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IN THE COURT OF APPEAL CRIMINAL DIVISION ON APPEAL FROM THE CROWN COURT AT READING (HER HONOUR JUDGE CAMPBELL) (43SW03411620) CASE NO:202403923 B4 Neutral Citation Number: [2025] EWCA Crim 1625 |
Royal Courts of Justice
Strand
London
WC2A 2LL
Before:
LADY JUSTICE ANDREWS
MRS JUSTICE CUTTS
MRS JUSTICE THORNTON
REX
v
STEPHEN RONALD COX
(The Sexual Offences (Amendment) Act 1992 applies)
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Computer Aided Transcript of Epiq Europe Ltd,
Lower Ground, 46 Chancery Lane, London WC2A 1JE
Tel No: 020 7404 1400; Email: rcj@epiqglobal.co.uk (Official Shorthand Writers to the Court)
_________
Non-counsel (conviction)
MR MICHAEL RAWLINSON appeared on behalf of the Appellant (Sentence)
MR CHRISTOPHER HEWERTSON appeared on behalf of the Crown
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JUDGMENT
MRS JUSTICE THORNTON:
The provisions of the Sexual Offences (Amendment) Act 1992 apply to these offences. Under those provisions, where an allegation has been made that a sexual offence has been committed against a person, no matter relating to that person shall during that person's lifetime be included in any publication if it is likely to lead members of the public to identify that person as the victim of that offence. This prohibition applies unless waived or lifted in accordance with section 3 of the Act.
Introduction
The appellant appeals, with leave, against a sentence of 22 years' imprisonment, following conviction for twelve counts of indecent assault. He is represented in this respect by counsel Mr Rawlinson.
The appellant also renews his application for leave to appeal his convictions, following refusal of the leave by the single judge. He has represented himself for these purposes.
Facts
The appellant was a GP in a practice in Berkshire in the 1980s and 1990s. Complaints were made about his conduct during examinations of young women. Thames Valley Police issued a press release about the subject matter of the complaints, and the appellant stood trial in February 2023 on an eight-count indictment alleging indecent assault against six women. He was found not guilty on one of the counts and the jury could not agree on the remaining seven counts. They were discharged.
Following a further press release issued by Thames Valley Police at the conclusion of the first trial, the appellant was retried on a sixteen-count indictment in October 2024. The counts all alleged indecent assault contrary to section 14(1) of the Sexual Offences Act 1956, which was the legislation in force as at the dates of his conduct.
The counts may be summarised as follows:
Counts 1-9 concerned one woman aged 23-24 at the time of the offending against her and who we shall refer to as C1. The counts spanned five separate incidents which occurred when C1 went to visit her GP. The conduct included the appellant touching her breasts and pressing his penis against her body. Count 4 alleged the appellant had put his fingers into her vagina, which would be charged as assault by penetration if it occurred today.
Counts 10, 11 and 12 concerned three women: C2, aged 20; C3, aged 30; and C4, aged 19-20. The conduct alleged included the appellant touching their breasts and nipples.
Count 13 concerned a very young woman, no more than 14 years old. The alleged conduct involved the appellant stroking her thigh and asking for a cuddle and rubbing her back.
Counts 14 and 15 concerned a sixth woman and alleged the appellant had touched her nipples and pressed his erect penis against her hand.
Count 16 concerned a seventh woman, in her late 20s, and concerned the appellant putting his fingers in her vagina, which, as with count 4, would be charged, if carried out today, as assault by penetration.
At trial the Prosecution case was that the appellant had used his position as a GP to sexually assault seven female patients under the guise of routine medical examinations. In support of its case the prosecution relied on:
The evidence of the women (both live and by way of ABE interview).
Evidence from family members of the women.
the expert evidence of a GP who gave evidence about the general course of breast and vaginal examinations and an assessment of the accounts given by each of the complainants.
The defence case was denial that the events complained of had occurred. In relation to C6 the defendant relied on an alibi, stating that he was away from the practice on the date of the alleged examination. The appellant gave evidence. The appellant relied on the expert evidence of a GP who was broadly in agreement with the prosecution's expert in relation to the circumstances and manner in which certain examinations should take place.
In relation to counts 7, 8, 12, 13 and 14, it was agreed that there was no medical justification for what was alleged to have taken place and the issue for the jury was whether or not the appellant behaved in the manner alleged.
In relation to counts 4, 5, 6, 10, 11 and 15, the issue for the jury was whether or not each of the examinations conducted was clinically justified, or whether it took place in circumstances that were indecent, and if so whether the appellant intended to commit an indecent assault.
In relation to count 16, the issue for the jury was whether or not the appellant was the doctor who conducted the examination.
At the end of the trial the appellant was convicted on counts 4-8 and 10-16. He was acquitted on counts 1, 2, 3 and 9.
