FITNESS TO PRACTISE PANEL 2 AUGUST 2010 - 3 SEPTEMBER 2010 Regents Place, 350 Euston Road, London NW1 3JN

Name of Respondent Doctor: Registered Qualifications: Area of Registered Address: Registration Number: Type of Case: Dr Theodore SOUTZOS MB BS 1990 University of London London 3453728 New case of impairment by reason of misconduct. Ms E Samupfonda, Chairman (Lay) Mr M Chapman (Lay) Mr S Galbraith (Medical) Dr A Vaidya (Medical) Mr D Smith Mr I Dennehey

Panel Members:

Legal Assessor: Secretary to the Panel:

Representation: GMC: Miss Sarah Plaschkes, Counsel, instructed by GMC Legal. Doctor: Dr Soutzos was present and was represented by Mr Stephen Climie, Counsel, instructed by Berrymans Lace Mawer, Solicitors. ALLEGATION That being registered under the Medical Act 1983, as amended, Patient A 1. Between January 1999 and December 1999 you worked as a Specialist Registrar in Psychiatry at Guys Hospital, London; Found Proved 2. From January 1999 until December 1999 you treated Ms A at the Maurice Craig Ward at St Guys Hospital; Admitted and Found Proved 3. Ms A was a vulnerable patient; Admitted and Found Proved 1

4. Between January 1999 and December 1999 you pursued and/or established an improper emotional and sexual relationship with patient A, in that, Found Proved a. On 6 March 1999 you met Ms A at the National Gallery, Found Proved b. On 11 March 1999 you told Ms A that you had previously had other borderline girlfriends, Found Proved c. On 14 March 1999 you met Ms A at the Tate Gallery, Found Proved d. On 20 March 1999 you, i. met Ms A at the National Gallery, Found Proved ii. took her swimming, Found Proved iii. took her to your flat, Found Proved iv. hugged her, Found Proved e. On 21 March 1999 you, i. met her at the Tate Gallery, Found Proved ii. took Ms A to her flat, Found Proved iii. outside the hospital you told Ms A to give you a strong signal and she rubbed your crotch, Found Proved f. On 25 March 1999 you offered to cook dinner for Ms A; Found Proved

5. On 26 March 1999 you had sexual intercourse with Ms A; Found Proved

6. In April 1999 you tried to prevent Ms A from informing anyone of your relationship, Found Proved a. You told her that it would destroy your career if anyone found out, Found Proved b. You told her that it would kill your mother, Found Proved c. You told her to lie about your relationship; Found Proved 7. On 29 April 1999 you tried to conceal evidence of your relationship by asking Ms A to hide her telephone records; Found Proved 8. On 9 February 2001 after you learnt that Ms A had told the Medical Director of your relationship, Found Proved a. You told her to retract the information, Found Proved b. You told her that unless she retracted the information your career would be destroyed, Found Proved c. You told her that she would kill your mother unless she retracted the information; Found Proved 9. Your conduct as set out in paragraphs 4. 8. above was, a. Inappropriate, Found Proved b. An abuse of your position of trust, Found Proved c. Liable to bring the medical profession into disrepute; Found Proved

Patient B 10. You worked as a Consultant Psychiatrist at the Bowden House Clinic in Harrow; Admitted and Found Proved 11. Between August 2003 and May 2005 you treated Ms B, a vulnerable patient; Admitted and Found Proved 12. Between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with patient B, in that, Found Proved a. You sent her inappropriate text messages, Found Proved b. In September 2003 you invited her out for dinner, Found Proved c. In September 2003 , i. you met her at the National Gallery, Found Proved ii. you took her out to tea, Found Proved iii. you hugged her, Found Proved d. In August 2004 you invited her to stay with you in Greece, Found Proved e. In 2006 you invited her out for a drink, Found Proved f. On 14 October 2006, i. you met her for dinner, Found Proved ii. you hugged her, Found Proved iii. you kissed her; Found Proved 4

13.

Your conduct as set out in paragraphs 12. above was, a. Sexually motivated, Found Proved b. An abuse of your position of trust, Found Proved c. Liable to bring the medical profession into disrepute; Found Proved

Patient C 14. Between 18 November 2004 and 11 March 2008 you held practising privileges at the Priory Hospital in Roehampton, London; Admitted and Found Proved 15. From August 2006, you treated Ms C, who was a vulnerable patient; Admitted and Found Proved 16. From August 2006 you pursued and/or established an improper emotional and sexual relationship with patient C, in that, Found Proved a. You invited her to go swimming, Found Proved b. You invited her to visit the Tate Modern; Found Proved 17. In October or November 2006 you embarked upon a sexual relationship with Ms C which lasted approximately six months; Admitted on the basis that at the time Ms C was no longer your patient. Found Proved as alleged on the basis that at the time Ms C was your patient. 18. In a letter dated 22 October 2006 to Ms C's General Practitioner you stated that, Admitted and Found Proved a. You had reviewed the patient over the telephone, Admitted and Found Proved b. You had reviewed her earlier than scheduled at her request, Admitted and Found Proved

c. You had offered her further follow up but she said there is no need; Admitted and Found Proved 19. In a letter dated 20 November 2006 to Ms Cs General Practitioner you stated that you had started a personal relationship with Ms C after her recent discharge from your out-patient clinic; Admitted and Found Proved 20. In a letter dated 11/12/2006 to Ms C's General Practitioner you stated that you had started a personal relationship with Ms C after her recent discharge from your out-patient clinic; Admitted and Found Proved 21. On 13 February 2008 you tried to conceal the details of your relationship with Ms C, you telephoned her and, Found Proved a. Asked her to help you, Found Proved b. Told her unless she did help, you were finished, Found Proved c. Told her to say that you were no longer her psychiatrist when the relationship started; Found Proved 22. On 15 February 2008 at a meeting with the Hospital Director you stated I have never had a relationship with a patient; Admitted and Found Proved 23. Your conduct as set out in paragraphs 16. 21. above was, a. Inappropriate, Found Proved b. An abuse of your position of trust, Found Proved c. Liable to bring the medical profession into disrepute; Found Proved 24. Your conduct as set out in paragraphs 18. and 22. above was dishonest; Found Proved

Breach of Conditions of Registration 25. From 8 April 2008 your registration was subject to the following conditions imposed by the Interim Orders Panel of the General Medical Council; Admitted and Found Proved 26. (1) a. You must confine your medical practice to posts in Psychiatry where your work will be supervised by a named Consultant Psychiatrist. Admitted and Found Proved (8). You must inform the following parties that your registration is subject to the conditions, listed at (1) to (7) above, Any organisation or person employing or contracting with you to undertake medical work.; Admitted and Found Proved 27. By letter dated 30 June 2008 Xxxx Xxxxx, a solicitor at Xxxxx, Xxxx and Xxxxx Solicitors instructed you to prepare a medical report on Ms D and informed you that the firm would meet your fee; Admitted and Found Proved 28. You failed to inform Mr Xxxxx that your registration was subject to conditions; Admitted and Found Proved 29. Your conduct set out in paragraph 28. above was, a. In breach of the conditions imposed upon your registration by the Interim Orders Panel, Found Proved b. Dishonest, Found Proved c. Liable to bring the medical profession into disrepute; Found Proved 30. Between September 2008 and December 2008 whilst working as a Consultant Psychiatrist you had a number of private consultations at 10 Harley Street, London with patient E, a seven year old boy; Admitted and Found Proved

31. You failed to inform patient Es mother that your registration was subject to conditions; Found Proved 32. Your conduct set out in paragraph 31 above was, a. In breach of the conditions imposed upon your registration by the Interim Orders Panel, Found Proved b. Dishonest, Found Proved c. Liable to bring the medical profession into disrepute; Found Proved And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct. Found Proved Determination on the Facts Dr Soutzos, Your case has been considered by a Fitness to Practise Panel applying the General Medical Council (Fitness to Practise) Rules Order of Council 2004. On your behalf, at the start of the hearing, Mr Climie admitted a number of the facts alleged as follows: paragraphs 1 (subject to clarification regarding your actual grading at the relevant times); 2; 3;10; 11; 14; 15; 18 in its entirety; 19; 20; 22; 25; 26; 27; 28; and 30. The Panel has already recorded that those facts were admitted and found proved. On 19 August, just before closing the case for the GMC, Counsel, Miss Plaschkes invited the Panel to consider, when in camera, amending paragraphs 12 c and 12d to read In about September 2003.. and In about August 2004 respectively. Mr Climie agreed on your behalf that the dates in question were not a material averment and he did not object to such an amendment being made. The Panel did not find it necessary to make such an amendment. In determining the disputed facts, the Panel has given careful consideration to all the evidence adduced, both oral and documentary. The Panel has given all the evidence such weight as it deemed appropriate. Where the Panel has preferred the evidence of one witness to that of others, it has given its reasons. The Panel has also taken account of the submissions made on behalf of the GMC by Miss Plaschkes, Counsel, together with those made by Mr Climie on your behalf.

