QUEEN'S BENCH DIVISION
Strand, London, WC2A 2LL
B e f o r e :
| DR STEVEN LOVETT (a protected party by his Deputy Mrs Jill Lovett)
|- and -
|HEALTH AND CARE PROFESSIONS COUNCIL
MISS JENNI RICHARDS QC (instructed by BIRCHAM DYSON BELL LLP) for the Defendant
Hearing dates: 6, 7, 8 & 9 March 2018
Crown Copyright ©
MR JUSTICE OUSELEY:
"Between 2008- 2012, whilst practising as a Clinical Psychologist, you:
1. Charged …[A] for treatment sessions on the following dates which did not take place: [6 are listed].
2. Charged…[B] for treatment sessions on the following dates which did not take place: [5 are listed].
3. Charged…[C] for double appointments on several occasions when the session were not double appointments.
4. Arrived late on several occasions for appointments (but on each occasion charged for a full appointment) with [A, B and C].
5. Falsely claimed for travel expenses for visits for purported visits to [B and C] on [16 dates].
6. Did not provide:
[A], her General Practitioner, and/or any other health professional responsible for her care with a copy of her health records;[B], her General Practitioner, and/or any other health professional responsible for her care with a copy of her health records;[C-likewise].
7. Made false or unjustified statements to [A's] General Practitioner, to the effect that:
[A] has "underlying psychological problems"; and"there are numerous safety issues surrounding [A's] psychopathology to herself and others under her care".
8. Made a false or unjustified statement to [B's] General Practitioner, to the effect that the release of [B's] health records may cause harm.
9. Did not provide [B] with appropriate treatment for post-traumatic stress disorder in that you [did not refer her to a trauma counsellor, or for Cognitive Behaviour Therapy or provide advice in relation to panic attacks].
10. Did not refer [A or B] to the respective General Practitioners.
11. Did not [set the goals of your therapy sessions with A or B].
12. Acted outside the scope of your practice in that, you [provided B with advice in relation to her personal injury claim].
13. Made false or misleading claims in that, you [informed A that you were registered with the GMC, were approved by all major medical insurance company when AXA PPP had revoked recognition, and accused A of making 50 harassing phone calls to you].
14. The matters set out in paragraphs 1,2,3,4,5 and 13a) and b) were dishonest.
15 and 17. [All matters except 9 to 12 amounted to misconduct; 9-12 amounted to lack of competence and/or misconduct].
16 and 18. By reason of that misconduct or lack of competence your fitness to practice is impaired."
The course of proceedings
"has capacity to litigate outside a hearing and he can interact with his solicitors; however it is my considered opinion that in the scenario of the hearing I do not believe he has the cognitive capacity to cope with being cross-examined or following evidence. It is my view that his attempts at concentration span is significantly limited and also his memory results in him making errors. I found in my assessment his concentration fluctuated and I do not believe that he will be able to comprehend the HCPC proceedings sufficiently to understand evidence in the hearing and from various experts to be able to discuss his responses to such evidence."
He would be unable to understand or follow information about the decisions he needed to make, to retain information in his mind, or communicate his decisions. He was not at present capable of effective participation. But Dr Fox thought that Dr Lovett's cognition was likely to improve sufficiently for him to participate in proceedings from early 2016, particularly if he had meanwhile some cognitive behavioural therapy.
"Between 2008-2012, whilst practising as a Clinical Psychologist, you:
6. did not provide:
a) [A], her General Practitioner, and/or any other health professional responsible for her care with a copy of [A'shealth records;b) [B], her General Practitioner, and/or any other health profession responsible for her care with a copy of [B's] health records; and
7. made false or unjustified statements to [A's] General Practitioner, to the effect that:
a) [A] has 'underlying psychological problems': andb) 'there are numerous safety issues surrounding [A's] psychopathology to herself and others under her care.'.
8. made a false or unjustified statement to [B's] General Practitioner, to the effect that the release of [B's] health records may cause harm;
9. did not provide [B] with appropriate treatment for Post-Traumatic Stress Disorder in that, you:
c) did not provide [B] with advice in relation to panic attacks and/or refer her elsewhere for such advice.
10. did not refer [B and/or A] to the respective General Practitioners;
11. did not:
a) set the goals of your therapy session(s) with [A];b) set the goals of your therapy session(s) with [B]; and
15. the matters set out in paragraphs 6, 7 and 8 amount to misconduct;
16. by reason of that misconduct your fitness to practise is impaired;
17. the matters set out in paragraphs 9, 10 and 11 amount to lack of competence and/or misconduct; and
18. by reason of that lack of competence and/or misconduct, your fitness to practise is impaired."
"Paragraph 4.4 of the report: "It is my view that he has the capacity to litigate outside the hearing and can interact with his solicitors but it is my opinion that in the scenario of a hearing, I do not believe that his cognitive capacity skill would cope with being cross-examined or following evidence. It is my view that his attempts at concentration span is limited and also his memory results in making errors. His concentration fluctuates and I do not believe that he would be able to comprehend the proceedings sufficiently to understand the evidence in the hearing and various experts to be able to discuss responses from such evidence. He is also suggestible and prone to errors which could result in him not communicating clearly."
"I believe Dr. Lovett would have difficulty concentrating on the volume of evidence that he would have to review. To some extent it depends upon the detail of the information in the files that are presented to Dr. Lovett. If there are specific particulars and dates that he needs to check to try and refresh himself on this could require considerable time. In addition it depends on his pain level which could distract him and the amount of pain medication which will slow him down. A rough estimate of one lever arch file could take him a maximum of five days for him to process. The difficulty then would be his retaining the information therefore he may well have to produce notes to prompt him and if his pain was bad or his pain medication increased further this process is likely to be more significantly impaired."
"the discretion to commence a trial in the absence of a defendant should be exercised with the utmost care and caution. If the absence of the defendant is attributable to involuntary illness or incapacity it would very rarely, if ever, be right to exercise the discretion in favour of commencing the trial, at any rate unless the defendant is represented and asks that the trial should begin."
"i. If the particulars are true, then Dr. Lovett may pose a significant risk to public safety, and to fail to take appropriate action to address that risk would fail to protect the public and would undermine public confidence in the profession and in the regulator.
ii. The particulars against Dr. Lovett stem from complaints made by two of his service users who have claimed, amongst other things, that their mental health was grossly and improperly impugned by Dr. Lovett. The continuing uncertainty of the validity of that claim will undoubtedly remain a source of stress for those individuals, who by the nature of their referral to Dr. Lovett must be considered to be vulnerable. The issue needs to be resolved.
