts found proved are remediable, have been remedied and whether there is a likelihood of repetition. 22. Throughout its deliberations, the Tribunal has taken account of the statutory overarching objective, which includes protecting the health, safety and wellbeing of the public, promoting and maintaining public confidence in the profession, and promoting and maintaining proper professional standards and conduct for the members of the profession. 23. The Tribunal specifically took into account Dame Janet Smith s remarks in relation to impairment at paragraph in the fifth Report to the Shipman Inquiry, which was approved in CHRE v NMC and Grant [2011] EWHC 927, in which she laid out the appropriate test for a Tribunal in deciding whether fitness to practice is impaired. Relevant to these proceedings, a Tribunal must consider whether findings of fact in respect of a doctors convictions show that his fitness to practice is impaired, in the sense that he has in the past acted and/or is liable in the future to act so as to: (a) cause unwarranted risk of harm to patients and/or (b) bring the profession into disrepute and/or (c) breach a fundamental tenet of the profession The Tribunal s Determination on Impairment 24. The Tribunal recognised that Dr Ineson had practised with distinction over a long period of time in both a military and civilian capacity, with no prior offending history. 25. In determining the seriousness of the conviction, the Tribunal took the following matters into account: 6

7 the repeated and protracted nature of his offending, involving convictions for 11 offences of sexual assault involving seven victims during the period the fact that the offending occurred in a clinical setting. the vulnerability of the patients by virtue of their possibly having cardiac conditions and the concerns thereby generated. It was noted that one patient was aged 16 when the first of two sexual assaults occurred. In almost every instance the victims expressed their sense of violation, with one patient requiring follow up psychiatric referral following his initial disclosure. the exploitative nature of the conduct giving rise to the convictions, which as far as the evidence indicates, was targeted at military patients. It was noted that some patients continued to address him as Colonel or Sir despite his working in a civilian environment, indicating the esteem in which he was held and magnifying the exploitation arising. It was also concluded that a number of patients either withheld their concerns, or were reluctant to make any complaint at the time given Dr Ineson s status and rank. the lack of evidence of insight, most particularly the fact that Dr Ineson continues to challenge the findings of the jury, and the absence of any evidence of remediation including the absence of any expressions of remorse or reparation to the victims. the gravity of the sentence imposed and the trial Judge s sentencing remarks in relation to the category of harm. 26. During its deliberations the Tribunal was mindful of the serious effect Dr Ineson s actions had on his victims. To quote the trial judge: It s clear that what happened to them has had a significant impact on their state of mind since. 27. The Tribunal also had regard to the trial Judge s remarks directed to Dr Ineson at sentencing stage: You, as was attested by many of your colleagues and others, have a, or have had a distinguished medical career, a very high reputation as a clinician and you have been an assessor for the GMC for many years. You unquestionably have great professional skill and experience. However, your very position created an opportunity for the commission of these offences, and [if] the commission of them constitutes a very grave breach of trust. The witnesses were all vulnerable, in the sense that they were referred because they had symptoms suggesting problems with their heart. 7

8 And when they were in the consulting room at the hospital, they were in the relationship between a patient and a doctor, but also between a junior serviceman and a senior officer, even though you didn t, yourself, use the title, colonel, you were known as such to these young men. And your very standing and [rep] high reputation made it considerably more difficult for them to report what happened to them. as a result of these verdicts your reputation is in ruins 28. The Tribunal referred to the editions of Good Medical Practice ( GMP ) relevant to the timeframe of Dr Ineson s offending, including the April 2013 edition. 29. The Tribunal concluded that the nature of the offences of which he was convicted together with the gravity of the sentence imposed represent very serious departures from fundamental tenets of the medical profession. With reference to the April 2013 edition of GMP, the Tribunal determined that his convictions and sentence were incompatible with the duties of a doctor as described in the following paragraphs: 1. Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law. 2. Good doctors work in partnership with patients and respect their rights to privacy and dignity 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession. 30. The Tribunal had no evidence before it to indicate that Dr Ineson has any level of insight into his offending, or the impact of his conduct upon the victims involved or upon the wider public interest, including the reputation of the profession. Indeed it is noted that he continues to challenge the convictions. The Tribunal is conscious that it is difficult to demonstrate remediation in cases of sexual offending but notes that Dr Ineson has presented no evidence that any steps towards remediation have occurred. 31. The Tribunal is most concerned that given the absence of insight or remediation that there is a significant risk of repetition of Dr Ineson s offending, 8

