dr michael ross 22 january 2016

7/25/2019 Dr Michael ROSS 22 January 2016

1/95

Record of Determinations

Medical Practitioners Tribunal

MPT:Dr ROSS1

PUBLIC RECORD

Dates: 1/10/2015-7/10/2015Reconvened: 7/12/2015-9/12/2015Reconvened: 11/01/2016 -22/01/2016

Medical Practitioners name: Dr Michael ROSS

GMC reference number: 2271383

Primary medical qualification: MB BS 1975 University ofLondon

Type of case Outcome on impairmentNew - Misconduct Impaired

Summary of outcome

Erasure

Immediate order imposed

Tribunal:

Lay Tribunal Member (Chair) Miss Karen Heenan

Lay Tribunal Member: Mr Keith Moore

Medical Tribunal Member: Dr Keith Dunnett

Legal Assessor: Mr Jonathan Whitfield QC

Tribunal Clerk: Mr Ian Leslie (1-7 October2015)Mrs Debra Heaton (7-9December 2015 and 11-22January 2016)

Attendance and Representation:

Medical Practitioner: Present and represented (1-7October and 7-9 December2015)Not present or represented (11-22 January 2016)

Medical Practitioners Representative: Mr Richard Partridge, Counsel,


2/95



MPT:Dr ROSS2

instructed by BLM Solicitors (1-7October and 7-9 December2015)

GMC Representative: Ms Bernadette Baxter,Counsel(1-6 October and 79December 2015 and 11-21January 2016) Mr Alan Taylor,Counsel (22 January 2016)

On 31 December 2015 a number of amendments were made to the Medical Act.These included changes to terminology used, including the way that hearings arereferred to. This hearing commenced before, and concluded after, 31 December2015. The determinations may therefore refer to both Fitness to Practise Panels

(pre-December 2015) and Medical Practitioners Tribunals (post-December 2015).

Allegation and Findings of Fact

That being registered under the Medical Act 1983 (as amended):

1.You were a GP involved in the care of Patient A at the Todmorden Group Practicebetween June 2008 and October 2010.

Admitted and found proved

2.You knew or ought reasonably to have known that Patient A was a vulnerable

patient because of her history of and on going treatment for mental healthproblems.


3. During more than one consultation with Patient A between approximatelySeptember 2009 and August 2010 you:

a. sat with Patient As knees between your knees,Found proved

b. put your hand on Patient As knees,

Found provedc. embraced Patient A.


4. Your behaviour as set out in paragraph 3 above was sexually motivated. Foundnot proved

5. In a consultation, in approximately May 2010, you told Patient A that there was avacant florist shop that she should look at.



3/95



MPT:Dr ROSS3

6. In further consultations between approximately May and July 2010 youmentioned the florist shop to Patient A on more than one occasion. Admitted and found proved

7. In a consultation with Patient A in approximately May - July 2010, you:

a. suggested [Mrs F] as a business partner for and Patient A sharepremises in the florist shop, Found proved as amended

b. gave Patient A [Mrs F]s telephone number,Admitted and found proved

c. suggested that Patient A call [Mrs F] to arrange a meeting to discussthe proposed business partnership. sharing of premises. Found

proved as amendedAmendment made pursuant to paragraph 17(6)(2016)

8. In approximately Spring/Summer 2010 you telephoned Patient As parentslandline, on more than one occasion:


a. to try to obtain contact details for Patient A, Found proved

b. during those calls you were abrupt with Patient As parents when they

declined to provide you with her contact details.Found proved

9. Following the consultation referred to in paragraph 7 above you:

a. obtained Patient As mobile telephone number from her medicalrecords, Found not proved

b. telephoned Patient A, on more than one occasion, asking if she hadcalled [Mrs F] or words to that effect. Found proved

10.In approximately mid/late Summer 2010 you:

a. knew that Patient A had arranged to meet with [Mrs F] to discuss theflorist shop business,


b. told Patient A not to mention her mental health problems to [Mrs F].Found proved


4/95



MPT:Dr ROSS4

11.Between approximately July and September 2010 you:

a. discussed the florist shop business with patient A during consultations,


b. asked Patient A to attend the surgery to collect documents relating tothe florist shop business,Found proved

c. saw Patient A in the florist shop premises in the evenings and/or atweekends.Found proved

12.Between August and October 2010 you exchanged e-mails with Patient A about

the florist shop business.Admitted and found proved

13. In September 2010, after you had received a report from the Dual DiagnosisTeam (the team) about Patient As mental health, you telephoned Patient A andshouted at her about the content of the report asking What is all this? or wordsto that effect. Found not proved

14.In a consultation with patient A on or around 22 September 2010 you:

a.

told Patient A that she needed to write to the team to tell them thatshe was unhappy with their report because it recorded that she wasstill taking alcohol and illegal drugs,Found proved

b. typed a letter, dated 27 September 2010, to the team purporting to befrom Patient A,Found not proved

c. did not record in Patient As clinical record that you had typed a letterin Patient As name.Found not proved

15.Following the consultation referred to in paragraph 14 above you asked Patient Ato keep her mental health problems under the radar or words to that effect.Found proved

16.You had a financial interest in the florist shop business opened by Patient A and[Mrs F].


17.Your actions as set out in paragraphs 10(b), 14(b) & (c) and 15 were:


5/95



MPT:Dr ROSS5

a. misleading,Found not proved in its entirety

b.

dishonest.Found not proved in its entirety

18. In February 2013 you were working as a Locum General Practitioner atthe Calderdale Community Practice.

19. On 8 and 15 February 2013, in a consultation with Patient 1, you failed toprovide good clinical care in that you did not:

a. take an adequate history, including an exploration of possible

addiction issues;

b. undertake an adequate examination, including a mental state

examination;

c. formulate an adequate follow up plan;

d. make an adequate clinical note of the matters set out in sub-paragraphs

19a-c above;

e. record your previous knowledge of Patient 1 in a different clinical setting;

f. on 15 February 2013 make an adequate clinical note of your rationale fora diagnosis of PTSD.

20. On 7 February 2013, in a consultation with Patient 2, you failed to provide goodclinical care in that you did not:

a. implement a management plan for treatment and/or rehabilitation of backpain and carpal tunnel syndrome when issuing a sick note for thoseconditions;

b. implement a new patient care plan when prescribing tramadol anddiazepam;

c. record the matters referred to in sub-paragraphs 20a-b above in the clinicalrecord;

d. prescribe benzodiazepines and opioids with sufficient caution in that youdid not;

i. limit the duration of the prescription to one month,


6/95



MPT:Dr ROSS6

ii. record the strength, dose, frequency and total quantity of theprescriptions in the clinical record,

e. record your previous knowledge of Patient 2 in a different clinical setting.

21. On 8 February 2013, in a consultation with Patient 4, you failed to providegood clinical care in that you did not:

a. take an adequate history, including an evaluation of Patient 4's anxiety anddepression;

b. undertake an adequate examination, including a mental state examination;


d. make an adequate clinical record of the matters set out in sub-paragraphs21a-c;

e. amend a prescription for 30 mirtazapine tablets to 14 tablets on thecomputer as you should have done to ensure the amended prescriptionwas recorded in the clinical record;

f. record your rationale for amending the prescription referred to in sub-paragraph 21e above in the clinical record;

g. record your previous knowledge of Patient 4 in a different clinical setting.


a. record the reason why you had issued Patient 5 with a sharp safe device;

b. record your previous knowledge of Patient 5 in a different clinical setting;

c. on 14 February 2013 when Patient 5 complained of chest pain you did not;

i. take an adequate history,

ii. undertake an adequate examination of patient 5s heart including acheck of the patients blood pressure,

iii. consider and/or make a referral for an ECG,

iv. diagnose the patients chest pain,

v. formulate an adequate follow up plan,


7/95



MPT:Dr ROSS7

vi. make an adequate clinical record of the matters set out in sub-paragraphs 22ci-v above.

23. a. On 15 February 2013, in a consultation with Patient 6, you prescribed84 x 300 milligram tablets of gabapentin.

b. You failed to provide good clinical to Patient 6 in relation to theprescription referred to in sub-paragraph 23a above in that you did not:

i. advise Patient 6 to start with a low dose and gradually increase theamount taken to titrate the dose upwards,

ii. record the advice referred to in sub-paragraph 23bi above in the

clinical record.