Sentence
In sentencing the appellant, the trial judge said that the convictions demonstrated a gross breach of trust on the part of the appellant. Doctors are amongst the most highly respected and trusted members of our society. The convictions strike at the heart of everything the medical profession stands for. She said that the appellant had picked his victims carefully - they were vulnerable or young. She detailed the experience of each of the women and their account of the impacts of the offending.
Turning to the relevant Sentencing Guidelines, she reminded herself that she was obliged to sentence in accordance with the maximum sentence at the time of the offending, which for all counts was 10 years, but to do so by measured reference to the guidelines currently in force. She directed herself in this regard by reference to R v H and Others [2011] EWCA Crim 2753.
For counts 4 and 16, the appropriate categorisation in the relevant guideline (assault by penetration) would be 2A, with a starting point of 8 years and a range of 5-13 years.
In relation to counts 5, 6, 7, 8, 10, 11, 12, 13 (where there was particular vulnerability as a child) 14 and 15, the appropriate categorisation was 2A, with a starting point of 2 years and a range of 1-4 years.
The judge considered it would be double counting to aggravate the starting point by virtue of particular vulnerability. She acknowledged there were no relevant previous convictions and concluded there was very little mitigation. She referred to the need to have regard to totality.
In relation to C1, the total sentence would be 11 years. This would be comprised of 8 years on count 4. On count 5, 3 years concurrent sentence. Count 6, 3 years consecutive sentence. Count 7- 2 years concurrent sentence and Count 8 -2 years concurrent. years concurrent.
For counts 10-15 there would be a sentence of 3-years, to be served consecutively.
On count 16 there would be a sentence of 8 years, to be served consecutively. Making a total of 22 years.
Grounds of appeal
Sentence
In relation to sentence, the grounds of appeal are that:
The judge erred in making the sentence on count 6 consecutive to the sentence on count 4. These were a series of offences of the same or similar kind, committed against the same person.
The starting points adopted by the judge were too high when taking into account the maximum sentence available at the time, the current guidelines and the consecutive sentences imposed.
The judge failed to have sufficient regard to the principle of totality generally and imposed a total sentence which was not just or proportionate.
As we have said, leave to appeal was granted by the single judge.
Before us today in oral submissions the grounds of appeal have been developed by Mr Rawlinson, who submitted that:
Where consecutive sentences are imposed there ought to be a downward adjustment, and that was not done in this case. A flawed approach was adopted to the starting point for counts 4 and 16 in failing to scale down to reflect the increased modern sentence, and in circumstances where consecutive sentences were imposed on these two counts. The guideline was applied in too mechanical a manner.
Imposing consecutive sentences in respect of the same victim -C1- was wrong in principle because they were the same victim and the judge had already adopted an overly inflated starting point for the most serious offence against that complainant.
The judge made no reference to the undisputed fact that C1, in respect of whom a sentence of 11 years was imposed, continued to go back to see the appellant for many years and for a number of other appointments. A sentence of 8 years against this lead complainant could not be criticised.
In relation to the other counts, the judge did not explain why she took an inflated starting point and effectively double counted the aspect of the breach of trust already reflected in the category 2A categorisation. Some of the incidents were relatively brief and at least partially resembled a genuine medical examination.
The sentence was manifestly excessive given the historic nature of the offences; the passage of time, and a sentence in the region of 15 years could not be criticised and would be just and proportionate.
In relation to conviction, the grounds of appeal may be summarised as follows.
The jury did not follow the judge's directions on how they should assess the evidence in relation to each count on the indictment. In each case, they did not properly consider whether the indictment referred to an offence that may or might have been doubted and the charges were not proved beyond reasonable doubt. Examples of this are said to be:
Where it was tangibly possible, if not probable, that the event did not occur on a day that the applicant was present, despite the doubts shed on the alibi document by the prosecution (as in the matters concerning C7).
Where there was no documented event during early pregnancy and where there is a clear probability of confusion of consultations (as in the matters concerning C1).
Every other charge on the indictment was shown by the applicant's evidence to have an explanation that the examination was reasonable, plausible and unmotivated or was reassurance. These explanations may not constitute proof but surely are sufficient to show reasonable doubt.
The not guilty verdicts in relation to counts 1-3 undermine the reliability of C1 as a witness and showed that the jury gave inconsistent verdicts in relation to the allegations concerning C1.
The jury mistakenly applied the civil standard of proof to all of the allegations, rather than the high level of proof needed in historic cases where there is
No tangible evidence of any forensic kind except for concurrent notes and very little witness evidence of any relevance,
A consistent defence, either of good medical practice, or of misinterpretation.
It cannot be acceptable for a conviction to be based on testimony alone when that testimony can be seen to be unreliable and has been reliably contradicted or is not supported by concurrent notes.
Leave was refused by the single judge and is renewed before us. In considering this renewed application we have considered all the relevant correspondence.