9 given the pattern of his offending over a prolonged period and his refusal to acknowledge it. 32. The Tribunal noted that all offences occurred in a clinical setting, where Dr Ineson relied upon his esteemed reputation and senior military rank to exploit and violate his victims. His conduct has clearly brought the medical profession into disrepute and wholly undermined his patients trust in him and the medical profession by breaching fundamental tenets of the profession. 33. Bearing all of the above in mind, the Tribunal concluded that it is essential to protect and promote the health, safety and wellbeing of the public, to promote and maintain public confidence in the medical profession and to promote and maintain proper professional standards and conduct for the members of the profession to find Dr Ineson impaired. 34. The Tribunal has therefore determined that Dr Ineson s fitness to practice is impaired by reason of conviction. Determination on Sanction - 27/07/ Having determined that Dr Ineson s fitness to practise is impaired by reason of conviction, the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules as to the appropriate sanction, if any, to impose. The Evidence 2. The Tribunal has taken into account evidence received during the earlier stages of the hearing where relevant to reaching a decision on sanction. Submissions 3. On behalf of the GMC, Ms Chaker submitted that taking no action would not be appropriate in this case. She indicated that the guidance was clear that such a disposal should be reserved for cases where exceptional circumstances justified this course, but this was not such a case. She submitted that a sanction of conditions would also not be appropriate as Dr Ineson has failed to recognise the seriousness of his offending and as a serving prisoner no workable conditions would be possible. 4. Ms Chaker submitted that it is not appropriate for a doctor to be registered on the Medical Register whilst also appearing on the Sex Offenders Register. She expressly referred the Tribunal to paragraphs 147 to 150 of the Sanctions Guidance (2018) ( SG ) and stated that it is in the interests of public protection and the wider public interest that his name be erased from the Medical Register. 9

10 The Tribunal s Determination on Sanction 5. The decision as to the appropriate sanction to impose, if any, is a matter for this Tribunal exercising its own judgement. 6. In reaching its decision, the Tribunal has taken account of the SG and relevant editions of Good Medical Practice ( GMP ) including GMP It has borne in mind that the purpose of a sanction is not to be punitive, but to protect patients and the wider public interest, although it may have a punitive effect. 7. Throughout its deliberations, the Tribunal applied the principle of proportionality, balancing Dr Ineson s interests with the public interest. It has taken account of the overarching objective, which includes the protection of the public, the maintenance of public confidence in the profession, and the promoting and maintaining of proper professional standards and conduct for members of the profession. 8. The Tribunal has already delivered a detailed determination on impairment and has taken those matters into account during its deliberations on sanction. 9. The Tribunal has borne in mind that Dr Ineson is not present or represented at these proceedings and proceeded with the utmost caution. 10. In considering sanction the Tribunal had regard to the mitigating and aggravating factors of the case. 11. The Tribunal considered the only mitigating factors evident in this case are that Dr Ineson was well respected by his peers and had no previous convictions. 12. The Tribunal has already discussed the aggravating factors at paragraph 25 of its determination on facts/impairment. It considered these provisions in line with paragraphs 51, 52a and c, 55 d, e and f of the SG which state: 51. It is important for tribunals to consider insight, or lack of, when determining sanctions 52. A doctor is likely to lack insight if they: a. refuse to apologise or accept their mistakes c. do not demonstrate the timely development of insight. 55. Aggravating factors that are likely to lead the tribunal to consider taking more serious action include: 10