24. On 7 February 2013, in a consultation with Patient 7, you failed to provide goodclinical care in that you did not:

a. take an adequate history from Patient 7 in relation to her;

i. nicotine addiction,

ii. insomnia and the need for zopiclone,

iii. menstrual problems and the need for norethisterone,

iv. need for gabapentin and buscopan,

b. undertake an adequate examination of Patient 7 in respect of thematters set out in sub-paragraphs 24ai-iv above;

c. formulate an adequate follow up plan in respect of the mattersset out in sub-paragraphs 24ai-iv above;

d. make an adequate clinical record of the matters set out in sub-paragraphs 24a-c above;

e. adequately record your previous knowledge of Patient 7 in a differentclinical setting;

f. record that Patient 7 was due to have a mesh rectoplexy the dayfollowing your consultation with her.

25. On 14 February 2013, in a consultation with Patient 8, you failed to provide

good clinical care in that you did not:


8/95



MPT:Dr ROSS8

a. take an adequate history, including a history of;

i. hypertension,ii.

insomnia,iii. alcohol misuse,iv. depression,v. diazepam use,vi. asthma.

b. undertake an adequate examination in respect of the matters set out insub-paragraphs 25ai-vi above including blood pressure and peak flow;

c. formulate an adequate follow up plan in respect of the matters set out in

sub-paragraphs 25ai-iv above;

d. make an adequate clinical note of the matters set out in sub-paragraphs 25a-c above;

e. prescribe an appropriate dose of diazepam;

f. record your previous knowledge of Patient 8 in a differentclinical setting.

26. On 15 February 2013, in a consultation with Patient 8, you failed to providegood clinical care in that you:

a. did not measure Patient 8s peak flow;

b. prescribed 84 x 10 milligram propranolol tablets (a beta blocker) whenyou knew or ought reasonably to have known that Patient 8 was alsoprescribed 28 x 10 milligram montelukast tablets for asthma;

c. did not adequately consider the danger of "bronchospasm" created by thecombination of medication set out in sub-paragraph 26b above;

d. record the matters set out in sub paragraphs 26a-c above;

e. record your previous knowledge of Patient 8 in a differentclinical setting.

27. On 7 and 14 February 2013, in a consultation with Patient 10, you failed toprovide good clinical care in that you:


9/95



MPT:Dr ROSS9

a. prescribed an opiate dependent detoxification regime that was not safe toprescribe in a primary care setting;

b. did not take an adequate history from Patient 10 before implementing theregime referred to in sub-paragraph 27a above;

c. did not undertake an adequate examination of Patient 10 beforeimplementing the regime referred to in sub-paragraph 27a above;

d. did not undertake any or any adequate investigations on Patient 10 beforeimplementing the regime referred to in sub-paragraph 27a above;

e. did not check Patient 10's blood pressure before prescribing lofexidineand/or propranolol;

f. did not arrange for the regular monitoring of Patient 10's blood pressurewhilst he was prescribed lofexidine and/or propranolol;

g. did not arrange for the regular monitoring of Patient 10's level ofconsciousness whilst he was prescribed the regime referred to in sub-paragraph 27a above;

h. did not implement an adequate management plan to ensure that Patient 10did not exceed the stated dose and/or take illicit drugs in conjunction with the

prescribed drug regime;

i. prescribed methadone without explaining the difference in dose betweenconsultations and/or the difference in dose from that prescribed on 6February 2013 by a different doctor;

j. did not record the matters set out in sub-paragraphs 27b-i above in theclinical record.


a. measure Patient 11s blood pressure before prescribing lofexidine;

b. arrange for the regular monitoring (daily or alternate daily) of Patient11's blood pressure whilst he was prescribed lofexidine;

c. undertake a urine drug test for the presence of opioids beforeprescribing naltrexone;


10/95



MPT:Dr ROSS10

d. undertake a liver function test before prescribing naltrexone;

e. prescribe the recommended starting dose of naltrexone;

f. follow usual practise by not prescribing lofexidine and naltrexone together;

g. prescribe the recommended starting dose of choral betaine;

h. formulate an adequate follow up plan;

i. record your rationale for the matters set out in sub-paragraphs 28a-habove in the clinical record;

j. record your prior knowledge of Patient 11 in a different clinical setting.

29. On 7 February 2013, in a consultation with Patient 12 you failed to provide goodclinical care in that you did not:

a. take an adequate history, including consideration Patient 12's opiateaddiction before prescribing diazepam;

b. undertake a urine test on Patient 12 before prescribing diazepam;

c. implement a treatment plan including adequate follow up and/ormanagement for Patient 12 whilst she was prescribed benzodiazepines;

d. record the matters set out in sub-paragraphs 29a-c above;

e. record your previous knowledge of Patient 12 in a different clinical setting.

30. On 8 February 2013, you failed to provide good clinical care to Patient 12 in thatyou:

a. issued a prescription for buprenorphine and diazepam on white paper when

you knew or ought reasonable to have known that such a prescription wasnot a valid NHS prescription;

b. issued the prescription referred to in sub-paragraph 30a above when therewas no benzodiazepine treatment plan in place for patient 12;

c. issued a verbal instruction to a pharmacist for an emergency prescription ofdiazepam without implementing a benzodiazepine treatment plan and/orliaising with other prescribers to formulate a treatment plan.


11/95



MPT:Dr ROSS11

31. On 11 February 2013, you failed to provide good clinical care to Patient 12 inthat you issued a verbal instruction to a pharmacist for an emergency prescription ofdiazepam without implementing a benzodiazepine treatment plan and/or liaising with

other prescribers to formulate a treatment plan.

32. On 14 February 2013 you failed to provide good clinical care to Patient 12 inthat you:

a. did not record your rationale for issuing two further prescriptions ofdiazepam for Patient 12;

b. personally attended at the pharmacy to present the prescriptions;

c. changed the dates on the prescriptions by hand;

d. issued the prescriptions without a benzodiazepine treatment plan in placefor Patient 12.


a. undertake a urine drug test to confirm the presence of opioidsbefore prescribing lofexidine;

b. arrange for regular monitoring of Patient 14's blood pressure (daily oralternate daily) whilst she was prescribed lofexidine;

c. arrange an adequate follow up plan;

d. record the matters referred to in sub-paragraphs 33a-c above in theclinical record.

34. On 15 February 2013 you failed to provide good clinical care to Patient 14 inthat you did not:

a. have a further, face to face, consultation with patient 14 beforeprescribing further lofexidine;

b. measure Patient 14's blood pressure;

c. carry out a urine drug test;

d. formulate an adequate follow up plan;

e. record the matters referred to in sub-paragraphs 34a-d above in the

clinical record.


12/95



MPT:Dr ROSS12

35. On 8 and 15 February 2013, in a consultation with Patient 15, you failedto provide good clinical care in that you did not:

a. take an adequate history of Patient 15's depression;

b. undertake an adequate examination of Patient 15's mental state,including suicidal ideation;

c. formulate an adequate follow up plan, including a care plan for diazepamtreatment;

d. on 15 February 2013 perform a urine drug test to confirm the presence ofopioids;

e. record the matters set out in sub-paragraphs 35a-d above in the clinicalrecord.

36. On 7 and 14 February 2013, in a consultation with Patient 16, you failedto provide good clinical care in that you did not:

a. take an adequate history of the patient's alcohol consumption/dependence;

b. undertake an adequate examination, including liver function and breathalcohol;

c. prescribe an alcohol detoxification drug regime as recorded insteadyou prescribed a benzodiazepine reduction regime;

d. formulate an adequate follow up plan;

e. record the matters referred to in sub-paragraphs 36a-d above in the clinicalrecord;

37. On 15 February 2013 you failed to record your rationale for prescribingpatient 16 a further 8 x 150 milligram tablets of trazodone when you had already

prescribed 21 x 50 milligram tablets of trazodone the day before.


a. take an adequate history of Patient 17's depression;

b. undertake an adequate mental state examination, including suicidalideation;



13/95



MPT:Dr ROSS13

d. record the matters referred to in sub-paragraphs 38a-c above in theclinical record;

e. record any previous knowledge of Patient 17 in a different clinical setting.

39. On 19 November 2013, in a GP consultation with Patient 19, you failed toprovide good clinical care in that you:

a. prescribed an excessive dose of lorazepam to Patient 19 namely 28x 1 milligram tablets,

b. did not record in the clinical notes an explanation as to how often themedication should be taken and in what quantity.