In reaching its decisions, the Panel has borne in mind that the burden of proof rests with the GMC throughout and that the standard of proof is the civil standard, namely the balance of probabilities. The GMC has advanced its case on the basis that your actions were, variously, inappropriate, an abuse of your position, sexually motivated, liable to bring the profession into disrepute, and in some instances dishonest. Many of the decisions which the Panel has had to make have involved the Panel reaching a view as to the credibility of various witnesses, since the Panel has had to resolve conflicting accounts of the events which are said to have taken place. In reaching its decisions, the Panel has not found it necessary to refer to the principles of similar fact evidence. The Panel has noted that aspects of the evidence of Mr Xxxxxxx (regarding Ms A) and the agreed statements of Mr xxxxx and Ms xxxxxx (regarding Ms B) involve matters of recent complaint evidence and, as such, demonstrate consistency. Mr and Mrs Xxxxxxx Mr Xxxxxxx gave evidence by video link as he was outside the UK. The evidence they gave was not always consistent in regard to some aspects, for example, the frequency of visits by Mrs Xxxxxxxs mother. Their evidence, if accepted in full, would provide you with an alibi in respect of the allegation that, on 26 March 1999, you had sexual intercourse with Ms A. The Panel has had to weigh their evidence and your own evidence against the oral evidence of Ms A and others and the documentary evidence submitted by the GMC. Patient Ms A Given the nature of her complaint, Ms A was deemed to be a vulnerable witness and was screened from you when she gave her evidence. The Panel took note of her extensive history of mental illness. Although she rejected the diagnosis that she suffered from borderline personality disorder, it was the evidence of Dr Hxxxxxx, a Consultant Psychiatrist, that she met all of the diagnostic criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, for that condition. However, he did not agree with the contention that she was a fantasist. The Panel found that Ms A was a credible witness though her reliability was tempered in the respect that she was adamant that she had not been attracted to you and had not acted in a flirtatious way towards you whereas Mr Xxxxxxxs evidence contradicted that. Ms A did not just provide oral evidence. The Panel also had regard to documentary evidence in the form of her filofax diary entries, which were contemporaneous records. Ms A conceded that she had made some written records in the nature of an abreaction although she accepted they were not true. The Panel considered that those false records could be distinguished from her contemporaneous diary entries which could not be said to have been created for dissemination and certainly not with a view, several years later, to provide the basis of a false allegation against you. 9

Ms Xxxxx The Panel did not find her an impressive or reliable witness. She presented primarily as an advocate for Ms A with an obvious hostility towards you. It did not give any significant weight to her evidence. Mr Xxxxxxx The Panel found Mr Xxxxxxx to be a credible witness. Some aspects of his evidence differed from the account given by Ms A but not to such a significant degree as to cause the Panel to doubt his evidence. For example, Mr Xxxxxxx did not always agree with Ms A as to dates and told the Panel that she had been attracted to you, had flirted with you. Mr Xxxxxxx also stated that he had fantasised, along with Ms A, about who they found attractive. Patient Ms B Given the nature of her complaint, Ms B was deemed to be a vulnerable witness and was screened from you when she gave her evidence. The Panel considered her to be a reliable witness. She realised she had a problem and wanted help to resolve it. Ms B had no motive to lie or exaggerate. The Panel found that the evidence in the form of the text messages which she supplied was particularly telling. Patient Ms C Given the nature of her complaint, Ms C was deemed to be a vulnerable witness and gave evidence by video link. The Panel considered her to be a reliable witness who acknowledged her lack of recollection of certain matters that were put to her. She did not wish to complain about what had occurred and told the Panel that she did not consider that your conduct had caused her any harm. The Panel found that she had no motive to deceive it by making false allegations about your behaviour. Mrs E Mrs E was not deemed to be a vulnerable witness but gave evidence by video link for scheduling reasons to enable the hearing to proceed in a timely fashion. The Panel found her to be a reliable and credible witness. Dr Soutzos The Panel found you to be an unreliable witness. It found that you were at times evasive and conceded points only when to do otherwise had become untenable, for example, when you were confronted by the content of the text messages which you had sent to Ms B, you accepted that these were inappropriate. Findings of Fact The Panels findings on those facts which remain in dispute are as follows: Paragraph 1 [The allegation is that, between January 1999 and December 1999, you worked as a Specialist Registrar in Psychiatry at Guys Hospital.] Paragraph 1 is found proved. The Panel notes that towards the end of this period you were appointed as a locum Consultant. 10

Paragraph 4a [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Patient Ms A in that, on 6 March 1999, you met her at the National Gallery.] Paragraph 4a is found proved. You conceded that you did meet Ms A at the National Gallery but did not accept that this was in pursuance of or in order to establish an improper emotional and sexual relationship with her as alleged. The Panel rejected this contention and concluded that this meeting was part of a deliberate process on which you embarked in order to establish an improper emotional and sexual relationship with Ms A. Paragraph 4b [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that, on 11 March 1999, you told her that you had previously had other borderline girlfriends.] Paragraph 4b is found proved. The Panel noted that Ms A and Mr Xxxxxxx were not in agreement as to the date when this remark was made but both were certain that you did say what is alleged. The Panel did not find this discrepancy as to the date to be significant. It preferred their evidence in this regard to yours. Paragraph 4c [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that, on 14 March 1999, you met her at the Tate Gallery.] Paragraph 4c is found proved. The Panel noted that Ms As oral evidence indicates that you had suggested she go on her own to the Tate Gallery on 14 March. She did so and, when there, had seen you in the company of a couple of friends. Ms A told the Panel that, at the time, she had not questioned your motives but did so later. Her account was that, on 15 March, you told her that you had wished she had been alone. Ms As diary entries include one on 11 March, suggesting you said you were going to the Tate Gallery; one on 14 March stating: Theo went with his mates Tate 2.30 Theo Tate Pollack exhibition anniv; and one on 15 March stating: I wish I had been alone yesterday I would love to have talked to you about art on your own Your evidence was to the effect that this meeting did not take place. The Panel preferred Ms As evidence to yours. Her inability to recall the gender of each of the two people with you was not significant.