11 No action d. abuse of professional position particularly where this involves: i. vulnerable patients e. sexual misconduct f. sexual offences and/or child sex abuse materials 13. In reaching its decision as to the appropriate sanction, if any, to impose in Dr Ineson s case, the Tribunal first considered whether to conclude the case by taking no action. Given the seriousness of the convictions the Tribunal took the view that taking no action would be wholly inappropriate. It determined that there were no exceptional circumstances to justify taking no action in this case. Conditions 14. The Tribunal next considered whether it would be appropriate to impose conditions on Dr Ineson s registration. It bore in mind that any conditions imposed must be appropriate, proportionate, workable and measureable. 15. The Tribunal determined that there are no conditions which can be formulated in this case which would be sufficient to protect the public and the wider public interest. It bore in mind that as Dr Ineson is currently serving a prison sentence he is clearly unable to practise at this time. Furthermore, his refusal to accept the Court findings and his lack of evidence of insight, remorse or remediation, effectively precludes the use of conditions. 16. The Tribunal further concluded that conditions are not adequate to meet the wider public interest in this case. Suspension 17. The Tribunal then went on to consider whether a sanction of suspension on Dr Ineson s registration would be appropriate and proportionate. 18. During its deliberations the Tribunal had regard to paragraphs of the SG which outline when suspension may be an appropriate sanction. It had particular regard to paragraph 92 and to the relevant indicative factors set out in paragraph 97: 92. Suspension will be an appropriate response to misconduct that is so serious that action must be taken to protect members of the public and maintain public confidence in the profession. A period of suspension will be appropriate for conduct that is serious but falls short of being fundamentally incompatible with 11

12 continued registration (ie for which erasure is more likely to be the appropriate sanction because the tribunal considers that the doctor should not practise again either for public safety reasons or to protect the reputation of the profession) 97. Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate. a. A serious breach of Good medical practice, but where the doctor s misconduct is not fundamentally incompatible with their continued registration, therefore complete removal from the medical register would not be in the public interest. However, the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors e. No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor s unwillingness to engage. f. No evidence of repetition of similar behaviour since incident. g. The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour. 19. The Tribunal was of the view that these paragraphs of the SG were relevant to its deliberations in this case. The Tribunal concluded that given the seriousness of Dr Ineson s conviction and in the absence of any evidence of insight, remediation or assurance that there is no risk of repetition, that it would not be appropriate to impose suspension on his registration. Furthermore a period of suspension would not sufficiently protect the reputation of the profession. It concluded that the nature and gravity of Dr Ineson s convictions were so serious that they could not be adequately marked with a period of suspension. 20. For these reasons, the Tribunal determined that suspension would not be an appropriate or proportionate sanction. Erasure 21. The Tribunal had regard to the relevant provisions of paragraph 109 of the SG which states: Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive). 12

13 a. A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor d. Abuse of position/trust e. Violation of a patient s rights/exploiting vulnerable people f. Offences of a sexual nature i. Putting their own interests before those of their patients j. Persistent lack of insight into the seriousness of their actions or the consequences. 22. It also had regard to paragraphs 147 to 150 of the SG, in particular paragraph 148 which states: More serious action, such as erasure, is likely to be appropriate where a doctor has abused their professional position and their conduct involves predatory behaviour or a vulnerable patient, or constitutes a criminal offence. 23. The Tribunal considered the public interest in this case and paid particular attention to paragraph 150 of the SG which states: 150. Sexual misconduct seriously undermines public trust in the profession. The misconduct is particularly serious where there is an abuse of the special position of trust a doctor occupies, or where a doctor has been required to register as a sex offender. More serious action, such as erasure, is likely to be appropriate in such cases. 24. The Tribunal concluded that given the repetitive and serious nature of Dr Ineson s offences, the gross breaches of trust and the risk of repetition are fundamentally incompatible with continued registration. It considered that members of the public were also likely to share this view. 25. The Tribunal concluded that erasure is the only appropriate and proportionate sanction sufficient to protect patients, maintain public confidence in the profession and declare and uphold proper standards of conduct. The Tribunal therefore directs that Dr Ineson s name be erased from the Medical Register. 26. Unless Dr Ineson exercises his right of appeal, his name will be erased from the Medical Register 28 days from the date on which written notice of this decision is deemed to have been served upon him. A note explaining his right of appeal will be sent to him. 13