Paragraphs numbered 18-39 inclusive withdrawn in their entirety bythe GMC

18. a. In February 2013 you were working as a General Practitioner at theCalderdale Community Practice.Admitted and found proved

b. Between 2010 and 2012 you worked as a General Practitioner at theTodmorden Group Practice.Admitted and found proved

19. On 8, 14 and 15 February 2013, you failed to provide good clinical care to

Patient 1, in that you did not:

a. take an adequate history, including an exploration of possible addiction

issues; Found not proved


examination; Found not proved

c. formulate an adequate follow up plan; Found not proved

d.

make an adequate clinical note of the matters set out in sub-paragraphs 19a-c above;Admitted and found proved

e. record your previous knowledge of Patient 1 in a different clinical

setting;Admitted and found proved

f. on 15 February 2013 you did not make an adequate clinical note of

your rationale for a diagnosis of PTSD recordingPTSDin the clinical

record.Admitted and found proved


14/95



MPT:Dr ROSS14

20. On 26 August 2010, in a consultation with Patient 4, you failed to providegood clinical care in that you did not:

a.

undertake any adequate examination of Patient 4 who reported that hehad vomited blood;Admitted and found proved

b. arrange any adequate investigations into Patient 4's symptoms referred

to in sub-paragraph 20a. above;Admitted and found proved

c. formulate an adequate follow up plan; Found proved

d. make an adequate clinical record of the matters set out in sub-paragraphs 20a-c above.Admitted and found proved

21. On 9 October 2012 you failed to provide good clinical care to Patient 4 inthat you prescribed hydrocortisone, a topical steroid, for rosacea when youknew or ought reasonably to have known that topical steroids are contra-indicated for the treatment of rosacea. Found proved


a. take an adequate history, including an evaluation of Patient 4's anxiety

and depression; Found not proved


examination; Found proved


d. make an adequate clinical record of the matters set out in paragraphs

22a.-c. above;Admitted and found proved

e.

amend a prescription for 30 mirtazapine tablets to 14 tablets on thecomputer as you should have done to ensure the amended prescription

was recorded in the clinical record;Admitted and found proved

f. record your rationale for amending the prescription referred to in sub-

paragraph 22e. above in the clinical record;Admitted and found

proved

g. record your previous knowledge of Patient 4 in a different clinical

setting.Admitted and found proved


15/95



MPT:Dr ROSS15

23. On 14 February 2013, in a consultation with Patient 5, you failed to providegood clinical care in that you did not :

a.

take an adequate history of Patient 5's chest pain;

b. make an adequate clinical record of the matters set out in sub-paragraphs 23a above.

make an adequate clinical record of whychestpainwas entered in thepatient record.Admitted and found proved

24. In August 2012 you failed to provide good clinical care to Patient 7 in thatyou:

a. prescribed a 50mg dose of diazepam to Patient 7 to be taken at night fora week when you knew or ought reasonably to have known that thisexceeded the maximum licensed daily dosefor diazepam, Foundproved

b. did not record your rationale for the prescription referred to at subparagraph 25 24a above, Found proved

c. did not take an adequate history before prescribing diazepam, Foundproved

d. did not undertake an adequate examination before prescribingdiazepam, Found proved

e. did not formulate an adequate follow up plan in respect of thepatient use of diazepam. Found proved


a. take an adequate history from Patient 7 in relation to her;

i. nicotine addiction;ii. insomnia and the need for zopiclone;iii. menstrual problems and the need for norethisterone;iv. need for gabapentin and buscopan;

Found not proved in its entiretyb. formulate an adequate follow up plan in respect of the

matters set out in sub- paragraphs 26 25ai-iv above;Found not proved


16/95



MPT:Dr ROSS16

c. make an adequate clinical record of the matters set out in sub-paragraphs 26 25a-b above;Admitted and found proved

d.

adequately record your previous knowledge of Patient 7 in a differentclinical setting;Admitted and found proved


a. take an adequate history, including a history of,

i. alcohol misuse,ii. depression,iii. diazepam use,

iv.

asthma.Found not proved in its entirety

b. undertake an adequate examination in respect of the matters set out insub-paragraphs 26 27ai-iv above including blood pressure and mentalstate examination; Found proved

c. formulate an adequate follow up plan in respect of the matters set outin sub-paragraphs 26 27ai-iv above, in particular, the patient's use ofdiazepam and Propranolol; Found not proved

d. make an adequate clinical note of the matters set out in sub-paragraphs 26 27a-c above;Admitted and found proved

e. prescribe an appropriate dose and quantity of diazepam;Admittedand found proved

f. record why you were prescribing further diazepam for Patient 8 whenyou had issued a prescription for diazepam the day before on 14February 2013;Admitted and found proved

g. record your previous knowledge of Patient 8 in a different clinicalsetting.Admitted and found proved

27. On 7 and 14 February 2013, in a consultation with Patient 10, you failed toprovide good clinical care in that you:

a. prescribed an opiate dependent detoxification regime that was not safeto prescribe in a primary care setting; Found proved


17/95



MPT:Dr ROSS17

b. did not take an adequate history from Patient 10 before implementingthe regime referred to in sub-paragraph 27 28a above; Foundproved

c. did not undertake an adequate examination of Patient 10 beforeimplementing the regime referred to in sub-paragraph 27 28a above;Found proved

d. did not undertake any or any adequate investigations, in particular aurine test, on Patient 10 before implementing the regime referred to insub-paragraph 27 28a above; Found proved

e. did not check Patient 10's blood pressure before prescribing lofexidineand/or propranolol;Admitted and found proved

f. did not arrange for the regular (daily) review of Patient 10 whilst hewas prescribed the regime referred to in sub-paragraph 27 28a aboveto monitor;

i. blood pressure;ii. levels of consciousness;iii. compliance;iv. signs of withdrawal;Admitted and found proved in its entirety

g. did not liaise with the community drug team who were prescribingmethadone to the patient;Admitted and found proved

h. did not record the matters set out in sub-paragraphs 27 28b-g abovein the clinical record.Admitted and found proved

28. Between 18 January 2013 and 7 February 2013 you failed to provide goodclinical care to Patient 11 in that you did not:

a. undertake a urine drug test for the presence of opioids or other drugsof addiction before prescribing naltrexone;Found proved

b. undertake a liver function test before prescribing naltrexone;Found proved

c. prescribe the recommended starting dose of naltrexone;Found proved

d. prescribe an appropriate dose of choral chloralbetaine in that youexceeded the maximum licensed dose;

Amended pursuant to Rule 17(3) (9/12/15)


18/95



MPT:Dr ROSS18

e. formulate an adequate follow up plan;Admitted and found proved

f. record your rationale for the matters set out in sub-paragraphs 28a-e

above in the clinical record;Admitted and found proved

g. record your prior knowledge of Patient 11 in a different clinical setting.Admitted and found proved


a. take an adequate history including consideration of Patient 12's opiateaddiction before prescribing diazepam;Found proved

b.

undertake a urine test on Patient 12 before prescribing diazepam;Found proved

c. implement a treatment plan including adequate follow up and/ormanagement for Patient 12 whilst she was prescribed benzodiazepines;Found proved

d. record the matters set out in sub-paragraphs 29 30a-c above;Admitted and found proved

e. record your previous knowledge of Patient 12 in a different clinicalsetting.Admitted and found proved

30. On 8 February 2013 you failed to provide good clinical care to Patient 12:

a. Issued a prescription for buprenorphine and diazepam on white paperwhen you knew or ought reasonably to have known that such aprescription was not a valid NHS prescription; Found proved

b. Issued the prescription referred to in sub-paragraph 30 31a whenthere was no benzodiazepine treatment plan in place for Patient 12;Found proved

c. issued a verbal instruction to a pharmacist for an emergencyprescription of diazepam without implementing a benzodiazepinetreatment plan. Found proved

31. On 14 February 2013 you failed to provide good clinical care to Patient 12 inthat you:

a. did not record your rationale for issuing two further prescriptions ofdiazepam for Patient 12; Found proved


19/95



MPT:Dr ROSS19

b. personally attended at the pharmacy to present the prescriptions;Found not proved

c.

changed the dates on the prescriptions by hand;Found not provedd. issued the prescriptions without a benzodiazepine treatment plan in

place for Patient 12. Found proved


a. undertake a urine drug test to confirm the presence of opioids andother drugs of addiction before prescribing lofexidine and/or diazepam;Found proved

b.

arrange for regular monitoring of Patient 14's blood pressure (daily oralternate daily) whilst she was prescribed lofexidine;

Admitted and found provedc. arrange an adequate follow up plan; Found proved

d. record the matters referred to in sub-paragraphs 32 33a-c above inthe clinical record.Admitted and found proved

33. On 15 February 2013 you failed to provide good clinical care to Patient 14when prescribing further lofexidine in that you did not:

a. record if Patient 14 was present in a consultation with you; Foundproved

b. measure Patient 14's blood pressure; Found proved

c. carry out a urine drug test; Found proved

d. formulate an adequate follow up plan; Found proved

e.

record the matters referred to in sub-paragraphs 33 34b-d above inthe clinical record. Found not proved


a. take an adequate history of Patient 15's depression; Found notproved

b. undertake an adequate examination of Patient 15's mental state,including suicidal ideation; Found not proved


20/95



MPT:Dr ROSS20

c. formulate an adequate follow up plan, including a care plan fordiazepam treatment; Found proved

d. on 15 February 2013 perform a urine drug test to confirm the presenceof opioids and benzodiazepines; Found proved

e. record the matters set out in sub-paragraphs 3435a-d above in theclinical record.Admitted and found proved


a. take an adequate history of the patient's alcohol

consumption/dependence; Found not proved

b. prescribe an alcohol detoxification drug regime as recorded instead youprescribed a benzodiazepine reduction regime; Found proved

c. formulate an adequate follow up plan; Found proved

d. record the matters referred to in sub-paragraphs 3536a-d above inthe clinical record.Admitted and found proved

36.