In considering the interests of Dr. Lovett the Panel has taken into account the following matters:
i. Dr. Lovett is entitled to a fair hearing and the public interest cannot justify, not be served by, any unfairness to Dr. Lovett.
ii. Dr. Lovett has always made it clear that he was keen for these proceedings to conclude and it cannot be in his interest for such serious particulars against him to remain unresolved, it that is avoidable."
"Dr Powell's expert evidence has been agreed and the only issues which have been outstanding for the last two years have been what was predicted to be another half day of cross examination of Dr Lovett on behalf of the HCPC, any re-examination of Dr Lovett, any Panel questions, and the evidence of Mrs Lovett about the invoicing."
"34. It is clear from the medical evidence that there is no foreseeable prospect of Dr. Lovett's further personal attendance at the hearing. It is also clear from the medical evidence that Dr. Lovett's capacity to give instructions to his legal representatives is also limited in that for him to re-familiarise himself with the evidence would be difficult, and his ability to do so would depend upon the volume and complexity of the relevant information. However, his long-term memory was considered to be satisfactory and the problems with his cognition could be overcome if he was given plenty of time to reflect, for his understanding to be checked and if he was given assistance to identify the material relevant to the issue he is supposed to be considering.
35. Having applied this information about Dr. Lovett's capacity to undertake the tasks which will necessarily flow from a resumption of the case, it is clear that any further cross-examination will be impossible. Nor will it be possible for him realistically to re-familiarise himself with all the evidence necessary to address his re-examination or prepare submissions on particulars 1, 2(c), 3 and 5(n). This evidence is detailed, complex and potentially confusing. It will, however, if provided with the adjustments suggested by Dr. Fox, be realistic for Dr. Lovett to re-familiarise himself for those purposes with the very straightforward evidence n relation to particulars 6(a), 6(b), 7(a), 7(b), 8 and 9)c), 10 and 11. These all relate to his clinical treatment and assessments of Service Users A and B."
"When the Committee drew a distinction between particulars involving dishonesty, which are stayed, and the broader, more general particulars focussing on the claimant's professional judgment regarding treatment et cetera, it demonstrated an obvious and valid concern to avoid the claimant having to deal any further with particulars involving detailed analysis of the evidence and cross referral to documents. It is not surprising that the panel used the word "straightforward" to describe the particulars remaining to be resolved. This was a perfectly sensible description and it reflects the fact that the claimant was able to deal with the remaining particulars in a concise way in his own statement."
"Insofar as the claimant wishes to pursue an argument that some of the particulars the committee has directed should proceed fall on the wrong side of the line it has drawn, and they are not accessible to the claimant in his current condition such arguments can be made and I would expect the committee to consider them rationally and fairly. But overall, it is impossible to conclude that the committee's decision to proceed in the way it has directed constitutes a serious procedural irregularity."
(a) The Panel accepted that his physical absence and current incapacity were genuine and involuntary ill-health. "However, it does not accept that Dr Lovett's failures to provide any further evidence, or to make any relevant submissions when he had the capacity to do so, are not deliberate. It is the Panel's view that for a significant period Dr Lovett had both the capacity and the opportunity to provide any further evidence and to make any submissions. He chose not to do so."
(b) That last point was relevant to the submission that the loss of capacity now found represented a fundamental change since its 15 March 2016 decision and Cheema-Grubb J's decision of 8 July 2016. It accepted that Dr Fox's examination in October 2016 showed that Mr Lovett's capacity to interact with his legal team had changed over the preceding year and that Dr Lovett now lacked any capacity in relation to the case. That was only one factor to be considered in assessing whether or not it was unfair to proceed.
(c) The Panel considered a number of detailed points in relation to the claim that Dr Lovett now faced "serious and irremediable prejudice in the presentation of his case and all future stages of these proceedings." It rejected the assertion that, had he remained able to interact with his legal team, he would have been expected to provide information or instructions. It did so because Dr Lovett had failed to take the opportunity provided by the Panel's directions of March 2016 to provide a statement and submissions responding to the HCBC's submissions which he had had since November 2014. He had chosen to take that course and, even after the 8 July 2016 decision of the Administrative Court, he had chosen to challenge the conduct of his then legal team in relation to the judicial review. At no time in the last three years had there been any engagement by Dr Lovett in relation to the substance of the case, when as far back as 3 July 2014, the Panel had "directed" that consideration be given to his making a statement dealing with any further issues he would wish to deal with evidentially, yet no such statement had ever been submitted. Any prejudice he faced now "stems predominantly from his voluntary failure to avail himself of the opportunities offered to submit any further evidence or to be involved in the preparation of submissions." It could see no reason either why preparation of submissions should be "seriously handicapped" by the lack of Dr Lovett's personal involvement, in view of his legal team and its access to the material.
(d) If there were important evidence in relation to the statutory grounds and impairment he had had the opportunity likewise to provide that, but he had chosen not to do so. (I add that, on the facts as found by the Panel, this issue is irrelevant, as Mr Grant recognised).
(e) The Panel disagreed with Mr Horne's submission that the remaining allegations were not so serious that the public interest required their determination. It repeated its view as to the very serious allegations in some of the particulars; they were serious in terms of the general public interest in the proper conduct of registered health professionals and in terms of the alleged impact on A and B, two vulnerable service users who claimed that Dr Lovett had grossly and improperly impugned their mental health.
(f) Although it might now be unlikely that Dr Lovett would ever be fit enough to return to work, the question of a possible return had to remain open, especially if anxiety about this case was a major issue in relation to his health.
"This application is based on the contention that the HCPC case that Dr. Lovett made the relevant statements to the GPs knowing them to be false will require the Panel to consider why Dr. Lovett would deliberately make statements he knew to be false to prevent disclosure of his records. The Panel does not accept that contention. The HCPC case has not been put on the basis that any false statements were made to prevent disclosure, in order to conceal any irregularities in the invoicing. It has been implied that there could have been such a motive but in the absence of any further consideration of the invoicing issues that can amount to no more than speculation. If it is proved that Dr. Lovett made the relevant statements to the GPs knowing them to be incorrect the Panel does not accept that the only plausible reason for that would be to prevent disclosure of any invoicing irregularities. There could be a number of reasons behind such conduct. The consideration of the word "false" in relation to particulars 7 and 8 cannot rely on the evidence adduced to support particulars 1, 2(c), 3 and 5(n) as those particulars have been stayed and it would clearly be inappropriate and unfair to rely on those matters as possible motivation. The evidence to support particulars 7 and 8, as drafted, must be examined discretely and that can be done without any unfairness to Dr. Lovett."