11

Paragraph 4d (i) [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that, on 20 March 1999, you met her at the National Gallery.] Paragraph 4d (i) is found proved. Ms As oral evidence indicates that on 20 March 1999, you met her at the National Gallery. Her account was that after visiting the gallery you purchased and ate some ice-cream with her. That was supported by her diary entry for that date which amongst other things records: Ice creamNat. Gallery The Panel preferred Ms As evidence to yours. Paragraph 4d (ii) [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that, on 20 March 1999, you took her swimming.] Paragraph 4d (ii) is found proved. Ms As diary entry for March 20 1999 records, amongst other things: swimming... Your own evidence was that, when swimming, your preferred stroke is butterfly. Ms As oral evidence was that you swam using that stroke. The Panel did not accept your contention that Ms A knew of this only because you had discussed swimming with her during consultations. Her account of your behaviour at the pool is credible. The Panel preferred Ms As evidence to yours. Paragraph 4d (iii) [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that on 20 March 1999 you took her to your flat.] Paragraph 4d (iii) is found proved. Ms As drawing of the lay-out of your flat was not challenged. The Panel considers that it is unlikely that she could have constructed this without having visited the flat. Her diary entry for 20 March also states: flat and the Panel accepts this is a reference to your flat, in support of her oral evidence. The Panel preferred Ms As evidence to yours. Paragraph 4d (iv) [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that on 20 March 1999 you hugged her.] Paragraph 4d (iv) is found proved. Ms As diary entry for this date describes a hug. Her oral evidence was that on 12

leaving your flat: before we got in the car he took a bag. It might have been my bag that I had my swimming stuff in and a towel, or it might have been a bag that he hadHe put it on the floor next to him and he said, Give me a hug. Before I had a chance to do anything he hugged me quite tightly. He hugged me for about ten seconds and then released meThen we got in the car. I felt quite awkward. The Panel accepted Ms As evidence on this issue. Paragraph 4e (i) [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that on 21 March 1999 you met her at the Tate Gallery.] Paragraph 4e (i) is found proved. Your evidence was that you went to a lecture at the Tate Gallery and were uncomfortable to find Ms A present but sat next to her because it was obvious that she had seen you arrive and you did not want to ignore her. Ms As evidence was that you had told her to go to the Gallery. She said: I turned up in the afternoon and a few minutes after the slide show started he [that is you, Dr Soutzos] came into the auditorium and sat next to me, and we watched the slide show. Ms A rejected your suggestion that this meeting occurred by chance. The Panel accepted her evidence that you had initiated this meeting. Paragraph 4e (ii) [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that on 21 March 1999 you took her to her flat.] Paragraph 4e (ii) is found proved. Ms A rejected the contention put to her in cross examination that she was unwell and asked you to take her home. Ms As oral evidence was that you both met Mr Xxxxxxx outside her flat. Your evidence was that he was already in the flat. Mr Xxxxxxxs account supported the evidence of Ms A. The Panel has rejected your account and accepted the evidence of Ms A. Paragraph 4e (iii) [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that on 13

21 March 1999 outside the hospital you told Ms A to give you a strong signal and she rubbed your crotch.] Paragraph 4e (iii) is found proved. Ms As diary entry described her groping you. That was also the effect of her oral evidence. She said that having left her flat: we got in Dr Soutzoss car again and he went to drive me back to the ward He parked round the back. That is when he came out with this remark; he said he was sick of giving me signals and me not responding, and he sounded quite annoyed and irritated. He said: I want you to give me a really strong signal so that I know that you know that what is going to happen is going to happen words to that effect. I knew exactly what he meantand I felt pressurisedThat is when I put my hand on his crotch and rubbed his crotch for about a minute Ms As oral evidence in this regard is not wholly supported by that given by Mr Xxxxxxx. His account was that the contact between you and Ms A was more overtly sexual than that which she described, namely that she masturbated you to the point of ejaculation. However, the Panel notes that Mr Xxxxxxx was not a witness to the event and could only report that which he recalled after a period of a decade. The Panel did not consider that this discrepancy undermined Ms As evidence. Your account was that this did not happen at all. The Panel preferred Ms As evidence to yours. Paragraph 4f [The allegation is that between January 1999 and December 1999 you pursued and or established an improper emotional and sexual relationship with Ms A in that on 25 March 1999, you offered to cook dinner for Ms A.] Paragraph 4f is found proved. The Panel noted that Ms As oral evidence and her diary entries supported this allegation. Your account was that this did not happen at all. The Panel preferred Ms As evidence to yours. Paragraph 5 [The allegation is that on 26 March 1999 you had sexual intercourse with Ms A.] Paragraph 5 is found proved. There are only two possible witnesses to the allegation that you had sexual intercourse with Ms A on 26 March 1999. On the one hand, the Panel has examined the account Ms A gave in her evidence; on the other it has examined the evidence you gave concerning your movements over the period of a few days either side of 14

26 March. You called Mr and Mrs Xxxxxxx to give evidence to the effect that you were not alone and therefore had not the opportunity to engage in sexual activity with Ms A as she described. The Panel was reminded that the raising of an alibi does not affect either the burden or standard of proof and that the GMC bears the responsibility of disproving the alibi. The Panel found Miss A to be a reliable witness in most aspects of her testimony despite the observations made on your behalf by Mr Climie and by you during the course of your evidence. The Panel found no evidence of fabrication, fantasy or elaboration in her evidence. She was measured, consistent and credible in what she said. Much of what she was to tell the Panel was supported, albeit not from an independent source, by her diary entries. No challenge was made as to their contemporaneity. Cross examination failed to undermine what she said and, in the view of the Panel, she left the witness stand with her credibility intact. The Panel tested her evidence further in the light of the evidence given and called on your behalf. The Panel noted that the alibi first came to light at the end of January/beginning of February 2008, almost nine years after the events complained of. This of itself is unremarkable but the Panel also noted the absence of any documentary evidence to support the assertion that the particulars of alibi related specifically to the 26 March 1999. For the Panel to find that the alibi undermined Ms As evidence of the 26 March it would have to be persuaded by argument that the alibi evidence rendered at least as likely that the intercourse could not have taken place on 26 March as that it did. Whereas the Panel is in no position to find that the circumstances described in the alibi did not take place, the evidence called in support, crucially, of 26 March 1999 is imprecise to the point that it does not undermine the evidence of Ms A. The Panel finds it hard to accept that a marital disagreement of the type described by Mr and Mrs Xxxxxxxx would endure for the length of time alleged. Mrs Xxxxxxxx was, it is said, in the late stages of pregnancy, and Mr Xxxxxxx said in evidence that had it not been for the chance meeting with you on the evening of his wifes birthday he would have made up with his wife and returned home that evening. Mr Xxxxxxx was a less than convincing witness under cross-examination. He was unable to recall important detail sought by Miss Plaschkes, but was able to volunteer without prompt the fact that he and you had shared a Chinese takeaway. This was a feature you raised. The Panel concluded that this insignificant detail was mere artifice, a device to create verisimilitude. Paragraph 6a [The allegation is that in April 1999 you tried to prevent Ms A from informing anyone of your relationship, telling her it would destroy your career if anyone found out.] Paragraph 6a is found proved. The Panel found Ms As oral evidence and her diary entries credible. She told the Panel that it was at this time that rumours had begun to circulate amongst other patients on the Maurice Craig Ward as to the nature of your relationship with her. 15

The Panel accepted Ms As evidence. Paragraph 6b [The allegation is that in April 1999 you tried to prevent Ms A from informing anyone of your relationship, telling her it would kill your mother.] Paragraph 6b is found proved. Ms As oral evidence was supported by her diary entries, The Panel accepted that evidence. Paragraph 6c [The allegation is that in April 1999 you tried to prevent Ms A from informing anyone of your relationship, telling her to lie about your relationship.] Paragraph 6c is found proved. Ms As oral evidence was supported by her diary entries, The Panel accepted that evidence. Paragraph 7 [The allegation is that on 29 April 1999 you tried to conceal evidence of your relationship by asking Ms A to hide her telephone records.] Paragraph 7 is found proved. Ms As diary entry for that day states: T is para about phone records She told the Panel that you telephoned her in a panic and said that you were: really paranoid about me leaving my phone records lying around. I think he was worried that his mobile number might appear if I had an itemised bill and I did hide my phone records anyway. The Panel accepted her evidence. Paragraph 8a [The allegation is that on 9 February 2001 after you learnt that Ms A had told the Medical Director of your relationship, you told her to retract the information.] Paragraph 8a is found proved. Ms As diary entry indicates that she had been very drunk that evening and made a number of telephone calls. She recorded that she could not remember every call she had made but was clear one had been to you. Her diary entry states as usual called Theo on his mobile. He told me to retract the whole thing it would destroy him, so I said I would. Ms A told the Panel that at the time she had been excluded from the ward and said: I had to go back home and sit on my own and I started panicking and worrying and that In the end I could not think of anyone to ring apart from Dr Soutzos, so I rang him in the evening, the Friday, and told him that I had spoken to Dr Mxxxxx. Yes, he went ballistic and he just 16