On 15 February 2013,you did notrecord your rationale for prescribingPatient 16 a further 8 x 150 milligram tablets of trazodone when you hadalready prescribed 21 x 50 milligram tablets of trazodone the day before.

Amendment following successful application under Rule17(3)(2015)

Admitted and found proved37. On 8 February 2013, in a consultation with Patient 17, you failed to provide

good clinical care in that you did not:

a. take an adequate history of Patient 17's depression and alcohol

dependence; Found not proved

b. undertake an adequate mental state examination, including suicidalideation; Found not proved


d. record the matters referred to in sub-paragraphs 3738a-c above inthe clinical record;Admitted and found proved


21/95



MPT:Dr ROSS21

e. record any previous knowledge of Patient 17 in a different clinicalsetting.Admitted and found proved

38.

On 19 November 2013, in a GP consultation with Patient 19, you failed toprovide good clinical care in that you:

a. prescribed an excessive dose of lorazepam to Patient 19 namely 28 x 1milligram tablets;Admitted and found proved

b. did not record in the clinical notes an explanation as to how often themedication should be taken and in what quantity.Admitted andfound proved

Allegation amended by the insertion of new paragraphs 18-38 inclusive, as

amended, following successful application for amendment under Rule17(3)(2015)

And that by reason of the matters set out above your fitness to practise is impairedbecause of your misconduct.

Attendance of Press / PublicThe hearing was all heard in public.

Determination on an adjournment

Dr Ross:

1. At the outset of the hearing and before any substantive issues were raised,Ms Baxter and Mr Partridge made an application to partially adjourn this hearing withregards to heads of charges 18 to 39.

2. Mr Partridge stated that the disclosure of medical records in this case hasoccurred recently. However your legal representatives only received the medicalrecords for the last four cases yesterday. He submitted that an expert report,

commissioned by your representatives, has not been finalised in these four cases.

3. Mr Partridge submitted that a hearing including the clinical issues will take alot longer than the 14 days allotted.

4. Mr Partridge stated there are contested issues by both sides and, in a casesuch as this, the two medical experts could meet up and collate their responses. Hesubmitted that this would save time in the long run.


22/95



MPT:Dr ROSS22

5. Mr Partridge also submitted that the panel should hear the facts stage inrelation to allegations 1 to 17. He submitted however that the panel should adjournthe hearing before reaching a finding of facts as this may disadvantage you.

6. Mr Partridge stated that his expert is in full time practice and could not makea full assessment on the reports of these four patients within the 14 days this case islisted for. He stated that he has a meeting with the expert on 14 October 2015 andprogress in this case is reliant upon the revised charges being prepared by the GMCexpeditiously.

7. Mr Partridge was concerned that if this panel opens the case, the panel andboth parties will have to find 20 supplementary days, in his opinion, to properly hearthe heads of charges from 18 to 39. Ms Baxter did not demur from Mr Partridgesestimate.

8. Ms Baxter submitted that prior to meeting today, the defence made twoapplications to postpone to the Case Manager on the basis of not being ready. Bothapplications were refused. She stated that the GMC is ready in the sense that itsevidence is ready. However she stated that the timeframe of 14 days, with two setsof expert evidence and supplemental evidence, is not sufficient.

9. Ms Baxter submitted that, in relation to Patient A, she is a vulnerable witness,these matters go back a considerable time, and the imperative is that her evidenceshould be heard as soon as possible. She submitted that if Patient As evidence is

heard at this hearing, there is no disadvantage to you. She stated that your legalrepresentatives are ready to address the panel on these matters and have a chanceto cross examine her. She submitted that the GMC are content to go ahead with thecase in respect of allegations 1-17.

10. In relation to the four patients whose medical reports were made availableyesterday, Ms Baxter submitted that the expert has been asked to provide asupplemental report which the GMC anticipates having by the end of next week.

Legal Assessor Advice

11. The Legal Assessor advised that, in balancing the needs of Patient A againstyour rights to have a fair and timely hearing, some emphasis should be placed uponher apparent vulnerability and the panel may therefore wish to hear her evidenceand your evidence now, adjourning the clinical issues to a later date. He furtheradvised that should the panel open this case, it will be required to allocate futuredates when parties will be available to continue it and the panel should robustlymanage the future timetable of the case.


23/95



MPT:Dr ROSS23

Panel Decision

12. The panel has determined that it will hear evidence from both parties in

relation to paragraphs 1-17 but that it will not hear submissions from either party onthe facts stage. It will adjourn the rest of the hearing until a later date.

13. This meets the needs of the vulnerable witness and allows you to hear andrespond to her allegations whilst they are fresh in everyones mind. The panel willtherefore hear all the relevant evidence on these issues (paragraphs 1-17) in one goand may thereafter refresh its memory by way of reading transcripts prior to makingits finding of fact. A robust timetable regarding allegations 18 onwards has beenagreed by all parties and will ensure that the case runs smoothly and efficiently tomeet the public interest and ensure that you have a fair hearing within a reasonabletimeframe.

Proposed Timetable

The GMC to serve the final version of the heads of charge 18 onwards uponyour legal representatives by 9 October 2015

The GMC expert report is scheduled to be concluded by 26 October 2015 andwill be served on 30 October 2015

The defence expert will provide a response to the GMC by 14 November 2015 The experts to liaise and/or meet to agree a joint report setting out areas of

agreement or contention between them. To be served by 30 November 2015

This hearing will recommence on 7 December 2015. All documents that the parties wish the panel to read in advance of hearing

live witnesses on 7 December 2015 to be placed on GMC Connect by the endof 2 December 2015.

14. The panel requested transcripts to be placed on GMC Connect and to bemade available to both parties prior to 7 December 2015.

15. The hearing is accordingly adjourned until 7 December 2015. Furtherinformation relating to dates will be announced in due course. The agreed timetable

set out by the panel includes an adjourned hearing after December 2015, namely11-22 January 2016. Every effort should be made to accommodate these dates.

Determination on Facts

Ms Baxter:

1. Since 31 December 2015, amendments have been made to the legislationwhich governs the way in which hearings are conducted, known as the section 60changes. One of these amendments is a change in the terminology to be used and


24/95



MPT:Dr ROSS24

Fitness to Practise Panels are now known as Medical Practitioners Tribunals.Accordingly, in this determination, the term Tribunal will be used throughout.

Admissions on paragraphs 1-17

2. At the outset of this hearing, Mr Partridge, on behalf of Dr Ross, admittedparagraphs 1, 3.c,5,6,7.b, 8,10.a,11.a,12, and 16 of the allegation on your behalf.The Tribunal therefore announced these paragraphs to have been admitted andfound proved.

3. At a later stage, Mr Partridge admitted paragraph 2 of the allegation on behalfof Dr Ross. This paragraph was announced to have been admitted and foundproved.

Application for amendment

4. The hearing was reconvened on 7 December 2015, after having beenadjourned following a joint application made by both parties. This application wasthe subject of an earlier determination. When the hearing reconvened, you made anapplication, on behalf of the General Medical Council (GMC), for the allegation to beamended, by the withdrawal of paragraphs 18-39 inclusive and the substitution ofnew paragraphs 18-38 inclusive. There was no objection and the Tribunal accededto the request.

5. Subsequently, you made a further application to amend paragraphs 19 and24. There was no objection and the Tribunal acceded to the request. The Tribunalalso identified a number of typographical errors in the allegation. Neither partyobjected to the proposed amendments. This determination therefore relates to theallegation, as amended.


6. Following the amendments referred to above, Mr Partridge went on to makefurther admissions on Dr Rossbehalf in respect of paragraphs 18.a, 18.b, 19.d,

19.e, 19.f, 20.a, 20.b, 20.d, 22.d, 22.e,22.f, 22.g, 23, 25.c, 25.d, 26.d, 26.e, 26.f,26.g, 27.e, 27.f (in its entirety),27.g, 27.h, 28.e, 28.f, 28.g, 29.d, 29.e, 32.b, 32.d,34.e, 35.d, 36, 37.d, 37.e, 38.a, and 38.b. The Tribunal announced theseparagraphs of the allegation as admitted and found proved.