Discussion
In sentencing for historic sex offences, the offender must be sentenced in accordance with the sentencing regime and practice applicable at the date of the sentence. The particular circumstances in which the offence was committed, and its seriousness must be the main focus. The fact that a court will reflect modern attitudes to such offences in its sentencing is of no consequence. Any sentence must be limited to the maximum sentence available at the date of the commission of the offence but otherwise it is wholly unrealistic to attempt to assess what the sentence would have been at the time. There should be measured reference to modern sentencing guidelines. Where the maximum sentence at the time of offending was lower than at present, then the starting point and category ranges have to be adjusted in a measured way to reflect the lower maximum sentence at the time: R v H [2011] EWCA 2753 at (47) and R v Forbes [2016] EWCA Crim 1388.
In relation to totality, as the sentencing guidelines make clear, when sentencing for more than one offence the overall sentence should reflect all of the offending behaviour and be just and proportionate. Whether a judge has applied totality is a question of substance and not form. The purpose of totality is to ensure that the final sentence is just and proportionate. On an appeal, this court should be able to identify whether a sentence is just and proportionate from a judge's recitation of relevant facts and aggravating or mitigating circumstances and from an assessment of how this is calibrated against the guideline: R v Bailey [2020] EWCA Crim 1719.
Counts 4 and 16 were the most serious offences. The particular vulnerabilities of the complainants in these two counts and the significant abuse of trust were appropriately categorised as 2A under the current guidelines, as was agreed by counsel at the time, with a starting point of 8 years for each offence and a range of 5-13 years. It was submitted that the judge should have scaled down the 8-year starting point in the Assault by Penetration Guidelines in order to reflect the greater maximum sentence for the modern offence. However, the judge acknowledged the principle of a scaled reduction in her remarks but explained that she had declined to scale down the starting point because of the high degree of trust in a doctor-patient relationship which would have led to her taking an increased starting point in any event. There is no error of principle in this regard.
Counts 4 and 16 were committed 7-9 years apart against different women and the judge was therefore entitled to impose consecutive sentences. The sentences on each count remained below the 10-year maximum applicable at the time of the offending.
It is submitted on behalf of the Appellant that the judge should not have imposed a sentence on count 6 consecutive to the sentence on count 4 because these were a series of offences of the same or similar kind, committed against the same person. Even if this could be said to be the case, the sentence on count 4, which was the most serious offence against C1 (assault by penetration) required an uplift to reflect the other action of the defendant on that occasion and his conduct over a 2-year period during two other visits to the surgery by the complainant. This particular complainant was particularly vulnerable, having been in a women's refuge following an abusive relationship.
There are different ways in which the sentence could have been structured. As the single judge said when granting leave, the core issue is the third ground, namely the aggregate sentence and whether or not it was just and proportionate.
The sentencing judge had presided over two trials of the appellant and was well placed to form the assessment required as to a just and proportionate sentence.
We recognise that this is a long sentence, but it is not manifestly excessive. This was shocking offending over nearly a decade, involving twelve indecent assaults of seven of the appellant's patients by their GP. It was repeated behaviour for sexual gratification and involved a high degree of breach of trust of women who were often especially vulnerable and involved digital penetration of the vagina in two instances. By rubbing his penis (albeit through clothing) against those he assaulted, there was an additional element of humiliation. The consequences for the victim were understandably often serious and lasting. One of the victims was no more than 14 years old.
Appeal against Conviction
In refusing leave to appeal against conviction, the single judge gave the following reasons:
"Rightly, you do not appear to suggest that the Judge erred, in respect of her summing up (described by your own Counsel as a 'model of fairness, balance and clarity') or in any other way. However, you submit that the jury did not follow the Judge's clear directions by (e.g.) failing to assess the specific evidence relating to each count, applying the civil (not criminal) burden of proof, and convicting in the face of a consistent defence and the evidence.
However, there is no basis for such an assertion. The jury were entitled to accept the evidence of the complainants and not your version of events. There is no basis for suggesting that they adopted the civil burden of proof in the face of the clear direction of the Judge to apply the criminal standard. They were equally entitled to conclude, on all the evidence, that some of the counts relating to the complainant C1 were proved and some were not. They were entitled not to accept your alibi evidence in relation to Count 16, on the basis that that evidence was not conclusive.
In short, all the matters you raise were matters for the jury. The jury clearly took their task carefully and thoroughly, and approached it with due diligence. They deliberated for four days before finding you guilty on most counts, but not guilty on some. The verdicts were by a majority. The assertion that they were not true to their oath, or that your convictions are in some other way arguably unsafe, is wholly without merit."
We agree and have nothing further to add.
Given our views on the merits of this application, it is unnecessary for us to consider the application for an extension of time.
Decision
For the reasons given above, the appeal against sentence is dismissed. The renewed application for leave to appeal conviction is refused, as is the application for an extension of time in which to renew the application.
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