Particulars 6-8 and the case considered by the Panel
"I do not believe that it would be in [A's] best interests for her to be provided with this information by simply reading this information in her clinical records. I believe that this could cause serious risk of harm, distress, denial, and anger. I am concerned that she will not accept the diagnosis if the information is presented this way and that this will negatively impact on her ability to address the condition."
He relied upon the exemption from disclosure in Article 5 (1) of the Data Protection (Subject Access Modification) (Health) Order 2000. This does indeed provide for an exemption where the personal data would be likely to cause serious harm to the physical or mental health or condition of the data subject or any other person.
"There is a considerable history to [B's] psychological profile and the manifestation of her difficulties and wider family dynamics, together with significant confidentiality issues. Because of the manner in which she ended her treatment I was unable to work through my clinical formulation concerning her underlying psychological problems.
[He referred to B knowingly making false allegations to the HCPC about overcharging and travel expenses and other complaints which she had withdrawn only to make a complaint about his withholding her medical records] …
The ICO then carried out an investigation and did not uphold [B's] complaint, fully accepting my professional and clinical exclusions and concerns (please find a copy of the ICO's decision enclosed). You will see from this that the ICO are indicating that I need not take any further action here, but I did offer a potential compromise.
This compromise will require [B's] full co-operation and in view of the litigious nature of complaints she has made about me and also about numerous other professionals previously, I am concerned that as healthcare professionals, [B's] difficulties remain centre stage and she, her family and any healthcare professionals who may become involved to work through issues relating to her underlying psychological problems are not placed in the position I have been over the past two years.
With the above points in mind finding the appropriate and safest way forwards will need some careful consideration. It is my opinion that in order to move matters forward I will initially need to liaise with an experienced and skilled clinical psychologist in your area in order that a hand over and proper management of my notes can be considered, worked through with [B], before any consideration is given to these being either passed to her or contained within any general medical files, in order to ensure all safeguarding issues are firmly in place prior to the commencement of this process.
On a final point [B] does still owe me money for treatment sessions I provided to her, which were fully funded through interim payments from the third party insurers in her personal injury claim and therefore not something she had to pay for herself. However, I have not pressurised her in any way for this payment, but I do consider that this is also something that needs to be addressed in order to fully conclude matters."
"Whilst the above is only a very brief description of the inherent problems encountered with [A], it is my opinion that they are consistent with her underlying psychological problems and wider family dynamics. Because of the manner in which she ended her treatment I was unable to work through my clinical formulation of her underlying psychological problems with her. It is my opinion that there are numerous safety issues surrounding [A's] psychopathology to herself and others under her care and that of any future healthcare professionals who may become involved in attempting to provide assistance."
[Dr Lovett added, after referring to the ICO as in his letter to [B], references to [A's] father's adverse personal response to him]:
"With respect to the above points and given that there remains an ongoing complaint about me from [A] to the HPC, there continues to exist a substantial confidentiality issues [sic] arising in this matter and I am concerned that these do not impede the safe disclosure of essential clinically relevant information and an appropriate clinical handover.
Furthermore, given the complexities of psychopathology [A's] it will be absolutely necessary for a professional multidisciplinary team approach, headed by a senior clinical psychologist, to ensure that all safety concerns are fully met and applied in this case. In addition, it is also my opinion that in order to move matters forward, I will initially need to liaise with the nominated clinical psychologist in your area in the first instance in order that a handover and proper management of my notes can be considered, then work through with [A], before any consideration is given to these being either passed to her, or contained within any general medical files.
Thank you for your offer to help in this case. I consider your involvement essential in this process, which was complicated, can be moved forwards in a safe and appropriate manner within a clinically oriented approach."
"I draw your attention to the section headed "Formulation". I am sure you understand my concern of the impact that these entries might have on [B] if you were to simply receive this material without any support or explanation. Whilst it is important that clients come to appreciate the nature of their problems, this needs to be handled in a controlled and therapeutic fashion."
Although he had had in mind providing them to a suitable specialist:
"this matter has now become highly litigious and I am coming under ever-increasing pressure to release the records forthwith. Hence I'm now providing them to you."
He hoped that she would take an appropriate view as to whether a specialist needed to be involved in dealing with the issues and in particular "the formulation section".
(i) in respect of B
"- Very traumatised by index incident.
- Sustained serious injury, [B's daughter] almost died (lost a leg) and mum did die – her family so impacted – moved home when well established with very good friendship network.
Life is almost always in chaos & B is distracted and often hysterical.
By contrast A is much calmer.
Never talks about panic attacks in any detail and no one telephones if she's needed to go into hospital?
Again, this is trauma induced by PD.
Both B and A can be pushy at times and do not take responsibility for their actions – they blame everyone else.
(ii) in respect of A
"- The trauma of the index accident has created considerable instability for A and I suspect she has had a great need to control the situation. Her sessions have been very controlled on the one hand and distracted on to others problems.
Both her and B seem to find it hard to process certain information at certain times and blame others for problems which, unfortunately, they create – (major problem).
Overall, primary problem here is most likely personality disorder brought on by trauma – or at least made these problems manifest again.
- The link between Autistic Spectrum Disorder and Narcissistic P.D has always been suggested and the high precedence of P.D in identical twins is one if one twin has problems well known.
- NPD explains A's control issues very well and her semi acceptance of support but often projecting that on to B or usually C is I only need help because of them, not me.
- Such a diagnosis explains why so many staff seem to have caused so many problems.
The Panel's Final Decision, FD
The role of this Court
"(i) Proceedings under section 40A of the 1983 Act are appeals and are governed by CPR part 52. A court will allow an appeal under CPR part 52.21(3) if it is 'wrong' or 'unjust because of a serious procedural or other irregularity in the proceedings in the lower court.
(ii) It is not appropriate to add any qualification to the test in CPR 52 that decisions are 'clearly wrong': see Fatnani at paragraph 21 and Meadow at paragraphs 125 to 128.""
"This [as an appeal by way of rehearing] does not, however, mean that the court will hear the case afresh. In Threlfall v General Optical Council  Lloyd's Rep Med 250, para 20, Stanley Burnton J put it this way: 'In other words, the appeal court does not normally hear evidence afresh, but considers the appeal on the basis of the record of the evidence in the court below'.