7. Mr Partridge also told the Tribunal that Dr Ross accepted the factual basis ofparagraphs 24.b, 28.a, 28.b, 29.b, 30.a, 30.c, 31.b, 31.c, 32.a, 33.a and 34.d.However, he said that Dr Ross denied that there was any failure on his part toprovide good clinical care in respect of those matters.


25/95



MPT:Dr ROSS25

Determination on an application to proceed in the absence of the doctor

8. Dr Ross was present and represented by Mr Richard Partridge, Counsel, for

the first eight days of this hearing, which adjourned part-heard on 9 December2015. When the hearing resumed on 11 January 2016, Dr Ross was not present orrepresented.

9. The Tribunal considered whether to proceed in Dr Ross absence in accordancewith Rule 31. It bore in mind that its discretion to proceed in the absence of thepractitioner must be exercised with caution and with regard to the overall fairness of theproceedings. It balanced the interests of the practitioner, including fairness to him,against the public interest, which includes the need to protect patients.

10. The Tribunal was provided with an email sent to the GMC by Dr Ross on 8

January 2016 in which he stated that he would not be present at the reconvenedhearing. He stated that he had discussed the matter with his former appraiser andsupporter, who had advised him especially without the benefit of having legalrepresentation that I should extract myself from the GMC process immediately andas completely as possible. XXX He also attached a document setting out his writtensubmissions regarding the matters alleged against him and said other documentswould be forwarded to the Tribunal, which were subsequently received.

11. Dr Ross made no formal application for an adjournment and did not requestany time to allow him to obtain other legal representation. The Tribunal also noted

that Dr Ross did not say that any of the circumstances mentioned in his email to theGMC prevented his attendance, but instead that they had influenced his decision notto attend for the rest of the hearing. It also noted that he stated that he hadaccepted the advice of his former appraiser who advised him to bring the hearing toa rapid conclusion.The Tribunal considered that Dr Ross comments in this respectwere a request for the hearing to proceed and not for it to be adjourned to a futureoccasion. Further, his email to the GMC, including his detailed comments regardingthe allegation against him, demonstrated that Dr Ross anticipated that the hearingwould proceed in his absence. In all these circumstances, the Tribunal consideredthat Dr Ross had deliberately absented himself and voluntarily waived his right to be

represented at this hearing.

12. The Tribunal also took account of the public interest, in particular in ensuringthat the case is dealt with expeditiously and the need to be fair to all parties. Whenconsidering the interests of the parties to the hearing, the Tribunal noted that, at anearlier stage, Dr Ross provided oral evidence in respect of that part of the GMC casethat related to Patient A, and was able to instruct his representative to present hiscase in the cross examination of GMC witnesses. Substantial documentation puttingforward his defence to the matters alleged had also been presented on his behalf tothe Tribunal. As outlined above, Dr Ross had also taken the opportunity to make


26/95



MPT:Dr ROSS26

further comments regarding the allegation in his email to the GMC dated 8 January2016.

13. The Tribunal noted that it had already received oral evidence from Dr Rossrelating to that part of the allegation involving Patient A, and would therefore beable to reach an assessment of his credibility in respect of that evidence in duecourse. It did, however, also bear in mind that, since Dr Ross was no longerattending the hearing, the Tribunal would, in due course, be required to assess theweight of the documentary evidence presented by him in respect of the clinicalaspects of his case, bearing in mind that this evidence had not been tested bymeans of cross examination. The Tribunal considered that, in these circumstances, itwould not be unfair to Dr Ross to proceed in his absence. In all the circumstances,the Tribunal determined that it was in the public interest and in Dr Ross owninterests to exercise its discretion and proceed with the case in his absence.

14. The Tribunal concluded it would be unfair to draw any adverse inference fromDr Ross non-attendance and it did not do so.

Determination on the facts

15. The Tribunal has taken account of the evidence, both oral and documentary,received in this case. It has also taken account of your submissions, on behalf of theGMC, and the written submissions made by Dr Ross.

16. The GMC called the following witnesses to give oral evidence:

Patient A Mrs A, Patient As mother

Mr A, Patient As step-father Dr B, a GP at Calder Community Practice.

17. Dr C, General Practitioner, provided expert oral evidence on behalf of theGMC, as well as his reports dated 6 March 2015, 23 October 2015 and 28 November2015.

18. The Tribunal also received witness statements from

Dr D, Deputy Medical Director for NHS England West Yorkshire, and Ms E, Advanced Nurse Practitioner.

19. Dr Ross gave oral evidence in respect of those allegations relating to Patient Aand oral evidence was also received from Mrs F. Witness statements were alsopresented on his behalf from:

Ms G, dated 30 September 2015


27/95



MPT:Dr ROSS27

Ms H, dated 28 September 2015. Ms I, dated 23 September 2015

20. The Tribunal also received documentation from Dr Ross, which included anumber of supportive testimonials.

Background to the reconvened hearing

21. At the outset of this hearing in October 2015, it became clear that, due topractical considerations, it was not possible for the evidence in respect of the clinicalmatters alleged against Dr Ross to be presented to the Tribunal at that time.Consequently, and with the agreement of both parties, the Tribunal received oralevidence on behalf of both the GMC and Dr Ross, which was limited to those parts ofthe allegation concerning Patient A. In particular, Dr Ross gave oral evidence in

relation to those matters and was cross examined.

22. The hearing was adjourned part-heard and, when it reconvened in December2015, it received evidence on behalf of the GMC regarding the clinical aspects of thecase at which time Dr Ross was present, represented and his case was put in crossexamination.

23. At the reconvened hearing which began on 11 January 2016, Dr Ross was nolonger present or represented. Consequently, the Tribunal has not received any oralevidence from Dr Ross in respect of the clinical aspects of the allegation, although

documentary evidence was presented by him and on his behalf. The Tribunal hastaken account of the cross examination of Dr C, which highlighted matters that DrRoss disputed.

The Tribunals deliberations

24. The Tribunal has taken account of your submissions, on behalf of the GMC,and the written submissions made by Dr Ross.

25. The Tribunal has borne in mind that the burden of proof rests with the GMC

and that the standard of proof is on the balance of probabilities, which means thatthe Tribunal will be satisfied that an event occurred if it considers that theoccurrence of the event was more likely than not.

The witness evidence

Patient A

26. The Tribunal considered that Patient A, at times, appeared confident andimpressive, but was also anxious. She appeared to be genuinely trying to do herbest in her replies to questions and was clear when she did not know an answer to a


28/95



MPT:Dr ROSS28

question. The Tribunal concluded that Patient A was generally plausible and sincere.The Tribunal bore in mind that much of the evidence she was required to giverelated to events which occurred over five years ago, and that this presented

difficulties in recollection. However, the Tribunal also noted that some aspects ofPatient As behaviour indicated that, despiteoutward appearances, she found theproceedings difficult. On occasions, Patient A appeared to become confused aboutthe number, sequence and timing of events.

27. It was not in dispute that Patient A visited the florist shop with a friend, afterDr Ross told her about the vacant premises and despite the possibility of enteringinto a business arrangement with Mrs F, and Patient A began negotiations for alease of the premises with the landlord. The Tribunal gave careful consideration tothese circumstances. Patient A said that she had been accompanied by a friend whowas described as her business partner and she had no intention of taking the lease

herself, but that the process had been a fact-finding process,before entering intobusiness with Mrs F. Although Dr Ross contended that this demonstrated that shewas not trustworthy and that her evidence was therefore not reliable, the Tribunaldid not conclude that this information, in itself, made the entirety of her evidenceunreliable, but it is an example of the care with which some of her assertions had tobe taken by the Tribunal. It considered that Patient A had been frank about hermotivation for conducting her business enquiries in this manner and that she hadbeen trying to ensure that she was entering into a good deal.

28. The Tribunal also considered the circumstances in which this allegation came

to light, following a dispute between Patient A and Dr and Mrs F over the business.The Tribunal concluded that this did not completely undermine Patient As evidence,but that parts of the evidence may have been exaggerated or recalled by Patient Ain a light favourable to her.

Mrs A and Mr A

29. Mrs A and Mr A both gave their evidence in a straightforward and forthrightmanner. The Tribunal did not consider that there was any evidence of collusion,either with each other or with Patient A. They were aware of the limitations in their

knowledge and the Tribunal considered that they were credible witnesses.

30. The Tribunal noted that Mrs A had views regarding Dr Ross motivation andthat her evidence was given in support of her daughter. However, the Tribunalconsidered that this did not affect her truthfulness and she provided independentand reliable evidence.