14 Determination on Immediate Order - 27/07/ Having determined that Dr Ineson s name be erased from the Medical Register, the Tribunal has considered, in accordance with Rule 17(2)(o) of the Rules, whether his registration should be subject to an immediate order. Submissions 2. On behalf of the GMC, Ms Chaker submitted that it would be appropriate to impose an immediate order of suspension on Dr Ineson s registration. She submitted that this was necessary in order to protect the public and to uphold the public interest. The Tribunal s Determination 3. The Tribunal had regard to paragraph 173 of the SG which states: An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety. For example, where they have provided poor clinical care or abused a doctor s special position of trust, or where immediate action must be taken to protect public confidence in the medical profession. 4. The Tribunal took account of the seriousness of Dr Ineson s conviction, the future risk to patient safety were he to be released from custody and the requirement to protect public confidence in the medical profession. It therefore, determined to impose an immediate order of suspension on Dr Ineson s registration. 5. This means that Dr Ineson s name will be suspended from the Medical Register from when notification is deemed to have been served upon him. The substantive direction, as already announced, will take effect 28 days from when written notice of this determination has been served upon him, unless an appeal is made in the interim. If an appeal is made, the immediate order will remain in force until the appeal has concluded. 6. The interim order currently imposed on Dr Ineson s registration will be revoked when the immediate order takes effect. 7. That concludes the case. Confirmed Date 27 July 2018 Ms Marianne O'Kane, Chair 14

15 ANNEX A 27/07/ Dr Ineson is neither present nor represented at these proceedings. 2. The Tribunal has considered whether notice of this hearing has been properly served upon Dr Ineson in accordance with Rule 40 of the General Medical Council (Fitness to Practise) Rules 2004 (as amended) ( the Rules ). In so doing, the Tribunal has taken into account all of the information placed before it, together with Ms Chaker s submissions on behalf of the General Medical Council (GMC). 3. The Tribunal has been provided with a service bundle, containing a copy of the Notice of Hearing dated 21 June 2018, which was sent to Dr Ineson s registered address and to his current address at Her Majesty s Prison High Down, care of the Governor. The letter to Her Majesty s Prison High Down is recorded as having been received on 22 June The Tribunal further considered correspondence from Dr Ineson s legal representative, dated 20 June 2018, which confirms knowledge of today s hearing date. Having considered all the information, the Tribunal is satisfied that notice of this hearing had been properly served upon Dr Ineson. 4. The Tribunal went on to consider whether to proceed in Dr Ineson s absence in accordance with Rule 31 of the Rules. 5. The Tribunal bore in mind that its discretion to proceed in the practitioner s absence must be exercised with caution and with regard to the overall fairness of the proceedings. In doing so, the Tribunal has balanced the interests of the practitioner with those of the GMC and the wider public interest. 6. The Tribunal reviewed the letter of 20 June 2018, previously referred to, from Dr Ineson s legal representative, in which it was confirmed that Dr Ineson is a serving prisoner and does not intend to participate in this Fitness to Practice hearing, nor be legally represented. 7. On the basis of the information provided the Tribunal is satisfied that Dr Ineson has voluntarily waived his right to be present and represented at this hearing and that he is aware that the hearing can proceed in his absence. The Tribunal considers that were it to adjourn today, it is very unlikely that Dr Ineson would attend a future hearing. The Tribunal has therefore determined that it is in the public interest and Dr Ineson s own interests to exercise its discretion to proceed with the case in his absence. Having reached this decision, the Tribunal wishes to emphasise that it will not draw any adverse inferences from Dr Ineson s nonattendance. 15