"5. The relevant principles of law are well established. When a registrant appeals to the High Court against a decision of the Council, the court's function is to determine whether the Council's decision was wrong. In General Medical Council v Meadow [2007 QB 462, Auld L.J. (in paragraph 197 of his judgment with which Sir Anthony Clark M.R. and Thorpe L.J. agreed) identified three factors which the court must have in mind and give appropriate weight: first that "[the] body from whom the appeal lies is a specialist tribunal whose understanding of what the medical profession expects of its members in matters of medical practice deserves respect", second, that "[the]" tribunal had the benefit, which the court normally does not, of hearing and seeing the witnesses on both sides", and third, that "[the]" questions of primary and secondary fact and the overall value judgment to be made by a tribunal, especially the last, are akin to jury questions to which there may reasonably be different answers."
"As a matter of general law, it is very well established that findings of primary fact, particularly if founded upon an assessment of the credibility of witnesses, are virtually unassailable."
"(1) Where a question of fact has been tried by a judge without a jury, and there is no question of misdirection of himself by the judge, an appellate court which is disposed to come to a different conclusion on the printed evidence, should not do so unless it is satisfied that any advantage enjoyed by the trial judge by reason of having seen and heard the witnesses, could not be sufficient to explain or justify the trial judge's conclusion; (2) The appellate court may take the view that, without having seen or hear the witnesses, it is not in the position to come to any satisfactory conclusion on the printed evidence; (3) The appellate court, either because the reasons given by the trial judge are not satisfactory, or because it unmistakably so appears from the evidence, may be satisfied that he has not taken proper advantage of his having seen and heard the witnesses, and the matter will then become at large for the appellate court."
The first main issue: the treatment of the psychology evidence
"That was Dr Lovett's professional view, and it is for the Panel to decide a) whether it was his genuine professional view and b) whether they have sufficient evidence to say that his view was wrong." A wrong view was not necessarily misconduct or incompetence. He would expect a psychologist to err on the side of caution, "and ensure that notes are only released under what are seen as safe circumstances which is what Dr Lovett did."
Professor Powell commented on Dr Halari's view that the notes provided no evidence of underlying problems of safety issues:
"However, Dr Halari does point to the indication of uncontrollable anxiety and considerable instability and Narcissistic Personality Disorder, so Dr Halari accepts that evidence to support Dr Lovett's statements are not "clear" rather than absent. I have not met the clients myself so cannot pass comment on the vulnerability. Dr Lovett did form the professional view that there were vulnerabilities, as expressed in his communications about the release of records."
(1) Conflation of diagnosis and formulation.
(2) Wrongly confining the basis of the formulation to session notes and other contemporaneous material.
(3) Substituting its own opinion for that of Dr Lovett
(4): Conflation by the Panel of statements of fact with opinion
(5): Sufficient evidence to support Dr Lovett's formulations
The second main issue: the Panel's handling of the allegations of dishonesty or knowingly making false statements was unfair
(1): The allegation that statements were made knowing them to be false was inadequately pleaded
Ground 2: the allegation of fraud must be put to the person accused of it
"55. At a relatively high level of generality, in such a case an appellate court should have in mind two conflicting principles: the need for finality and minimising costs in litigation, on the one hand, and the even more important requirement of a fair trial, on the other. Specific factors to be taken into account would include the importance of the relevant issue both absolutely and in the context of the case; closeness of the grounds to the points which were put to the witness; the reasonableness of the grounds not having been put, including the amount of time available for cross-examination and the amount of material to be put to the witness; whether the ground had been raised or touched on in speeches to the court, the witness statement or other relevant places; and, in some cases, the plausibility of the notion that the witness might have satisfactorily answered the grounds."
The Board also cited, with approval, what Lord Hoffmann said in Biogen Inc v Medeva Plc  RPC 45, and adopted in Piglowska v Piglowski  1 WLR 1360, 1372:
'…[S]pecific findings of fact, even by the most meticulous judge, are inherently an incomplete statement of the impression which was made upon him by the primary evidence. His expressed findings are always surrounded by a penumbra of imprecision as to emphasis, relative weight, minor qualification and nuance…of which time and language do not permit exact expression, but which may play an important part in the judge's overall evaluation.'
"His Lordship conceded that there was no obligation to raise such a matter in cross-examination in circumstances where it is 'perfectly clear that (the witness) has had full notice beforehand that there is an intention to impeach the credibility of the story which he is telling'. His speech continued (at 72): 'All I am saying is that it will not do to impeach the credibility of a witness upon a matter on which he has not had any opportunity of giving an explanation by reason of there having been no suggestion whatever in the course of the case that his story is not accepted.'"
"First, where a witness' honesty is to be challenged, it will always be best if that is explicitly put to the witness…But what ultimately matters is that the witness has had fair notice of a challenge to his or her honestly and an opportunity to deal with it. It may be that in a particular context of a cross-examination which does not use the words "dishonest" or "lying" will give a witness fair warning. That will be a matter for the trial judge to decide."
"PRESENTING OFFICER: I am just going to set the scene a little bit because we have had a little bit of a break over lunch. The way that charge – the allegation – against you is pleaded is that either your formulation/your comments about B were false, and that is the questions that I have been posing to you so far, that there is no correlation between your formulation and your notes such that the formulation, I suggest, could be a construct; something that has arisen later. Do you understand that is what I am saying?
Dr. Lovett. I do understand your concern, absolutely.
Q. So that is that. The case is also pleaded in a way which leaves open to the Committee the possibility that they might consider – they need not – that the formulation and the terms you ascribe to the individuals was unjustified, so not based upon proper and sound reasoning.
A. Of course, I understand that."
(3): the Panel and the burden and standard of proof in relation to dishonesty
(4): The consideration of the evidence of Dr Lovett's alleged dishonesty
The third main issue: the fairness of the hearings and decision
(1) The absence of a party
"17. In my judgment, the principles set out in R v Hayward, as qualified and explained by Lord Bingham in R v Jones, provide a useful starting point for any direction that a legal assessor provides and any decision that a Panel makes under rule 31 of the Rules. Having said that, however, it is important to bear in mind that there is a difference between continuing a criminal trial in the absence of the defendant and the decision under rule 31 to continue a disciplinary hearing. This latter decision must also be guided by the context provided by the main statutory objective of the GMC, namely, the protection, promotion and maintenance of the health and safety of the public as set out in section I(IA) of the 1983 Act. In that regard, the fair, economical expeditious and efficient disposal of allegations made against medical practitioner is of very real importance.
18. It goes without saying that fairness fully encompasses fairness to the affected medical practitioner (a feature of prime importance) but it also involves fairness to the GMC (described in this context as the prosecution in R v Hayward, para 22(5)). In that regard, it is important that the analogy between criminal prosecution and regulatory proceedings is not taken too far. Steps can be taken to enforce attendance by a defendant; he can be arrested and brought to court. No such remedy is available to a regulator.