Mrs F

31. The Tribunal formed the view that Mrs F provided clear and straightforwardevidence in the hearing.


29/95



MPT:Dr ROSS29

Dr Ross

32. When considering the credibility of Dr Ross oral evidence, the Tribunal borein mind that he is a person of good character. It took account of the advice of theLegal Assessor that a person of good character may be less likely to be untruthfulthan someone of bad character and may have a lesser propensity to breach rules orguidelines. It also took into account the complimentary testimonial evidenceconcerning his character and clinical expertise. However, it also noted that Dr Rossevidence regarding the clinical aspects of the case had not been tested by way ofcross examination.

33. The Tribunal considered Dr Ross evidence was given confidently, although hedid, on occasion, give the impression that he had a high opinion of his own abilities

and experience. Further, the Tribunal noted that he became less confident, andtherefore less convincing when he was challenged in his evidence, as he appearedreluctant to consider anothers opinion. On occasion, the Tribunal considered thathe became evasive, for example, when asked about his touching of Patient A.

34. With regard to the clinical matters, the Tribunal noted that Dr Ross is anexperienced GP, although he did not provide evidence of a formal qualification inrelation to addiction issues. It also noted that the Todmorden Group practice did notwork in collaboration with the local Substance Misuse Service for shared carearrangements for patients with addiction issues. He was therefore working, at the

time, in isolation from support services for this particular patient group. The Calderpractice had a policy not to accept patients with these issues, although Dr Rosscontinued to treat such patients when he was working for that practice. The Tribunalacknowledged that Dr Ross had shown an interest in the general area of drugmisuse and dependence and that he had been Clinical Director of Bradford DrugDependency Clinical Services from 1996-2005. There was no evidence of any formalroles or continuing professional development in that area of clinical practice after2005.


Dr C

35. The Tribunal noted that Dr C is an experienced GP, who also has significantexperience in treating patients with addiction issues. It considered that his evidencewas convincing, and was supported by reference to nationally implemented clinicalguidelines, namely Drug misuse and dependence: UK guidelines on clinicalmanagement(known as the Orange guidelines) and backed up by his ownexperience. The Tribunal considered that Dr Cs evidence was not in support of a

gold standard, but rather he indicated the level of care and experience required ofall GPs, including Dr Ross, to meet the needs of a challenging patient group. Dr C


30/95



MPT:Dr ROSS30

did not provide blinkered evidence in support of clinical guidelines, rather he wasable to explain the risks and potential unsafe nature of practice which might arise byfailing to follow the guidelines. Dr C was also prepared to concede points when he

was provided with additional information. The Tribunal concluded that Dr C providedrobust expert evidence to the hearing outlining the appropriate standard of care andexpertise to be applied in this case.

The Tribunals findings

36. The Tribunal has considered each paragraph of the allegation separately andhas reached the following findings:

Background to paragraphs 1-17

37. Patient A had originally lived in the Todmorden area. She had been trainedand worked as a florist, and had also lived in the Manchester area where she workedas a junior fee earner at a firm of solicitors. Patient A returned to the Todmordenarea where her parents were living and registered at the Todmorden practice whereDr Ross was working as a GP in June 2008. Patient A suffered from a number ofmental health concerns, and had been under the care of mental health services inManchester. Dr Ross has accepted that he was aware of her vulnerabilities.

38. Patient A was made redundant from her role as a florist in the summer of

2010. Following a consultation with Dr Ross, when he told her that there was avacant florist shop in Haworth, she arranged to view the premises with a friend. Shebegan negotiations for a lease with the landlord, Ms H, although Patient A withdrewfrom the transaction on 22 July 2010.

39. Patient A and Mrs F met each other at the end of July 2010, and theysubsequently agreed a business arrangement to work together in the vacant floristshop. Patient A registered with the Calder Practice on 24 September 2010, when sheceased to be registered as a patient of Dr Ross.

40. The business at the florist shop opened in mid-October 2010. Patient Aseparated from her partner at Christmas 2010, and tried to commit suicide. She washospitalised and absent from the business, returning in January 2011. Patient A andMrs F ran the business in Haworth together until March 2013. They also opened asecond shop together in 2012. However, a number of differences arose betweenPatient A and Mrs F and the business arrangement came to an end, although therewere ongoing financial disagreements.

41. On 4 May 2013, Patient A attended a consultation with Dr B, and specificallyrequested her to write in the notes that her ex-business partner was XXX formerTodmorden GP, Dr Ross. It was recorded that Patient A felt angry and betrayed,


31/95



MPT:Dr ROSS31

particularly due to Dr Ross profession. The matter was subsequently referred to theGMC.

Paragraph 3

During more than one consultation with Patient A between approximatelySeptember 2009 and August 2010 you:

a. sat with Patient As knees between your knees, Found proved

42. The Tribunal noted that Patient A had four consultations with Dr Ross thatwere recorded in the period alleged.

43. Patient A told the Tribunal that Dr Ross sat with her knees between his kneesand that he would touch her hand and place his hand on her knee, with an overlapbetween his knees and her own, and that this occurred on numerous occasions. Shesaid she was uncomfortable and she was concerned that his behaviour wasoverfamiliar. She said that she mentioned it to her mother, who attended twoappointments and witnessed this behaviour.

44. Patient As mother told the Tribunal that when Patient A told her that Dr Rosshad approached her about going into business, she attended with Patient A at thenext consultation. Patient As mother said that, during theappointment, Dr Ross was

very touchy towards Patient A. At the following appointment, she said that she wastotally shocked when he positioned his chair directly in front of Patient A with hislegs spread wide on either side of her legs, getting hold of her hands and touchingher arms, while he spoke to Patient A about the business proposition.

45. In Dr Ross statement dated 28 September 2015, he stated that he did nothave any recollection of any occasion when he deliberately touched Patient As kneesor sat with his knees between hers. He acknowledged that he was generally tactilewith patients and would sometimes hug patients. He stated that it was possiblethat, on occasion, he touched Patient As hands in a sympathetic fashion, and that

this was likely because she was doing well and making progress. Dr Ross stated thatpatients sit on a chair to the right hand side of his desk in his consulting room. Hesaid that, on occasion, he would wheel his chair, which was on castors, towards thepatients chair. He stated that, although he had not consciously sat in a position thatmeant that his legs were on either side of a patients legs, there may have beenaccidental touching of their knees with his own, given the proximity of the chairs.

46. In the light of the clear evidence by Patient A and Mrs A and the explanationgiven by Dr Ross regarding the manner in which he sat in his consultation room, theTribunal considers that it is more likely than not Dr Ross sat with Patient As knees


32/95



MPT:Dr ROSS32

between his own on more than one occasion as alleged. Accordingly, this paragraphof the allegation is found proved.

b. put your hand on Patient As knees, Found proved

47. Patient A alleged that Dr Ross would place his hand on her knee. Dr Rossdenied that he did so, although he accepted that he might have placed his handover hers, when it was placed on her knee.

48. In her evidence, Mrs A said that Dr Ross rubbed Patient As legs, during theconsultations.

49. The Tribunal noted that there was a discrepancy in the manner in which DrRoss was alleged to have touched Patient A, as stated by Patient A and her mother,

albeit that her mother confirmed that some touching took place. It considered thatPatient A was more likely to provide a reliable account than her mother, since shewas the person who had been touched. Dr Ross accepted that he might havetouched Patient As hands when they were resting on her knees and the Tribunalnoted his evidence that he was tactile with patients. In all the circumstances, theTribunal has concluded, on the balance of probabilities, that Dr Ross touched Patient

As knees during his consultations with her. Accordingly, this paragraph of theallegation is found proved.

Paragraph 4

Your behaviour as set out in paragraph 3 above was sexually motivated.Found not proved

50. In her witness statement, dated 7 September 2015, Patient A stated that DrRoss would embrace her as she was leaving appointments and would pat her on theback, which she felt was a way to reassure her. She said that she did not want tochallenge him as she did not want to offend him in case he was just being nice. Shesaid that, at that time, her emotions were all over the place, her illness wasundiagnosed and she did not know if she was overreacting. She said that she was an

over trusting person and she did not want to cause a scene as she relied on DrRoss for help.

51. Dr Ross denied that his conduct towards Patient A had been sexuallymotivated. He said that his behaviour towards her had been no different thantowards many other patients, when he had empathised by sharing compassion orcongratulating them in relation to progress in treatment.