said: Oh my God, oh my God, you have to retract it, retract it. You have to retract the disclosure.. You conceded having a conversation with Ms A around this time but not the details which she recorded. The Panel accepted Ms As evidence Paragraph 8b [The allegation is that on 9 February 2001 after you learnt that Ms A had told the Medical Director of your relationship, you told her that, unless she retracted the information, your career would be destroyed.] Paragraph 8b is found proved. Ms A gave oral evidence of her conversation with you. She said: He reminded me that, you know, I would be destroying his career and told the Panel that she had therefore agreed to retract her allegation. Documentary evidence adduced confirms that she made the retraction. Paragraph 8c [The allegation is that on 9 February 2001 after you learnt that Ms A had told the Medical Director of your relationship, you told her that she would kill your mother unless she retracted the information.] Paragraph 8c is found proved. Ms As diary entry does not make reference to this particular allegation. However, in oral evidence she said; I think he probably said the thing about his mother. I mean, in my Filofax here I have just said it would destroy him. I think the likelihood is that he would have said it would kill his mother again because he said it a couple of times before to me. Under cross examination Ms A was referred to the content of her witness statement in which she records that you had said she would kill your mother if the disclosure was not retracted. She conceded that her oral evidence [as quoted above] was not the same as her witness statement, agreed that she could not be100% accurate but also said that you: would repeat that. The two things went together: it would kill his mother and destroy his career.

17

Paragraphs 9a, 9b and 9c [The allegation is that your conduct in respect of paragraphs 4-8 was inappropriate, that you abused your position of trust, and that your conduct was liable to bring the medical profession into disrepute.] On your behalf, Mr Climie conceded that if the Panel found proved the facts alleged at paragraph 4-8, then paragraphs 9a, 9b and 9c would be made out. In the light of the Panels factual findings at paragraphs 4- 8 and having regard to that concession, paragraphs 9a, 9b and 9c are found proved. Paragraph 12a [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that you sent her inappropriate text messages.] Paragraph 12a is found proved. The Panel noted that you conceded that the contents of the text messages you sent to Ms B were inappropriate. You said: When I first heard of the allegations it took me by surprise because in my view I had not behaved inappropriately at all. When I saw the text messages, that again took me greatly by surprise because I simply did not remember them, and then a couple of days into these proceedings I remembered something that Ms B told me and she said to me once: Is it normal to be sending this type of text? And I said to myself okay. She said One of my friends is questioning whether it is normal to be sending this type of text and I thought to myself right, that is absolutely correct. I have lost some boundary with Ms B. You did not accept that your actions were in pursuance of and/or were to establish an improper emotional and sexual relationship. You told the Panel that Ms B, seemed to want a very informal way of engaging. You also told the Panel that when you were texting Ms B you were, at the same time, giving a lot of advice to one of your cousins, who was a similar age as Ms B and who had a couple of friends who were going through a few issues. You said: I was foolish enough to make the mistake of lumping Ms B, who had similar characteristics, with those and a lot of the texts I was sending my cousin, her friends were Greek which in retrospect do not translate at all well, so while I was busy sending texts to my cousin, I was also sending texts to Ms B and Of course, the error of judgment that I made was that I lumped Patient B into this milieu, this category, in other words, one of a trusted uncle who was doing his best to try and help and give as much support as possible. You also said when Ms B told you that one of her friends asked if your texts were

18

normal that you considered this and thought: okay, you know you are absolutely correct. I have made a mistake here and they are not normal, so I stopped them. The Panel had noted the content of your text messages, some of which referred to cuddles, your having a soft spot for Ms B, recommendations that she should seek an older less attractive boyfriend, a request to join Ms B in her bath, and the message, who says Im not your boyfriend. By this time you were an experienced consultant psychiatrist. The Panel rejects your explanation for the text messages sent to Ms B and your attempt to present yourself as an avuncular figure. The Panel is satisfied that these messages give the strongest indication of your intention to pursue and establish an improper emotional and sexual relationship with Ms B. Paragraph 12b [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, in September 2003, you invited her out for dinner.] Paragraph 12b is found proved. Ms B was clear that you had invited her to dinner. She said: I had a call or I saw the phone ringing. I did not answer it in any case and just sent a text saying Hello, sorry I missed your call and got a response saying, Hi, are you free for dinner tomorrow night?, which would have been the Saturday. The Panel accepted her evidence and concluded that there was no reason for such an invitation except in pursuance of an improper emotional and sexual relationship. Paragraph 12c (i) [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, in September 2003, you met her at the National Gallery.] Paragraph 12c (i) is found proved. Ms Bs evidence was clear. You were more equivocal saying: I do not really remember. If I force myself I can conjure up an image of her in the Gallery... The Panel considers your lack of memory one way or the other inherently unlikely 19

unless you were in the habit of taking so many patients to art galleries that it was a common occurrence. The Panel accepted the evidence of Ms B. The Panel concluded that your actions form part of a course of conduct, not designed for any therapeutic reason but the pursuance of an improper emotional and sexual relationship. Paragraph 12c (ii) [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, in September 2003, you took her out to tea.] Paragraph 12c (ii) is found proved. Ms Bs evidence, which the Panel accepted, was clear. Describing a visit to a gallery she said: we went in and looked at the painting, which he said the story of Ariadne and Theseus had reminded him of me chasing this young boy who sort of did not really care very much. So we went in and looked at that. We then went out to a hotel for tea The Panel concluded that there was no reason for you to take Ms B to tea except in pursuance of an improper emotional and sexual relationship. Paragraph 12c (iii) [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, in September 2003, you hugged her.] Paragraph 12c (iii) is found proved. Ms B told the Panel that: it was common that [Dr Soutzos] would hug me at the beginning of a session or meeting or anything like that. The Panel accepted her evidence. It rejected your evidence that it was Ms B who initiated the hugs. It concluded that there was no reason for you to hug Ms B except in pursuance of an improper emotional and sexual relationship.

20

Paragraph 12d [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, in August 2004, you invited her to stay with you in Greece.] Paragraph 12d is found proved. You contended that Ms B had misunderstood your offer that, in the event that she went to Greece, she could contact members of your family who owned restaurants etc and who would provide her with assistance. Ms Bs evidence, which the Panel preferred, was that you sent her your phone number in Greece because you were actually away at the time and asked if she wanted to join you. Ms B said: he asked me if I wanted to go out to Greece around the end of August, saying he said, Well, do you want to join me? My friends and family would love you and you can just get the plane out to Athens and then there is a hydro-boat, or something like that, that takes you across to the island and it is all very easy and you would be most welcome. The Panel concluded that there was no reason for you to invite Ms B to Greece except in pursuance of an improper emotional and sexual relationship. Paragraph 12e [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, in 2006, you invited her out for a drink.] Paragraph 12e is found proved. The Panel noted the extracts from Ms Bs diary, in which she which recorded as follows: Theo & I are going out next Saturday night on a date. I dont even know if Ive been on a real one of these before, I think they belong to his generation, that of going for a drink & dinner. The Panel concluded that there was no reason for you to invite Ms B to go for a drink except in pursuance of an improper emotional and sexual relationship. Paragraph 12f (i) [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, on 14 October 2006, you met her for dinner.] Paragraph 12f (i) is found proved. Ms Bs evidence was that she met you for dinner on 14 October. Her oral account is

21

supported by her diary entry. She records as follows: My God, So many hundreds of things to say. Saw Theo for first time in a year & a half tonight & kissed him. Im sure I shouldnt have for various reasons but nothing felt wrong about it & now its a matter of waiting to see if I was a conquest, a mission. Your lack of memory prevented you from challenging Ms Bs account. Paragraph 12f (ii) [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, on 14 October 2006, you hugged her.] Paragraph 12f (ii) is found proved. The Panel accepted Ms Bs evidence with regard to hugging. Paragraph 12f (iii) [The allegation is that between August 2003 and October 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms B in that, on 14 October 2006, you kissed her.] Paragraph 12f (iii) is found proved. The Panel accepted Ms Bs evidence with regard to kissing. It rejected your contention that she misinterpreted what occurred when you lent across in your car to kiss her on the cheek in farewell. Paragraph 13a [The allegation is that your conduct as set out in Paragraph 12 was sexually motivated.] Paragraph 13a is found proved in respect of Paragraph 12. The Panel considers that its reasons for this finding are self-evident. Paragraph 13b [The allegation is that your conduct as set out in Paragraph 12 was an abuse of your position of trust.] Paragraph 13b is found proved. Ms B was a vulnerable patient. You were an experienced consultant psychiatrist. It was your responsibility to maintain the proper doctor/patient relationship at all times. You did not do so and deliberately embarked on a course of conduct designed to establish an improper emotional and sexual relationship with Ms B. The Panel has concluded that this was an obvious abuse of your position of trust.