19. There are other differences too. First, the GMC represent the public interest in relation to standards of healthcare. It would run entirely counter to the protection, promotion and maintenance of the health and safety of the public if a practitioner could effectively frustrate the process and challenge a refusal to adjourn when that practitioner had deliberately failed to engage in the process. The consequential cost and delay to other cases is real. Where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed.
20. Second, there is a burden on medical practitioners, as there is with all professionals, subject to a regulatory regime, to engage with the regulator, both in relation to the investigation and ultimate resolution of allegations made against them. That is part of the responsibility to which they sign up when being admitted to the profession."
Appendix (1): The Panel's Final Decision
At , the Panel set out a few observations on its approach to the evidence. It had excluded from consideration evidence relating to particulars which were stayed or where there had been no case to answer. It drew no adverse inferences from the fact that Dr Lovett had not supplied a statement by way of re-examination but noted simply that it did not have whatever evidence it might have contained. It was for the HCPC to disprove any contention raised by Dr Lovett, for example in relation to non-disclosure of medical records. It would not speculate as to what that evidence might have been. It would not make a finding adverse to Dr Lovett unless there were reasonable and proper grounds for rejecting an alternative explanation. Although Dr Lovett had intended to call Professor Powell, he did not do so because his report was agreed by the HCPC, and the Panel thought that there were few differences between his views and those of Dr Halari, but to the extent they diverged the opinions of Professor Powell were to prevail.
The Panel expressed its views on the witnesses at :
"A and B: they are twin sisters and their presentation to the Panel had many similarities. They were articulate and self-confident … "with a strong air of the correctness of their interpretation of events", and doing their best to recount events to the best of their recollection, "the reliability of their testimony was compromised in two ways. First, the events in question had occurred over an 18 month period several years previously… at a time of great upset and upheaval [when they had] few reliable markers by which to fix particular events and issues and the passage of time had clearly taken its toll on the accuracy of their recollections of many details. They had to accept on occasions that they were mistaken. Second, both… had developed significant antipathy towards Dr Lovett. They made no attempt to hide this and made clear that their strongly held view was that Dr Lovett had exploited and cheated them, betraying the trust they had placed in him stop their recollection of interactions with Dr Lovett was coloured by this antipathy and his conduct always liable to a negative interpretation. Accordingly, when assessing their evidence the panel took great care in considering the extent to which it could be relied upon."
"Dr. Lovett. In assessing the credibility and reliability of Dr. Lovett, the Panel took into account his good character and that he is a well qualified and very experienced clinical psychologist. In the light of that professional background the Panel would have expected a clear, logical and reasoned defence of his professional views and conduct. In the event he presented quite differently. As will be seen when the Panel turns to explain its particular decisions, his evidence was frequently inconsistent, occasionally evasive and sometimes misleading. His decision making processes were opaque and his explanations for his conduct were confusing and unconvincing. Accordingly the Panel considered that his evidence has to be approached with caution and his explanations carefully scrutinised in terms of their plausibility and credibility."
The Panel opened its consideration of particulars 6 to 8, with a general discussion:
"16 In dealing with Particulars 6, 7 and 8 the Panel has considered each separately but, to avoid unnecessary repetition, explains its reasoning behind its finding looking at them together, as they are essentially linked. They are linked because the validity of the reasons put forward by Dr. Lovett for not providing the records to the G.P.s (particular 6) are essentially the same as the alleged false or unjustified statements subject of particulars 7 and 8. Thus it is not possible sensibly to disentangle particular 6 from either particular 7 or particular 8, and whilst it would be possible to deal with matters separately in relation to Service User A and Service User B, the material and issues to be considered are so similar that it would be unhelpfully repetitive to do so.
17 It is not disputed that, in the absence of a good reason or lawful excuse, Dr. Lovett was under a duty to provide the records requested and the crux of the case in this regard was whether Dr. Lovett had, or genuinely believed he had, any good reason or lawful excuse to withhold his notes, or to put conditions on disclosure of them. In determining this issue the Panel took as its basis for consideration, the test set out in the agreed expert opinion of Professor Powell [7/1074]:
"If I were asked whether it was reasonable for Dr. Lovett to refuse to disclose records direct to the clients, then I would say that I have never met any of the clients and cannot therefore express an opinion. It is for Dr. Lovett to explain why he would only release the notes under the supervised circumstances. That was Dr. Lovett's professional view, and it is for the Panel to decide (a) whether it was his genuine professional view and (b) whether they have sufficient evidence to say that his opinion was wrong…"
Accordingly, the Panel first considered "whether it was Dr. Lovett's genuine professional view", i.e. that he could only release the notes under supervised circumstances, as he told the G.P.s, and whether the reasons, which are the subjects of particulars 7 and 8, represented his genuine opinion.
"19. Dr. Lovett's evidence was essentially that he could not unconditionally disclose his notes because to do so would cause harm to the A and B. The reasons it could cause harm were that in both cases the notes contained a diagnoses of personality disorder which could cause distress and anger which, particularly in the case of someone with a personality disorder, could cause harm. He summarised his position in his evidence in chief when he said, "My fear was that these notes would be misunderstood; they would cause significant distress and harm in a situation which was volatile and changeable. And these particular, or , my particular...which I call "formulations" needed explanation". Dr. Lovett set out his concerns even more graphically in a letter to B's GP dated 5 March 2012. This letter was never sent, but Dr. Lovett stood by its contents as explaining his position. The letter made reference to features of "personality conditions…suffering with a mixed personality disorder showing features of both narcissistic personality disorder and borderline personality disorder", for all of which Dr. Lovett claimed in the letter there was substantial evidence, and which he said justified his concerns about disclosure.