52. The Tribunal considered the long professional relationship which had existedbetween Dr Ross and Patient A and the evidence that, on at least one occasion, thebehaviour complained of had taken place in front of Mrs A, Patient As mother. It


33/95



MPT:Dr ROSS33

also noted the nature of Patient As health issues and her own uncertainty aboutwhether she was overreacting. The Tribunal took account of Dr Ross previous goodcharacter and the testimonial evidence it received on his behalf, in particular the

evidence in those testimonials which supported his own account of his tactilemanner with patients. The Tribunal also bore in mind the academic literatureadduced by Dr Ross regarding empathy, when treating patients.

53. Although the Tribunal considered that such conduct may risk beingmisinterpreted and may cause alarm or offence, in all the circumstances it was notsatisfied on the balance of probabilities, that Dr Ross behaviour was sexuallymotivated. Accordingly, this paragraph of the allegation is not found proved.

Amendment

54. In your submissions on behalf of the GMC, you said that if the Tribunal shouldconsider that there was a material distinction between the sharing of the businesspremises and its understanding of the definition of a business partner or partnership,then it might consider an amendment to paragraph 7 of the allegation to reflect theconcessions made by Dr Ross.

55. The Tribunal noted that, under Rule 17(6), it has the power to amend theallegation at any time, provided that it does not prejudice the doctor.

56. The Tribunal considered that the terms business partner and partnership

indicated a formal partnership agreement between the parties. This did notaccurately reflect the type of informal arrangement which was evidenced as havingbeen suggested by Dr Ross, which he admitted. In all the circumstances, theTribunal determined that an amendment to paragraphs 7.a and 7.c was appropriate,and did not result in any injustice to Dr Ross, as it accurately reflected the businesssituation which he had asserted was being suggested. The Tribunals findingstherefore are in respect of paragraph 7.a and 7.c as amended.

Paragraph 7

In a consultation with Patient A in approximately May - July 2010, you:

a. suggested [Mrs F] as a business partner for and Patient Ashare premisesin the florist shop,

Amended in accordance with Rule 17(6)Found proved as amended

57. In her witness statement, Patient A said that, during June 2010, Dr Rossmentioned the flower shop to her at every consultation. Patient A said that she mayhave wanted to impress him as he was talking about the opportunity of setting upmy own business and that it seemed too good to be true. She said that she felt


34/95



MPT:Dr ROSS34

quite pressured to visit. When she had done so, she was interested in it, and whenshe mentioned this to Dr Ross at her next consultation, she said that he mentioned[Mrs F] and that Dr Rossthen said that we should definitely do this together. In

Patient As oral evidence, she agreed that Dr Ross had suggested that she met withMrs F to consider whether they could share the premises.

58. In his witness statement, Dr Ross accepted that, in a telephone consultationin approximately July/August 2010, he had suggested that [Mrs F] might beinterested in sharing the florist shop premises with Patient A. Dr Ross stated that herecalled Patient A communicating to him that she did not have the resources to goahead with the shop on her own. He said that it seemed a shame to miss this rareopportunity for her to walk into a business without having to buy in as he thoughtthat her taking up a business would be helpful for her.

59. It was not in dispute that Dr Ross suggested to Patient A that she and Mrs Fmight share premises in the florist shop. Accordingly, this paragraph of theallegation is found proved.

c. suggested that Patient A call [Mrs F] to arrange a meeting todiscuss the proposed business partnership sharing of premises.

Amended in accordance with Rule 17(6)Found proved as amended

60. Patient A said that Dr Ross gave her [Mrs F]smobile telephone number and

told her to call Mrs F as they needed to meet to swap ideas about the florist shop.

61. Dr Ross said that he accepted that he gave [Mrs F]smobile telephonenumber to Patient A, and suggested that, if she wished, Patient A could call [Mrs F]to discuss the possibility of sharing the shop premises.

62. It was not in dispute that Dr Ross suggested that Patient A should call Mrs Fto arrange a meeting to discuss the proposed sharing of premises. Accordingly, thisparagraph of the allegation is found proved.

Paragraph 8

In approximately Spring/Summer 2010 you telephoned Patient As parentslandline, on more than one occasion:

a. to try to obtain contact details for Patient A,Found proved

63. Mrs A told the Tribunal that, although she was not certain as to the exactdates, she answered the telephone when Dr Ross called her landline telephonenumber on two or three occasions over approximately 2-3 weeks in early summer


35/95



MPT:Dr ROSS35

2010. She recalled that she and [Dr Ross] had been on holiday and that the callswere around the end of May or the beginning of June. She said that Dr Ross askedfor Patient A and identified himself. He asked if Patient A was living there and asked

for Patient As landline number or mobile telephone number. Mrs A declined to givePatient As contact details.

64. Mr A told the Tribunal that he had received three calls from Dr Ross in whichhe had asked for Patient As phone number or her mobile telephone number. Mr Adeclined to provide this information.

65. Dr Ross accepted that in May 2010, he telephoned Patient As parentslandline on two occasions and asked to speak to Patient A. On the first occasion, hesaid that he spoke to her mother who told him that Patient A did not live there, sohe asked Patient As mother to pass on a message for Patient A to contact him. He

stated that when he did not hear back from Patient A, he was concerned that theoption of taking on the shop may disappear as an opportunity. He thereforetelephoned the house again and spoke to Patient As father. Dr Ross said that heasked for Patient A to contact him and denied that he had asked for Patient Ascontact details.

66. The Tribunal noted that it was not in dispute that Dr Ross had telephoned Mrand Mrs A, although the evidence differed in respect of the number of calls madeand the matters discussed. The Tribunal has accepted the evidence of Mr and Mrs A,who, when challenged, remained confident in their recollection of the conversations.

Mr and Mrs A had written statements recalling these events on 19 September 2013.It was satisfied, on the balance of probabilities, that Dr Ross rang them on morethan one occasion, and that he asked for Patient As telephone contact details.

Accordingly, this paragraph of the allegation is found proved.

b. during those calls you were abrupt with Patient As parentswhen they declined to provide you with her contact details.Found proved

67. Both Mr and Mrs A told the Tribunal that they declined to provide Dr Ross

with Patient As telephone number. In his oral evidence, Mr A said that when DrRoss rang, he seemed arrogant, quite rude. Mrs A said that Dr Ross was irritatedand, sort of, worked up kind of thing.

68. In his witness statement, Dr Ross denied that he had been abrupt withPatient As parents and he disputed that they had declined to provide him withPatient As contact details.

69. The Tribunal has accepted the evidence of Mr and Mrs A. As stated above,they gave evidence firmly and fairly. The Tribunal noted that Dr Ross was anxiousthat Patient A should not lose the business opportunity. It has also taken into


36/95



MPT:Dr ROSS36

account Dr Ross manner in giving evidence under cross examination. It concludes,on the balance of probabilities, that he was abrupt with them, when they did notprovide the contact information requested. Accordingly, this paragraph of the

allegation is found proved.

Paragraph 9

Following the consultation referred to in paragraph 7 above you:

a. obtained Patient As mobile telephone number from her medicalrecords,Found not proved

70. The Tribunal noted that Patient As telephone number was recorded in her

medical records in the note of an appointment with another doctor on 6 May 2010.

71. Patient A stated that she did not remember giving Dr Ross her mobiletelephone number, and that he must have got it from her patient records. She saidthat she gave Dr Ross the telephone number for her parents, as there wereproblems with the reliability of the mobile telephone signal in the area.

72. Patient As mother and step-father both told the Tribunal that they did notprovide Patient As telephone details to Dr Ross.

73. In his witness statement, Dr Ross did not accept that he obtained Patient Astelephone number from her medical records.

74. Patient A did not know how Dr Ross obtained her telephone number and theTribunal received no other evidence as to how it was obtained. The Tribunal hasfound that Dr Ross telephoned Patient As parents to obtain her contact details. If DrRoss had taken Patient As number from her medical records, it would not have beennecessary to do so. Conversely, whilst the Tribunal may infer that Dr Ross obtainedthe number as alleged, having failed to get it from Mr and Mrs A, it could not beconfident in drawing such a conclusion. In these circumstances, the Tribunal is not

satisfied, on the balance of probabilities, that Dr Ross obtained Patient As telephonenumber as alleged. Accordingly, this paragraph of the allegation is not found proved.

b. telephoned Patient A, on more than one occasion, asking if shehad called [Mrs F] or words to that effect. Found proved

75. Patient A stated that, a couple of days after the consultation when Dr Rossgave her [Mrs F]stelephone number, Dr Ross rang her on her mobile number andasked whether she had called [Mrs F]. She stated that he rang her three or fourtimes asking her if she had phoned [Mrs F]. She told the Tribunal that Dr Ross rangher mobile consistently, and that she did not receive any phone calls from Mrs F. In


37/95



MPT:Dr ROSS37

her oral evidence, she said that it was nonstop, constant-constant-constant, ringing,phoning. You know, like, When, when will you ring [Mrs F]?