22

Paragraph 13c [The allegation is that your conduct as set out in Paragraph 12 was liable to bring the medical profession into disrepute.] Paragraph 13c is found proved. The Panel considers that its reasons for this finding are self evident. Paragraph 16a [The allegation is that from August 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms C, in that you invited her to go swimming.] Paragraph 16a is found proved. Ms Cs evidence was that after a number of consultations you invited her swimming. She told the Panel that swimming had been discussed a number of times, and that you had demonstrated techniques, for front crawl. There had been some banter between you about who was the better swimmer. She readily admitted that she had been somewhat flirtatious. She told the Panel that she had been quite flattered by the invitation and said: I thought maybe it was just one of his processes of helping me get better. The Panel notes that you accepted that you took Ms C swimming but contended that it was after she had ceased to be your patient. The Panel rejected your contention. Paragraph 16b [The allegation is that from August 2006 you pursued and/or established an improper emotional and sexual relationship with Patient Ms C, in that you invited her to visit the Tate Modern.] Paragraph 16b is found proved. Ms C told the Panel that: I cannot remember how the arrangement was made, but we made the arrangement to go to the Tate Modern on a Saturday night, because they do a late night opening, and because of my love of art I thought Great, you know. I did not think anything weird about it, I just thought Oh, that would be nice, you know, to go to the Tate Modern with someone. I had lost a lot of friends through my illness and from leaving university, so it was nice to have some company. The Panel accepted Ms Cs evidence. The Panel notes that you stated that your lack of memory again prevented you from disputing this visit as you said, we went to galleries several times.

23

Paragraph 17 [The allegation is that in October or November 2006, you embarked upon a sexual relationship with Ms C which lasted approximately six months.] Paragraph 17 is found proved. Ms Cs evidence, which the Panel accepted, was that following the evening when she had gone with you to the Tate Modern, you had engaged in a sexual relationship with her which had lasted until Easter of the following year. Paragraph 21a [The allegation is that on 13 February 2008 you tried to conceal the details of your relationship with Ms C, you telephoned her and asked her to help you.] Paragraph 21a is found proved. Ms Cs evidence was that she remembered receiving a telephone call from you. She agreed that the essential nature of the call was as alleged but conceded she could not recall the specific words that had been used. The Panel is satisfied that it is more likely than not that the purpose of your call was to seek Ms Cs help, as alleged. Paragraph 21b [The allegation is that on 13 February 2008 you tried to conceal the details of your relationship with Ms C, you telephoned her and told her unless she did help, you were finished.] Paragraph 21b is found proved. The Panel reached this finding on the same basis as its finding in respect of paragraph 21a above. Paragraph 21c [The allegation is that on 13 February 2008 you tried to conceal the details of your relationship with Ms C, you telephoned her and told her to say that you were no longer her psychiatrist when the relationship started.] Paragraph 21c is found proved. The Panel noted that in cross examination you told the Panel that you said to Ms C: What is going on? I was not your doctor and you will have to tell them I was not your doctor, because it is true. In reaching this finding the Panel also had regard to the evidence which supported its finding in respect of paragraph 21a above.

24

Paragraph 23a [The allegation is that your conduct in respect of paragraphs 16, 17, 18, 19, 20 and 21 was inappropriate.] Paragraph 23a is found proved in respect of each of paragraphs 16, 17, 18, 19, 20 and 21. The Panel considers that its reasons for this finding are self-evident. Paragraph 23b [The allegation is that your conduct in respect of paragraphs 16, 17, 18, 19, 20 and 21 was an abuse of your position of trust.] Paragraph 23b is found proved in respect of each of paragraphs 16, 17, 18, 19, 20 and 21. Ms C was a vulnerable patient. The Panel notes with dismay that it was only in hindsight that you felt able to concede this point. It was your responsibility to maintain the proper doctor/patient relationship at all times. You did not do so and deliberately embarked on a course of conduct designed to establish an improper emotional and sexual relationship with her. The Panel considers that Ms C was a consenting participant in the relationship but this cannot absolve you of your duty to uphold the appropriate standards of professional and ethical conduct. You told the Panel that this was not a matter which had been specifically covered during your medical training but you also told the Panel that: The generality is that I, like any other doctor, I expect, would absolutely guard and respect and honour a patients trust. The Panel did not accept your contention that you were no longer Ms Cs doctor and has concluded that your actions constitute an obvious abuse of your position of trust. Paragraph 23c [The allegation is that your conduct in respect of paragraphs 16, 17, 18, 19, 20 and 21 was liable to bring the medical profession into disrepute.] Paragraph 23c is found proved in respect of each of paragraphs 16, 17, 18, 19, 20 and 21. The Panel considers that its reasons for this finding are self-evident. Paragraph 24 [The allegation is that your conduct in respect of paragraphs 18 and 22 was dishonest.] Paragraph 24 is found proved in respect of paragraph 18. The Panels finding is that you had not reviewed Ms C over the telephone, earlier than scheduled and had not offered her follow up which she had declined. Ms Cs evidence did not support those contentions. The Panel has determined that your motivation in writing to Ms Cs General Practitioner as you did was a cynical means to establish that your professional relationship with Ms C had ended. This was not true and was therefore dishonest. 25

Paragraph 24 is found proved in respect of paragraph 22. When you met with the Hospital Director on 15 February 2008 you stated that you had never had a relationship with a patient. This statement was untrue and you knew it to be untrue. The Panel has determined that this was dishonest. Paragraph 29a [The allegation is that your conduct, in failing to inform Mr Xxxxx of Xxxxx Xxxxx and Xxxxx Solicitors, that your registration was subject to Interim Orders Panel conditions was in breach of those conditions.] Paragraph 29a is found proved. You clearly knew of the restrictions imposed upon your registration by the GMCs Interim Order Panel, one of which required you to disclose to any organisation or person employing or contracting with you to undertake medical work that your registration was subject to interim conditions. The Panel finds that you had a contract with Mr Xxxxx of Xxxxx Xxxxx and Xxxxx Solicitors to prepare a medical report on Ms D. The Panel is satisfied that, as a consequence of the IOP conditions, you had a duty of disclosure in respect of Xxxxx Xxxxx and Xxxxx. The Panel found your contention that your contract was with Ms D and that you had fulfilled your responsibilities regarding disclosure was disingenuous. It is clear from the correspondence that it was Xxxxx Xxxxx and Xxxxx who were instructing you to prepare a report and that they were therefore, an organisation contracting with you to undertake medical work. However, even if Ms D had been the principle contractor, it is clear that Xxxxx Xxxxx and Xxxxx were acting as her agents. The condition required you to make disclosure to, any organisation or person, and the Panel finds that even if Xxxxx Xxxxx and Xxxxx had only been Ms Ds agents, in order to comply fully with the terms of the order, you would still have owed a duty to disclose the interim conditions to them. Paragraph 29b [The allegation is that your conduct in failing to inform Mr Xxxxx, of Xxxxx Xxxxx and Xxxxx, Solicitors, that your registration was subject to Interim Orders Panel conditions, was dishonest.] Paragraph 29b is found proved. You told the Panel that medico-legal work represented a significant part of your work. You also told the Panel that some patients who knew of the conditions had stopped attending. Disclosure to Xxxxx Xxxxx and Xxxxxx might have led to the withdrawal of the instructions. The Panel finds that you deliberately chose not to comply with your duty to disclose the nature of the restrictions imposed by the Interim Orders Panel. The Panel finds that your actions in this regard were dishonest. 26