20. Dr. Lovett also asserted unequivocally in his statement that, "Informing a client or patient that they suffer with a form of personality disorder requires specialist skill and knowledge. It is significantly different to diagnosing an anxiety disorder, depression or for that matter, PTSD…Given the circumstances, I had real concern for the impact that the entries in the notes might have on my former clients if they were simply to receive this material in the post without any support or explanation…I did, however, state that I would be prepared to provide them to a suitable healthcare professional…I had in mind a professional with an expertise in psychological care. I was anxious about providing them to a non-specialist such as a GP…"
21. In explaining how he came to this view, Dr. Lovett asserted that, despite previously, and for the overwhelming majority of the time that he interacted with A and B, having considered that they were both presenting with issues arising from post traumatic stress, anxiety or adjustment, he was prompted by events to review his opinions and create new formulations respectively, each of which included a diagnosis of personality disorder. Neither formulation was dated, and none of the material included therein had been discussed with either A or B. Dr. Lovett was unsure of when his change of opinion occurred, but suggested that, "It began to click around Spring , and certainly by the June time". In relation to the new formulation for B, he said, "I can't tell you the date. I know that it was made between…Towards the end of June and July ". It certainly appeared that it occurred after 22 April 2009 in relation to which he stated, "Whilst I was increasingly of the opinion that there may be some personality overlay at work with both [A and B], it is one of prioritising really. My view was still that this was the immediate stress and the demands of the environment and the family that was probably generating these problems and therefore that was still the most pressing clinical aspect to focus on".
22. In relation to A, Dr. Lovett claimed that the most significant event in his change of directions towards personality disorder was a session on 14 May 2009 when she presented as angry and upset by a newspaper article written by her brother-in-law. In relation to B, Dr. Lovett did not claim that there was any significant event which prompted his change of opinion towards his formulation and diagnosis of a personality disorder, but he implied that it arose from a review of material already in his possession which he had previously attributed to stress, anxiety or adjustment.
23. In refuting a suggestion based on the absence of any relevant references in his session notes, that his formulations and diagnoses of personality disorder had been subsequently constructed to justify his refusal to disclose his notes, Dr. Lovett referred to a note of a telephone conversation with his Instructing Solicitor, Ms JK. That call was dated 29 October 2008. Dr. Lovett noted that he, "Explained [to Ms JK] that both B and A present more like PD's and that extreme trauma can make underlying personality issues reemerge…"
24. Dr. Lovett's explanation for not having discussed any of the issues arising from his formulation and diagnosis of personality disorder with either A or B, was that the former was pregnant, and he considered that raising the issue with either of them could initiate an extreme reaction which could harm A.
25. In support of his diagnoses of personality disorder, Dr. Lovett referred to a number of occurrences of which he was aware and which he considered to exemplify the criteria for a diagnosis of personality disorder. These examples were that:
a. A and B had unrealistic expectations of others and failed to understand boundary issues. He referred to complaints from a member of staff at a care management company with which A and B were in dispute regarding its responsibilities towards another family member. He referred also to discussions he had had with his Instructing Solicitor on what appeared to be the same issue.b. A had expressed anger and resentment over a newspaper article written by her brother-in-law. He suggested that this was significant because it was a direct observation of behaviour that he had not seen before, but had been relayed to him, i.e. that described at a. above.c. A had emailed him on 8 December 2008 and this revealed that she had left a person for whom she had responsibility, an individual who 'lacked capacity', in charge of young children, but was concerned only that the person did not appreciate her needs. This was put forward by Dr. Lovett as an example of A showing serious misunderstanding of a vulnerable person's needs.d. B revealed that she had dismissed her housekeeper following an argument over her refusal to undertake wider responsibilities involving occasional childcare. She had become very angry on encountering the former housekeeper working in a charity shop. This was given as an example of "an increasing instability in her presentation".e. B had told him that she had fond memories of her childhood and being brought up in a mansion. This was suggested as an example of grandiosity.f. B had told him that she missed her husband who was away during the week at work. This was put forward as an example of 'a strong element of a sense of being abandoned'.g. B had expressed her anger regarding an Orthopaedic Consultant whom she saw as responsible for a Disability Living Allowance being disallowed, and that the family may launch a campaign against him.h. B experienced distress about her leg which had sustained a serious de-gloving injury in the index incident, and had thoughts of wanting to cut it off.i. People were very cautious around A at times, wanted to please her and were certainly worried if they antagonised her. This was given as an example of 'a grandiose sense of self-importance'.
26. However, as Dr. Lovett developed his evidence and attempted to clarify his reasoning he contradicted himself on a number of critical points. Significant examples in this respect occurred in both his examination in chief and in his cross-examination. The most significant contradiction was his subsequent assertion that in relation to B, the material which he had previously referred to as a diagnosis was not a diagnosis, but only a formulation. (See Dr. Lovett's witness statement). In relation to his formulation for B Dr. Lovett said in his examination in chief, "This was written as a reminder to me. It was me thinking out loud but writing it on the page to make a file note. In many respects I never saw this as actually part of B's notes, but once a problem had arisen, I simply couldn't remove it. It left me with an ethical dilemma." He was further asked in relation to that material, "Were you certain when you wrote those words down that that was what was fundamentally at issue with [B]?" His answer was, "Not at all...this was not a diagnosis of any kind…and certainly I have never conceptualised [B] or [A] as experiencing any more than a mild or moderate type of personality dysfunction". The issues previously put forward as a diagnosis of a personality disorder were then described on his behalf as "your tentative views on the traits in play".
27. These contradictions developed further in the evidence Dr. Lovett gave under cross-examination when he retreated almost completely from his earlier assertions that he had good reasons for believing that A and B had personality disorders. In relation to whether B could properly be said to have this "formulation NPD/Borderline mixed", he said, "I don't make the claim that necessarily they can be properly describe…I had no intention of actually working with [B] or [A] in terms of treatment of personality traits particularly because I'd got a relationship, I tried to do some initial assessment I think, and I think I would have needed to review matters at that point. The formulation…is very much a note to me because I knew that in fact I wouldn't be seeing [A] for a while…And for [B] the same in many respects because it would've been very, very difficult to have started to discuss such issues with [B]. Again, I'd n ever conceptualised these problems as really anything more that mild or moderate…" He then went on to describe the formulation in respect of B which had previously underpinned his "diagnosis" of narcissistic/borderline personality disorder as, "…it was actually a note to me that really wasn't a clinical note at all. It really was just my mental thoughts, my ideas put down that had we gone on I would've actually confirmed or disconfirmed. It wasn't a diagnosis and it wasn't a fixed formulation". He continued, "It wasn't an assessment, it was just some ideas. It was thoughts really that I was putting down on paper".
28. In the light of this shift in Dr Lovett's evidence about the nature of the material previously described by him as diagnoses of personality disorders, but subsequently described as just some thoughts or ideas put down on paper and, "not a clinical note at all". The Panel then examined Dr Lovett's explanation of why he had believed that a disclosure of his notes had required the inclusion of this material.