76. Dr Ross stated in his witness statement that his recollection was that he hadno reason to contact Patient A once she had made contact with [Mrs F], as theywere making arrangements for the shop between them. He had no recollection ofmaking any such calls.

77. The Tribunal noted that Patient A was confused about the timing of the callsmade by Dr Ross to her parents in May/June 2010, which she placed in July 2010.The Tribunal also considered that, although she was doing her best, Patient As oralevidence regarding this paragraph of the allegation was unreliable. For example, shesaid that, when Dr Ross was phoning her, she had just had a new baby. At the timethat the calls were made, the baby was around 9 months old. However, whilst she

may be unreliable regarding the overall number of calls, she consistently maintainedthat Dr Ross telephoned her on more than one occasion, asking if she had called MrsF. She had no reason to lie regarding this, and the requests were consistent with DrRoss attempts to help her start up the working relationship. In these circumstances,the Tribunal has concluded that, on the balance of probabilities, Dr Ross telephonedPatient A on more than one occasion, asking if she had called Mrs F. Accordingly,this paragraph of the allegation is found proved.

Paragraph 10

In approximately mid/late Summer 2010 you:

b. told Patient A not to mention her mental health problems to[Mrs F].Found proved

78. In her witness statement, Patient A stated that, before she met Mrs F, DrRoss told her not to mention anything about her illness to [Mrs F]. Patient A couldnot remember whether this was said during a consultation or during a telephonecall. She said that she met Mrs F at the end of July 2010 in a coffee shop and that,

subsequently, there were a number of conversations with Mrs F about how thebusiness would work. Patient A said that she had been concerned about what shehad to say to Mrs F in response to any personal questions.

79. In his witness statement, Dr Ross denied that he had told Patient A not tomention her mental health problems to [Mrs F], although he accepted that he wouldhave told Patient A that he would not breach her confidentiality. In his oral evidence,he told the Tribunal that there was an iron curtain separating business mattersinvolving Mrs F and Patient As health issues. This was in accordance with hisgeneral assertion that people with mental health issues should not sufferdiscrimination.


38/95



MPT:Dr ROSS38

80. In her evidence to the Tribunal, Mrs F said that she would not have wished togo into business with Patient A, if she had been aware of Patient As health issues.

81. The Tribunal accepts that Dr Ross may have wished to reassure Patient A thather health issues were confidential, but it also considers Dr Ross would have beenaware that any disclosure to Mrs F about Patient As health might have affected theplans for the proposed business. The Tribunal accepts Patient As evidence that shehad been nervous about her meeting with Mrs F, and was uncertain about what sheshould and should not say to Mrs F, because of what Dr Ross had told Patient A. Inall the circumstances, the Tribunal is satisfied, on the balance of probabilities, thatDr Ross told Patient A not to mention her mental health problems to [Mrs F].

Accordingly, this paragraph of the allegation is found proved.

Paragraph 11

Between approximately July and September 2010 you:

b. asked Patient A to attend the surgery to collect documentsrelating to the florist shop business, Found proved

82. Patient A told the Tribunal that Dr Ross would often ask her to go into thesurgery to pick something up.

83. In his witness statement, Dr Ross denied that he asked Patient A to attendthe surgery to collect documents relating to the florist shop business, although hesaid that he received emails from her at various points and including after he hadceased to be her GP, in which she asked him to leave documents at reception forher. In this respect, Dr Ross presented an email dated 21 January 2011 from Patient

A to Dr Ross requesting printing of items for a wedding fair.

84. The Tribunal noted an email from Dr Ross to Patient A, dated 26 September2010 at 8:03, in which he replied within the text of Patient As earlier email of thesame date, timed at 6:33. This included the comment:

As you now have the bank account with cheque book and cheque card youcan probably start using the bank account. We will load it with 5k. As theremay be problems getting this done by Tuesday I think that [Mrs F]ssuggestion is going to be the best one. Can you call into the health centre toorganise this

85. The Tribunal accepts Patient As evidence. It also considers that the contentsof Dr Ross email of 26 September 2010 corroborate her account that she was askedto attend the surgery in relation to business documents. The Tribunal therefore


39/95



MPT:Dr ROSS39

finds, on the balance of probabilities, that Dr Ross asked Patient A to attend thesurgery as alleged. Accordingly, this paragraph of the allegation is found proved.

c. saw Patient A in the florist shop premises in the evenings and/orat weekends.Found not proved

86. Patient A said that between July and August 2010, she was doing somefreelance working by helping someone open a bar. She said that she would drive tothe florist shop in the evenings and at the weekends and that Dr Ross would oftenbe there. She said that she would see him there about twice a week. She told theTribunal that it was incorrect to say that the keys to the shop were only received inSeptember 2010.

87. Patient A said that her partner at the time took care of her child carecommitments, although on numerousoccasions she had to take her son with her tothe shop, while it was being prepared to open. She said that Dr Ross came freely atthat time. She also said that Dr Ross came to the shop every Saturday to collect themoney for banking, and that he would also stand behind the counter while the shopwas trading.

88. Dr Ross stated that the shop opened on 15 October 2010 and that when heattended there, [Mrs F] and Patient A would have been present. He said that, due towork commitments and child care arrangements, he was not able to visit the shop,

either during the day or in the evenings or at weekends and he did not recall visitingthe shop at all in the period alleged. However he said that, if he did so, it was simplya case of his popping in to provide moral support to Patient A and [Mrs F]. Dr Rosshad a clear recollection that the first time he saw the shop counter in place was atthe opening of the shop on 15 October 2010.

89. Mrs F told the Tribunal that in August, September and October 2010, Dr Rossdid not go into the florist shop at weekend or evenings. She said that the keys werenot made available until 2 September 2010 and that Dr Ross had never been a keyholder at any time. Mrs F explained that Dr Ross also had caring responsibilities XXX

at that time and would have been unable to leave him unaccompanied.

90. Mrs F also said that, at that time, Patient A had been busy with herManchester contract, and had not been available in the evenings, as she had a longdrive home and childcare commitments. Mrs F also said that Patient A nevermentioned to her that she had met Dr Ross during this period, when they wereworking long hours together. Mrs F could not imagine in that context that Patient Awould have failed to do so.

91. The Tribunal considered that Patient As evidence regarding Dr Rossattendance at the shop in the period alleged was either confused or perhaps


40/95



MPT:Dr ROSS40

exaggerated. It also noted that Patient A acknowledged that, during this period, shewas experiencing a manic phase in her bi-polar disorder during this period whichmay have affected her recollection. In particular, the Tribunal noted that it was not

in dispute that the florist shop opened in mid-October 2010. It further consideredthat if Dr Ross attended the shop to collect money, this could only have taken placeafter the shop had opened, which was after the period alleged. The Tribunal istherefore unable to rely on the evidence of Patient A in this respect, and is thereforenot satisfied, on the balance of probabilities, that Dr Ross attended the florist shopas alleged. Accordingly, this paragraph of the allegation is not found proved.

Paragraph 13

In September 2010, after you had received a report from the Dual DiagnosisTeam (the team) about Patient As mental health, you telephoned Patient A

and shouted at her about the content of the report asking What is all this?or words to that effect.Found not proved

92. In her account given to Dr D at a meeting on 15 August 2013, Patient A wasreported to have stated that Dr Ross phoned her and was very upset that the reportsaid I was using drugs, he said [Mrs F] must not find out and that I had to come foran appointment with him.

93. In her witness statement, Patient A stated that when Dr Ross received the

report from the Dual Diagnosis team in September 2010, he rang her about it andshouted at her on the telephone, asking her what is all of this? Patient A said thathe was extremely, extremely annoyed with me.

94. Dr Ross stated that when he received the Dual Diagnosis report about PatientA, he telephoned Patient A and asked her to make an appointment with him todiscuss its contents. He did not accept that he shouted at her about the content,which he said would have been entirely inappropriate and contrary to his style ofpractice, and would have been counter-productive to her attending.

95. The Tribunal notes that it was not in dispute that Dr Ross telephoned PatientA on receipt of the Dual Diagnosis report. However, the Tribunal also noted thatPatient A did not refer to Dr Ross having shouted in her earlier account of theincident and did not refer to the words he used. Rather, this supports Dr Rossversion of events. In these circumstances, the Tribunal was not satisfied, on thebalance of probabilities, that Dr Ross shouted at Patient A as alleged. Accordingly,this paragraph of the allegation is not found proved.

Paragraph 14

In a consultation with patient A on or around 22 September 2010 you:


41/95



MPT:Dr ROSS41

a. told Patient A

dr michael ross 22 january 2016

Documents