Paragraph 29c [The allegation is that your conduct in failing to inform Mr Xxxxx, of Xxxxx Xxxxx and Xxxxx, Solicitors, that your registration was subject to Interim Orders Panel conditions, was liable to bring the medical profession into disrepute.] Paragraph 29c is found proved. The Panel concluded, as a matter of principle and in compliance with the requirements of good medical practice, that doctors are expected to behave with complete probity at all times. Patients, fellow professionals and the public at large expect nothing less. The Panel finds that a failure to act in accordance with one of the fundamental tenets of the medical profession constitutes conduct liable to bring the profession into disrepute. Paragraph 31 [The allegation is that you failed to inform the mother of patient E, a seven year old boy, that your registration was subject to conditions.] Paragraph 31 is found proved. Mrs Es evidence, which the Panel accepted, was clear. She was a credible and reliable witness. She was happy with the treatment you provided to her son. She told the Panel that she had not been aware of any restrictions on your registration and said it would not have made any difference to her if she had known of the conditions. Your evidence was that you had instructed your PA to inform patients of the conditions when appointments were arranged. You told the Panel that you did not discuss what you described as administrative issues during your consultations, evidence which you subsequently contradicted under cross examination. You eventually conceded that it was, ultimately, your personal responsibility to ensure compliance with the requirements of the conditions. Paragraph 32a [The allegation is that your conduct, in failing to inform the mother of patient E that your registration was subject to Interim Orders Panel conditions was in breach of those conditions.] Paragraph 32a is found proved. The Panel considers that its reasons are self evident, given the finding in respect of paragraph 31. Paragraph 32b [The allegation is that your conduct was dishonest.] Paragraph 32b is found proved. The Panel finds that it was your duty to comply with the conditions imposed by the Interim Orders Panel and to ensure that Mrs E was made aware of the nature of the restrictions on your registration. You did not do so. You had a financial interest in continuing to treat her son. There was a risk that she would have taken her son to another doctor. You could not have known that Mrs E would adopt the approach that she did. 27

The Panel finds that your conduct, in failing to advise Mrs E of the interim conditions, was dishonest. Paragraph 32c [The allegation is that your conduct in failing to inform patient Es mother that your registration was subject to conditions was liable to bring the medical profession into disrepute.] Paragraph 32c is found proved. The Panels reasons for this finding are the same as those which apply to its finding at paragraph 29c above. Having reached these findings on the facts, the Panel will now invite Miss Plaschkes to adduce further evidence and make submissions on behalf of the GMC as to whether, on the basis of the facts found proved, your fitness to practise is impaired. Following those submissions, Mr Climie will be invited to respond on your behalf and to call any evidence he may wish about your fitness to practise. Miss Plaschkes, do you wish to address the Panel now or do you wish to have some time to consider the Panels findings? Determination on Impairment Dr Soutzos, This determination should be read in conjunction with the Panels earlier determination on the facts. The Panel considered whether your fitness to practise is impaired by reason of your misconduct. In so doing it had regard to all the evidence presented to it. It has taken account of the submissions made on behalf of the General Medical Council (GMC) by Miss Plaschkes, Counsel, together with those made on your behalf by Mr Climie, Counsel. Miss Plaschkes submitted that your fitness to practise is impaired on the grounds that you have serially abused your position of trust to pursue and/or establish improper emotional and sexual relationships with three vulnerable female patients, that you had tried to conceal those relationships and that, on two separate occasions, you had flagrantly and dishonestly breached conditions imposed on your registration by a GMC Interim Orders Panel. She told the Panel that your conduct had repeatedly fallen seriously below the standards of Good Medical Practice. Miss Plaschkes referred the Panel to a number of authorities and to GMC guidance documents Good Medical Practice and Maintaining Boundaries. Mr Climie did not submit that your fitness to practise was not impaired. He invited the Panel to address the question of misconduct individually in respect of its findings relating to Ms A, Ms B, Ms C and dishonesty. 28

In reaching its decision, the Panel took account of what was said by Cranston J in Cheatle v GMC [2009] EWHC 645 (Admin). Cranston J said: Whatever the meaning of impairment of fitness to practise, it is clear from the design of section 35C that a panel must engage in a two-step process. First, it must decide whether there has been misconduct. and, Then it must go on to determine whether, as a result, fitness to practise is impaired. Cranston J also said: There is clear authority that in determining impairment of fitness to practise at the time of the hearing regard must be had to the way the person has acted or failed to act in the past. As Sir Anthony Clarke MR put it in Meadow v General Medical Council [2006] EWCA Civ 1390; In short, the purpose of [fitness to practise] proceedings is not to punish the practitioner for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise. The FPP thus looks forward not back. However, in order to form a view as to the fitness of a person to practise today, it is evident that it will have to take account of the way in which the person concerned has acted or failed to act in the past (para 32) Cranston J then continued: In my judgment this means that the context of the doctors behaviour must be examined. In circumstances where there is misconduct at a particular time, the issue becomes whether that misconduct, in the context of the doctors behaviour both before the misconduct and to the present time, is such as to mean that his or her fitness to practise is impaired. The doctors misconduct at a particular time may be so egregious that, looking forward, a panel is persuaded that the doctor is simply not fit to practise medicine without restrictions, or maybe at all. On the other hand, the doctors misconduct may be such that, seen within the context of an otherwise unblemished record, a Fitness to Practise Panel could conclude that, looking forward, his or her fitness to practise is not impaired, despite the misconduct. The Panel was guided by Silber Js judgment in the case of Cohen v GMC [2008] EWHC 581 (Admin), in which His Lordship stated at paragraphs 62 and 63 that, the task of the Panel is to take account of the misconduct of the practitioner and then to consider it in the light of all the other relevant factors known to them in answering whether by reason of the doctor's misconduct, his or her fitness to practice has been impaired.

29

He also said: I must stress that the fact that stage 2 is separate from stage1 shows that it was not intended that every case of misconduct found at stage1 must automatically mean that the practitioner's fitness to practice is impaired. The Panel had regard to the case of Yeong v GMC [2009] EWHC Admin 1923. In that case there was a prolonged sexual relationship with a patient. Sales J stated: Where a medical practitioner violates such a fundamental rule governing the doctor/patient relationship as the rule prohibiting a doctor from engaging in a sexual relationship with a patent, his fitness to practise may be impaired if the public is left with the impression that no steps have been taken by the GMC to bring forcibly to his attention the profound unacceptability of his behaviour and the importance of the rule he has violated. and, The publics confidence in engaging with [the doctor] and with other medical practitioners may be undermined if there is a sense that such misconduct may be engaged in with impunity. Having considered the legal authorities, the Panel then had regard to the GMC guidance documents to which it was referred. Good Medical Practice sets out the duties and responsibilities of a doctor. Good Medical Practice dated 1998, states that: All patients are entitled to good standards of practice and care from their doctors. Essential elements of this areobservance of professional ethical obligations. That edition of the guidance also makes clear that a doctor must not abuse his position to establish improper personal relationships with patients. Good Medical Practice dated 2001, states that doctors must be honest and trustworthy and must avoid abusing their position as a doctor. Paragraph 20 of that guidance states that: You must not allow your personal relationships to undermine the trust which patients place in you. In particular you must not use your professional position to establish or pursue a sexual or improper emotional relationship with a patient... Good Medical Practice dated November 2006, makes clear that serious or persistent failure to follow the guidance will put a doctors registration at risk. Under the heading Good Doctors it states that: Patients need good doctors. Good doctors make the care of their patient their first concern they establish and maintain good relationships with patients are honest and trustworthy, and act with integrity. 30