29. In his witness statement Dr. Lovett suggests, "What I could, and probably should, have done was to separate the notes from the diagnosis. In truth it was the diagnosis that was likely to be the part that would cause difficulty for [B] and [A] and it would have been possible to have disclose (sic) the notes but not the diagnosis. I believe that the notes (because they are my aide memoire to what was actually said) with some interpretation from me may have been upsetting but not such a focussed (sic) manner as the diagnosis itself" However, in his evidence in chief, referring to this material as it related to B he asserted "In many respects, I never saw this as actually part of [B]'s clinical notes, but once a problem had arisen I simply couldn't remove it. It left me with an ethical dilemma." In cross-examination when it was pointed out in relation to the same material that he had appeared to have treated similar material differently and removed it from his notes, Dr Lovett said, " I put this into the clinical notes, it was written, it wasn't an assessment, these were my thoughts and, therefore , when this case…. When we actually started to get the complaints I just felt ethically I couldn't remove it. I couldn't remove it. I just out it into the assessment part of my file. It wasn't an assessment, it was just some ideas. It was thoughts really that I was putting down on paper."
30. At another juncture of his cross-examination, Dr Lovett stated, "It has never been my practice to disclose information about my assessments of individuals, either to G.P.s or, for that matter, in legal matters…" He continued, in relation to not disclosing a visual formulation but considering that he had a duty to disclose a narrative formulation, "Because I actually saw this as distinct, and maybe incorrectly I saw this distinct and part of my assessment process and distinct from my clinical records such as…"
31. The Panel then considered whether in the light of all this evidence, it was Dr Lovett's genuine professional view that he was justified in not providing his notes to the service users and/or to their G.P.s for the reasons he gave. In coming to its decision on this question the Panel noted in particular the following points:
a. When his purported diagnoses of personality disorder in relation to both service users were examined, Dr Lovett denied that they were diagnoses and claimed that they were formulations, works in progress, potentially an alternative way of interpreting evidence which he had hitherto considered to be features of other psychological issues, such as adjustment to the aftermath of a traumatic event.b. When his formulation in relation to B was challenged, Dr Lovett retreated further, describing it variously as, "actually a note to me that really wasn't really a clinical note at all", and… it was just come ideas" and more in the same vein.c. The evidence put forward by Dr Lovett to support his contention that he was justified in either diagnosing or even formulating any form of personality disorder in relation to either A or B was entirely unconvincing. It appeared to the Panel that without gross exaggerations of the nature of the incidents to which he referred, those matters were all much more reasonably to be considered referable to the impact of the trauma and stress on the service users, in relation to which Dr Lovett's services had been engaged. The way in which it appeared to the Panel that Dr Lovett was prepared exaggerate and distort what seemed to relatively trivial matters was well illustrated by the matters referred to in paragraph 25 of this determination. Furthermore, the Panel took the view that Dr. Lovett's evidence was misleading on occasions, such as when asked if any of the examples he was using were "enduring" or pervasive" in nature, as would be required to raise a concern about a personality disorder, he said "….I thought that that may be the case, but I have no…I have no conclusive evidence by any means that that was the case." This was clearly misleading as he was implying that he had some, albeit not conclusive, evidence, and he must have known that he had no evidence at all.d. Dr. Lovett's evidence in relation to what, out of his records, he ought to disclose was incoherent and made no sense. He variously implied that he could have withheld the potentially harmful material even when he described it as diagnoses, but also indicated that, even when it qualified as no more than a few ideas and not necessarily even a clinical record, he felt it had to be disclosed.e. When originally asked for the clinical notes of B and A, albeit not by their G.P.s or other medical professionals, Dr. Lovett raised none of the concerns that he subsequently expressed. In fact, he stated in a letter that he would be pleased to provide them when his outstanding invoices were paid. He then entered into further correspondence to explain what he claimed he was owed. Although Dr. Lovett claims that this response was made on legal advice it begged the question of what information from Dr. Lovett any such purported advice was based on. In any event, had there been genuine reasons for believing that service users would be exposed to the risk of harm by the disclosure of records relating to them, Dr. Lovett would have been under a professional duty not to disclose the records whatever legal advice he was given.f. Dr. Lovett maintains that the risk of harm in disclosing his notes could only be properly addressed by providing them to "a suitable healthcare professional…I have in mind a professional with expertise in psychological care". This only makes sense if his notes included not only a diagnosis of a personality disorder, but some reasoned basis for such a diagnosis. It appeared to the Panel that even the best qualified professional with expertise in psychological care would not be able to provide any support or assistance to either A or B or their respective G.P.s. if presented with simply with "really just my mental thoughts, my ideas put down that had we gone on I would've actually confirmed or disconfirmed…". Dr. Lovett's assertion that this material needed to be released in a "safe and controlled manner" makes no sense in the light of his contentions that it did not amount do diagnoses and, in any event, had not been worked on, thought through, exemplified, or referenced to any of the session notes. This point is underlined, particularly with regards to B, by Dr. Lovett's agreement in cross examination that his contemporaneous written notes do not support in any way the formulation.g. If Dr. Lovett's claim is correct that his note of a telephone conversation with his Instructing Solicitor in October 2008 shows that he was already considering issues of personality disorder at that stage, and that, therefore, they could not simply be a device to justify non-disclosure, then he must be wrong to that these issues only "clicked" around Spring or Summer 2009. He would also have no basis on which to claim either that he felt it was inappropriate to broach the subject with either of A or B (A was not pregnant then), or that he had no real opportunity to start to try to "confirm or disconfirm" his "ideas".h. It was noted that although in his statement Dr. Lovett says, "…it appears to be [A]' belief that she only ever saw me on four (possibly five) occasions…my records show that I met with her on many more occasions that she recalls", in a leter to A's Solicitor on 11 October 2010 he states, "Whilst I saw[A] at her sister's house on many occasions, it is my opinion that there are only three appointments the (sic) represent clinical sessions with her." In that respect the opinion of Dr. Halari is relevant when she suggested that Dr. Lovett's contact with A was so limited that it would be "difficult" to come to his formulation of personality disorder. Dr. Halari was referring, of course, to the formulation as described in his statement rather than the significantly reduced version settled on by Dr. Lovett at the end of his oral evidence.i. Dr. Lovett's claimed concerns about personality disorders affecting either A or B are not supported by any of their health records gleaned from other professionals involved in their care, which were produced as a result of disclosure applications made by Dr. Lovett in advance of the commencement of the hearing. This lack of support is particularly apparent in relation to B, who appears to have been dealt with by a significant number of health professionals over the period before and after the tragedy at the root of this case. The only mention of personality issues comes from Dr. Cleare, a Psychiatrist whose report of his first assessment of B dated 28 December 2007 notes, "a degree of histrionic overlay, which likely relates to [B]'s pre-morbid personality" but who diagnosed a combination of Post Traumatic Stress Disorder and Major Depression."
