General Medical Council, R (on the application of) v Stevenson

MR JUSTICE SILBER: The General Medical Council seeks an order pursuant to section 41A(6) and (7) of the Medical Act 1983 to extend the interim order of suspension, initially made on 9 March 2005 against Dr Michael Stevenson ("the defendant"), for a further period of 12 months from 7 September 2007. The present order for suspension expires tomorrow.

It is common ground between counsel that there has to be an extension. It is said by Ms Lambert on behalf of the defendant that it should only be for a period of six months, while Mr Colman on behalf of the General Medical Council says that it should be for a period of 12 months.

This doctor came to the attention of the General Medical Council when the North Cumbria Primary Care Trust wrote to them in February 2005 saying that they had suspended Dr Stevenson from their performer's list following the high administration of diamorphine resulting in the death of one patient suffering from migraine headaches and injury to other persons. The defendant was subsequently charged with the manslaughter of the patient who died, Mrs Margorie Wright, and on 18 April 2007 at the Preston Crown Court, he pleaded guilty and was sentenced to a term of imprisonment of 15 months which was suspended.

There was also evidence that shortly after administering the high level diamorphine to Mrs Wright, he also injected too much and too quickly to another patient, without having also again, as in Mrs Wright's case, an appropriate antidote.

The conviction of Dr Stevenson has been referred for a substantive hearing before a Fitness to Practise Panel of the General Medical Council. A date for that hearing has not yet been set.

A further development occurred in the summer of this year when, as a result of a police investigation into Dr Stevenson's prescribing and treatment of patients, a number of new cases were identified for further investigation and analysis by medical experts. Information in respect of those cases was sent to the General Medical Council under cover of a letter of 21 June 2007, which enclosed the expert witness reports commissioned by the Cumbria Constabulary. I should say that no charges have been brought against Dr Stevenson in respect of these matters.

As a result of the information that has been supplied, the General Medical Council has opened a new and separate inquiry to consider Dr Stevenson's role, if any, in the death of a further 14 patients. It is explained that these investigations will involve an in-depth analysis by investigation officers of the GMC, and by medical experts instructed on behalf of the GMC, so that the GMC's case examiners would then have sufficient information to determine whether allegations in respect of these additional cases should be heard before a Fitness to Practise Panel. Those cases would be additional to the matter covered by the conviction for manslaughter recorded against Dr Stevenson and to which I have already referred.

In August of this year, Dr Stevenson's lawyers were told of these further inquiries. The basis of the request for the extension of 12 months is first to ensure that the public would remain protected during the time that it would take for the General Medical Council to complete its investigation into these 14 further cases, referred to it by the Cumbria Primary Care Trust, and second for the case examiners of the General Medical Council to make their decision as to whether to refer the allegations against Dr Stevenson for a substantive hearing. There would also be the need, according to the evidence of the General Medical Council, that if referral took place, for sufficient time to be allowed for the GMC to prepare its case and for Dr Stevenson's legal representatives to prepare his defence as well as for the substantive hearing to take place.

On that basis, the General Medical Council ask for the interim order of suspension to be for a further 12 months from 7 September 2007. As I have explained, the case for Dr Stevenson is that the appropriate period for an extension should be six months. It is explained that there is evidence that he resides in a psychiatric hospital, "The Retreat" in York, and that evidence has been adduced about his psychiatric history. He accepts that his medical career is over. He acknowledges that compulsory erasure is the only appropriate sanction in respect of his negligence leading to the death of Mrs Wright.

Evidence has been put in by Dr Andrea Brown, a consultant psychiatrist, who explains that allowing the GMC proceedings to become protracted by a further 12 months could potentially have a deleterious effect on his mental state as he is recovering from the depression that he had suffered. It is also explained that he had been suicidal previously, and there is a risk that he may become so again in the future should he become severely depressed. The view of Dr Brown is that it would be in Dr Stevenson's best interest if the issues before the General Medical Council could be resolved with minimal delay.

It was said by Ms Lambert on behalf of the defendant that the extension that is sought could only be justified on the basis of the need to provide protection over a period which would include a substantive hearing in the event of a case examiner referring the matter forward. It is said that it cannot be predicted whether such referral would take place. An extension which covers referral forward, she says, is premature.

My attention has been drawn to the report of Dr Hugh Reeve, which was prepared for the Cumbria National Health Service Primary Care Trust. It refers to 11 cases in which Dr Reeve has found gross negligence on the part of Dr Stevenson in connection with the injection of diamorphine and midazolam. In many of those cases he says that this is likely to have accelerated death. He also says that the standard of Dr Stevenson's record keeping during the last period of the life of these patients was in many cases unacceptable. It would seem to me to be reasonably likely that the case examiners might or will refer the allegations in many if not all of these cases for a substantive hearing.

The point on which Ms Lambert attaches substantial importance is that no account has been given by the General Medical Council as to what investigations have taken place since it received the copies of the reports from the Cumbria Primary Care Trust on 21 June 2007. She expresses a concern that there might be further delay in the investigation by the General Medical Council. I consider that there is some validity in her submission.

Mr Colman points out that the General Medical Council cannot be expected to set out step by step as to what they have actually done in order to carry out inquiries. Nevertheless, there is a very noticeable absence of any information about what steps, if any, which have been taken to pursue the investigation into these cases and to provide information which would become of value for the GMC's case examiners.

In my view, there should be an extension of the period. Doing the best I can, I come to the conclusion that an extension of nine months would be appropriate. I do this in the knowledge that Dr Stevenson's solicitors could apply for a discharge if they have reason to believe matters are going too slowly. The only problem for the General Medical Council is that it might become necessary for them to seek a further extension and that might cost some money. It seems to me I have to reach a balance. The balance I arrive at, taking all factors into account, is an extension of nine months, which takes the suspension up to 6 June of next year.

Thank you both, very much, for your submissions.

MS LAMBERT: My Lord, there is the issue of costs.

MR COLMAN: My Lord, there is. There are applications on both sides. My learned friend was prepared to concede six months. We asked for 12. Your Lordship has found somewhere in between. I do not know whether your Lordship thinks in those circumstances that costs should lie where they fall.

MR JUSTICE SILBER: My provisional view is no order as to costs.

MS LAMBERT: It is difficult to see that that does not have a certain compelling logic.

MR JUSTICE SILBER: It does have logic?

MS LAMBERT: It does have a logic.

MR JUSTICE SILBER: Thank you both for your help. I am very grateful.

MR COLMAN: Would your Lordship's associate be assisted by a draft order?

MR JUSTICE SILBER: If you could do a draft order that may be appreciated. I do not think it is going to take you too long to draft. Thank you.