Under the heading Maintaining trust in the profession it states that: You must not use your professional position to establish or pursue a sexual or improper emotional relationship with a patient Under the heading Probity it states that: Probity means being honest and trustworthy, and acting with integrity: this is at the heart of medical professionalismYou must make sure that your conduct at all times justifies your patients trust in you and the publics trust in the profession and If youhave restrictions placed upon your practice you must, without delay, inform any other organisations for which you undertake medical work and any patients you see independently. The Panel noted that the question of impairment is a matter of judgment for the Panel. There is no burden or standard of proof to be applied. In considering the issue of impairment the Panel first determined whether or not the facts found proved amounted to misconduct and, if so, whether that misconduct was serious. You were aware of Ms As longstanding psychiatric history. You exploited her vulnerability for your own sexual gratification. In these proceedings you sought to conceal your culpability by claiming that she was a fantasist who had constructed an imaginary relationship with you. You sought to portray yourself as the victim of her false allegations. This was a callous exploitation of Ms As illness. In relation to Ms B, a young woman aged about 18 at the time, you first claimed not to recall the text messages which you sent to her. Subsequently, when you were confronted by the inappropriate and sexual content of your messages, you conceded that they were wrong but claimed that your boundaries had become blurred as a consequence of advice you were giving to a cousin of yours, a young woman of a similar age to Ms B. You said that, in relation to Ms B, you saw yourself as a protective uncle. The Panel considered that the messages you sent her were far removed from the category of avuncular communication from a protective relative. You deliberately embarked on a course of conduct designed to establish an improper emotional and sexual relationship with Ms C. It was only in hindsight that you felt able to concede that she was a vulnerable patient. The fact that she was a consenting participant in the sexual relationship you established does not absolve you of the responsibility to maintain the proper doctor/patient relationship at all times. When this relationship came to light you asked her to lie and say that you were not her doctor at the time. The Panel has determined that the facts found proved in respect of Ms A, Ms B and Ms C constitute a pattern of predatory and reprehensible sexual misconduct towards vulnerable patients which endured over a period of several years. The Panel determined that your actions in pursuing and establishing improper emotional and sexual relationships with these three patients amounted to 31

misconduct, falling seriously short of the standards expected of a registered medical practitioner. Your repeated dishonesty in seeking to conceal your relationships with patients was a clear violation of the requirements of Good Medical Practice to act with probity at all times. Your actions in respect of Mr Xxxxx and patient Es mother constitute dishonest attempts to circumvent the conditions imposed on your registration by the GMCs Interim Orders Panel. This Panel has determined that this dishonesty represented a flagrant disregard for the system of registration which is designed to protect patients and the wider public interest. You lied when you told the Medical Director of the Priory Hospital, Roehampton, that you had never had a relationship with a patient. You told both Ms A and Ms C to lie on your behalf about the nature of your relationship with them. Your correspondence with Ms Cs General Practitioner in late 2006 was a flagrant attempt to mislead. The Panel had no difficulty in concluding that your acts were dishonest and amounted to serious departures from the standards of behaviour required from doctors. The Panel is satisfied that all the matters found proved amount to misconduct. The Panel then went on to consider whether your fitness to practise is impaired by reason of your misconduct. In reaching its decision, the Panel has had regard to all of the relevant factors and information, including the question of insight and remediation. In determining those two matters, the Panel also bore in mind the legal authorities referred to in detail earlier in this determination. You told the Panel that you had attended a course on boundaries. You conceded, eventually, that your messages to Ms B were inappropriate. The Panel gave you appropriate credit for that admission. However, in coming to a view as to the level and quality of your insight, the Panel also noted that your concession only came once these proceedings had commenced and when you had been confronted with the content of the messages in question. The evidence you gave seeking to explain away those messages negated your claims that you had gained insight. The Panel also noted that you have maintained throughout that Ms A invented the sexual relationship as a consequence of her mental illness. The Panels overall view is that you made concessions only when to do otherwise would have been untenable. The Panel considers that you have demonstrated no appreciable insight into your wrong doing or the effects your misconduct may have had upon on your former patients. Nor do you appear to have considered the damage such misconduct is almost certain to have caused to the collective good name of the medical profession. In any event, even if you had demonstrated greater insight into your misconduct, any steps taken to remediate your wrong doing would have been of limited impact, because the Panel concluded that your misconduct is properly encapsulated in the dictum of Cranston J in Cheatle, being, so egregious that, looking forward, a panel is persuaded that the doctor is simply not fit to practise medicine without restrictions, or maybe at all. 32

The Panel has determined that the totality of the facts proved constitute repeated and serious breaches of many of the essential tenets of Good Medical Practice. Public confidence in the good name of the medical profession is likely to have been damaged by such behaviour. Your misconduct is of such a nature that the Panel has concluded that your fitness to practice is impaired by reason of that misconduct. Determination on Sanction Dr Soutzos, The Panel has already determined and announced that your fitness to practise is impaired by reason of your misconduct. As undertakings were not offered, the Panels first task was to decide whether it was necessary to make an order in respect of your registration. The Panel considered the submissions made on behalf of the General Medical Council (GMC) by Miss Plaschkes who argued that the erasure of your name from the Medical Register was the only appropriate sanction in the circumstances, in the light of the gravity of the misconduct which the Panel has already found proved. Miss Plaschkes referred the Panel to sections of the GMCs Indicative Sanctions Guidance [April 2009 edition, revised August 2009]. She invited the Panel to conclude that your misconduct as found proved in respect of Ms A, Ms B, and Ms C together with your dishonesty was so serious that no sanction short of erasure would be sufficient to protect patients and the wider public interest. The Guidance makes clear that the Panel may erase a doctor in any case except one which relates solely to the doctors health where this is the only means of protecting patients and the wider public interest. Miss Plaschkes submitted that this provision applied to your misconduct. On your behalf, Mr Climie submitted that erasure was not the only way to protect patients and the public interest. He did not invite the Panel to consider a sanction lesser than a lengthy period of suspension. He asked the Panel to consider the evidence given by patients and fellow professionals which indicates that you are a caring and dedicated psychiatrist. Professional colleagues continued to refer patients to you, despite being aware of the allegations which led to this hearing. The patients who gave live character evidence on your behalf were aware of the Panels factual finding but nevertheless made clear that they wished to continue as your patients. Some stated that your treatment and care had changed their lives for the better. Given the gravity of the misconduct found proved, the Panel determined that it would be wholly inappropriate to conclude this case without taking any further action.

33

Having determined that it is essential to impose a sanction in respect of your registration, the Panel considered the sanctions available starting with the least restrictive. The GMCs Indicative Sanctions Guidance document makes clear that any conditions must be appropriate, proportionate, workable and measurable. Paragraph 57 of that guidance states that conditions: might be most appropriate in cases...where there is evidence of shortcomings in a specific area or areas of the doctors practice. Panels will need to be satisfied that the doctor has displayed insight into his/her problems, and that there is potential for the doctor to respond positively to remediation/retraining and to supervision of his/her work. Clinical competence was not an issue in your case. The Panel heard that you are a highly competent consultant psychiatrist. However, your misconduct is related to your dishonesty and repeated use of patients for your own sexual purposes. The Panel has already found that your misconduct in respect of Ms A, Ms B and Ms C constituted a course of conduct which you pursued over a period of several years. You have demonstrated negligible insight into your wrong doing. In the Panels view, conditions requiring a doctor to comply with the most basic requirements of registration, such as refraining from establishing improper sexual or emotional relationships with patients and being honest would be otiose. Appropriate conditions could not be constructed which would address your repeated and sustained exploitation of vulnerable patients for your own sexual purposes. The Panel also concluded that conditions would not be a sufficient or appropriate response to your repeated dishonesty and the contempt you have demonstrated for the conditions imposed by the Interim Orders Panel. The imposition of conditional registration is insufficient to protect patients and the wider public interest given all the circumstances of this case. Having determined that a period of conditional registration would be inappropriate and insufficient to protect the public interest, the Panel considered the sanction of suspension. Paragraph 69 of the Indicative Sanctions Guidance states that: Suspension has a deterrent effect and can be used to send a signal to the doctor, the profession and public about what is regarded as behaviour unbefitting a registered medical practitionerSuspension will be an appropriate response to misconduct which is sufficiently serious that action is required in order to protect patients and maintain public confidence in the professiona period of suspension will be appropriate for conduct that falls short of being fundamentally incompatible with continued registration and for which erasure is more likely to be the appropriate response namely conduct so serious that the Panel considers that the doctor should not practise again 34

either for public safety reasons or in order to protect the reputation of the profession . Paragraph 75 of the Indicative Sanctions Guidance states that suspension may be appropriate where some or all of the following factors are apparent: A serious breach of Good Medical Practice where the misconduct is not fundamentally incompatible with continued registration and where therefore complete removal from the register would not be in the public interest, but which is so serious that any sanction lower than a suspension would not be sufficient to serve the need to protect the public interest. No evidence of harmful deep-seated personality or attitudinal problems. No evidence of repetition of behaviour since incident. Panel is satisfied doctor has insight and does not pose a significant risk of repeating behaviour.