32. Having carefully considered all those points the Panel has been persuaded that it was not Dr. Lovett's genuine professional view that he was justified in not providing his notes to A and B and/or to their G.P.s as alleged at Particulars 6(a) and 6(b). It was clear to the Panel that on his own evidence there was no justifiable basis on which he could have come to a diagnosis of any kind of a personality disorder in relation to either A or B. As such there was no justifiable basis on which he could have considered himself under an obligation to provide any information or documentation which included or implied such a diagnosis in any health records he had a duty to disclose. Having accepted that the formulations he provided were only ideas to explore, he must have known they could not make sense to any third party. They were effectively inexplicable and had no place in records to be shared with any other health professional. Thus Dr. Lovett had no good reason or lawful excuse not to provide the health records requested.
Particulars 6(a) and 6(b) are both proved
33. On the same basis and for the same reasons, the Panel also found proved the particulars at 7(a), 7(b) and 8 in so far as they related to the allegation that Dr. Lovett's statements to the G.P.s were unjustified. The Panel has interpreted the wording of the allegation in 7(a) as linked to failure to provide the health records subject to particular 6 as that is clearly its import, that is how it has been presented and that is how it has been defended. To do otherwise would make a nonsense of particular 7(a) as it would be trite to suggest that a service user has "underlying psychological problems" if they are engaged in therapy with a Clinical Psychologist.
34. In further considering particulars 7(a), 7(b) and 8 as to whether the statements were false i.e. whether Dr. Lovett knew they were not true when he made them, the Panel considered whether there could be some other explanation for his conduct, such as simply a mistaken belief in the validity of his formulation of personality disorder. However, the Panel rejected that possibility for several reasons. First, it is very difficult to reconcile with Dr. Lovett's initial response to the request for his records which was to say that he would be pleased to disclose them subject to payment of his outstanding invoices. Second, it is impossible to reconcile with the content of his draft letter to Dr. Cross of 5 March 2012, which although not sent was adopted by Dr. Lovett as valid when he gave his evidence in chief. In that letter Dr. Lovett makes extensive claims about the presentation of B which involve gross distortions of relatively trivial matters so as to exemplify his claimed diagnosis of personality disorder. This was no accident or oversight but a clearly false picture. Third, Dr. Lovett is a highly qualified and very experienced Clinical Psychologist for whom such a mistake simply not credible."
Particulars 7(a), 7(b) and 8 are proved in relation to making false and unjustified statements
Mr Grant also referred to the following passages in the Panel's decision on misconduct:
"The Panel first considered the matters dealt with in Particulars 6(a) and 6(b), the failures to provide the Service Users and their GPs with copies of their health records. The Panel has found the Dr. Lovett had no good reason not to provide the records as requested, he had no basis on which to set the conditions he laid down for their provision, and it was apparent from the evidence of both Service Users that his failure to provide the records caused them significant concern. Whatever the basis for the Service Users' earlier concerns about Dr. Lovett's conduct, his prevarication over the provision of their helath records further undermined their trust in him. Even without the seriously aggravating feature of the false and unjustified statements Dr. Lovett made in the context of h is refusal to provide the records, it is the Panel's view that his failures to provide the records as requested were serious professional failings and breaches of the following standards of the HCPC Standards of Conduct, Performance and Ethics Committee:…
The Panel was aware that breach of the standards alone does not necessarily constitute misconduct. However, the Panel was satisfied that Dr. Lovett's behaviour fell far below the standards expected of a registered Practitioner Psychologist. Whatever Dr. Lovett's motive for his refusal to provide the records, it caused upset to the Service Users and was clearly not in their best interests. In compliance with the requirement to communicate properly and effectively with service users and other practitioners, Dr. Lovett should have promptly provided the health records as requested, having exercised appropriate professional judgement in relation to what he should responsibly include therein.
Dr. Lovett's failings in this regard were serious and would be regarded as deplorable by fellow professionals. The matters found proved at Particulars 6(a) and 6(b) amount to misconduct.
The Panel then gave consideration to the same question in relation to its findings on Particulars 7 and 8. These findings are that Dr. Lovett made the relevant statements without justification and knowing them to be wrong. The mischief of these statements was not simply what was said on the face of the documents but that they directed the reader to purported diagnoses on which they were based. These purported diagnoses of personality disorder, narcissistic/borderline/mixed, were inevitably extremely distressing to the Service Users to whom they related. Dr. Lovett's conduct was deliberate and it is apparent that it caused considerable anguish to both Service Users. Dr. Lovett had a good knowledge of these Service Users, he knew of their vulnerabilities and he must have known what sort of impact on them his statements were likely to have. It is the view of the Panel that his conduct in this regard and in relation to each particular amounts to a very serious breach of Standards 1 and 7 (above) of the HCPC Standards of Conduct, Performance and Ethics Committee…"
Appendix (2): Anonymity
At the outset of the Panel hearing in November 2013, anonymity for A and B was considered. They did not in fact ask that any part of the evidence concerning their medical conditions be heard in private. The Panel had no power to order anonymity in relation to evidence heard in public; it decided that it would judge when evidence should be heard in private, which it did on a number of occasions, including some of those in which the issue of personality disorders arose. Its published decisions however refer to "service users A and B", whom I have referred to as A and B.
At the outset of the appeal, Mr Grant asked that I should lift an order protecting the identity of A, B and C made by Choudhury J on 30 November 2017 in connection with an unsuccessful application for permission for Dr Lovett to call evidence for the appeal that was not before the Panel. Mr Grant identified a particular aspect of the public interest involving the actions of A's husband. I maintained the order because the interests of C, and A and B's children, needed to be protected; this was not an appropriate case for any part of the hearing to be in private; and the judgment would need to refer to the personality disorders which it was said by Dr Lovett that A and B might have, in order for the basis of the Panel's findings, and this Court's decision on the appeal to be understood. This was obviously an important case for Dr Lovett, for A and for B, but in view of the particulars, findings and consequences, it was also important for the public that the reasons why Dr Lovett was struck off, or, having been struck off, was successful in his appeal, should be public. I could think of no way of achieving those various ends, other than by anonymity, as ordered by Choudhury J. I add that, towards the very end of the appeal hearing, I received a written request from a BBC journalist that anonymity be lifted. After hearing from the parties briefly, but not from A or B, I replied saying that if a media organisation wished to make an application for the lifting of that order, it could do so, if it thought fit, in the light of the judgment after its delivery.