Of the factors identified above, the Panel found only one to be applicable. The Panel has not been presented with evidence to suggest that you have persisted in your proven misconduct with vulnerable patients or repeated your dishonesty. However, it has noted that your misconduct occurred over a number of years. You made only limited admissions in respect of the matters alleged against you and made no significant acknowledgement of fault, or expression of contrition. The Panel considered a number of authorities. The Panel took account of the case of Giele v GMC [2005] EWHC 2143 (Admin) and noted that Collins J referred to his own observations in the case of Council for the Regulation of Health Care Professionals v GMC & Southall [2005] EWCA 579 (Admin) in which he stated that: testimonials which establish that a doctor is, in the view of eminent colleagueswho have worked with him, one who is not only competent but whose loss to the profession and to his potential patients would be serious indeed can, in my opinion, be accorded substantial weight. The Panel had regard to a further authority, quoted at paragraph 78 of the Indicative Sanctions Guidance. In the case of Bolton v the Law Society [1994] 1WLR 512, [1993] EWCA Civ 32, Lord Bingham, Master of the Rolls, said: The reputation of the profession is more important than the fortunes of an individual member. Membership of a profession brings many benefits but that is part of the price. The Panel also noted the case of Gupta v GMC [Privy Council Appeal No 44 of 2001] in which the approach set out in Bolton v the Law Society was adopted. Their Lordships emphasised the GMCs role in maintaining justified confidence in the

35

profession and, in particular, that erasure was appropriate where, despite a doctor presenting no risk: the appellants behaviour demonstrated a blatant disregard for the system of registration which is designed to safeguard the interest of patients and to maintain high standards within the profession. Paragraph 81 of the Indicative Sanctions Guidance states: There are some examples of misconduct where the Privy Council has upheld decisions to erase a doctor despite strong mitigation. This has been because it would not have been in the public interest to do otherwise given the circumstances concerned. Paragraph 82 of that guidance makes clear that erasure may be appropriate when the behaviour involves any of the following factors: Particularly serious departure from the principles set out in Good Medical Practice Abuse of position/trust Offences of a sexual nature Dishonesty, especially where persistent and/or covered up Persistent lack of insight into seriousness of actions or consequences.

Each of the factors set out above apply in your case. You have broken many of the fundamental tenets of Good Medical Practice. Your misconduct amounts to behaviour which is fundamentally incompatible with being a registered medical practitioner. It was your role as a psychiatrist which gave you the opportunity to pursue and establish improper sexual and or emotional relationships with Ms A, Ms B and Ms C. They trusted you and you betrayed that trust. You were dishonest in lying about and attempting to conceal your relationships with patients. You were dishonest in your communications with Ms Cs General Practitioner in late 2006. You were dishonest in failing to disclose to Mrs E and to Xxxxx Xxxxx and AXxxxx Solicitors that your registration was subject to restrictions imposed by the Interim Orders Panel. The Panel is not satisfied that you have developed any appreciable insight into the consequences of your actions for your patients or for the reputation of the profession at large. The Panel considers that when doctors behave as you have done, they damage not only the patients whose trust they have abused but also put at risk the essential trust which is necessary between the public and the medical profession in general. Patients are entitled to expect that when they consult with a doctor, they will be treated with dignity and respect, not that they will be used for the practitioners sexual gratification. If members of the public do not trust their doctors, then their health care is placed at risk. The Panel has determined that a direction suspending your registration, even for the maximum period of 12 months, would not be sufficient to protect patients and the 36

wider public interest. Suspending your registration would not be proportionate to the seriousness of your misconduct. The Panel is satisfied that the only sufficient and proportionate way in which patients, the public and the reputation of the profession can be protected is by directing the Registrar to erase your name from the Medical Register. The Panel is satisfied that your misconduct will have damaged the reputation of the profession. Doctors, patients and the public at large need to be reassured that serious misconduct of the kind in which you have repeatedly engaged cannot be tolerated. The Panel therefore revokes the current interim order and directs that your name be erased from the register. The Panel having taken its decision on sanction, Dr Soutzos Solicitors submitted by email a further testimonial from Dr T M Gibson, dated 31 August 2010. The Panel considered this document de bene esse. Having done so, the Panel reflected upon its content and further discussed the issue of sanction. The document did not persuade the Panel to alter its decision. Unless you exercise your right of appeal, this determination will take effect 28 days from when written notice of the determination is deemed to have been served upon you. You will be provided with a note explaining your right of appeal. The Panel will now consider whether it is necessary to order that your registration be suspended forthwith and invites both Counsel to make submissions on that matter. Miss Plaschkes and Mr Climie, are you ready to address the Panel or do either of you require any time to consider the determination just announced and/or take instructions? Determination on Immediate Sanction Dr Soutzos, Having directed that your name be erased from the Medical Register, the Panel has considered whether your registration should be suspended forthwith, as provided for by section 38 (1) of the Medical Act 1983, as amended. The Panel has considered the submissions made. Miss Plaschkes, Counsel, on behalf of the General Medical Council (GMC) submitted that the Panel, having revoked the interim order, should go on to order that your registration be suspended forthwith in the light of its earlier direction for the erasure of your name from the Medical Register. She reminded the Panel that, in the absence of an order for the immediate suspension of your registration, you would be able to practise medicine without restriction for the 28 day appeal period or longer.

37

On your behalf, Mr Climie, Counsel, invited the Panel to consider the limited number of extremely vulnerable patients whose care you have not yet managed to transfer to other practitioners. He told the Panel you were greatly concerned for their on-going care. Through him, you told the Panel that there was no question of your taking on new patients. He accepted that there was some risk in taking the course of action he encouraged. In considering whether to make an order under section 38 (1) of the Medical Act, the Panel has had regard to its direction for the erasure of your name from the Medical Register and to the fact that the interim order previously in effect has now been revoked. The Panel had regard to the principle of proportionality. Having determined that the only way in which patients and the wider public interest could be protected was by directing that your name be erased from the Medical Register, the Panel has further determined that it would be inappropriate to allow you to practise medicine pending the outcome of any appeal or until the substantive direction for erasure takes effect. If an immediate order is not made, you will be free to practise medicine without restriction for 28 days, or for significantly longer if you lodge an appeal. In the light of the Panels previous findings, that would not serve the wider public interest. The Panel does not consider that an immediate order would prevent you from handing over the care of existing patients to other practitioners or from discussion of their care with the doctors who will be assuming responsibility for them. The Panel therefore orders that your registration be suspended forthwith. This means that your registration will be suspended from today. The substantive direction erasing your name from the Medical Register as already announced, will take effect 28 days from the date when notice of the determination is deemed to have been served on you unless, in the interim, you exercise your right of appeal. If you lodge an appeal, this order suspending your registration forthwith will continue in force until that appeal is concluded. That concludes your case.

Confirmed 3 September 2010 Chairman

38