“Erasure would be a disproportionate response”
File image of Bristol Royal Hospital for Children(Image: SWNS)
A medical tribunal panel has said it did not strike off a doctor who engaged in a relationship with a 13-year-old patient at a Bristol hospital because he had apologised and had ‘well-developed insight and remorse’ about what happened.
Instead, the tribunal panel opted to just suspend him for a year, and said ‘erasure’ – being permanently struck off the medical register as a doctor – would have been a ‘disproportionate response’.
The General Medical Council had called for Dr Cian Hughes, now one of Google’s leading experts in the field of using AI in medicine, to be struck off for his four-year relationship with ‘Patient A’, who was a vulnerable 13-year-old girl when she was admitted to Bristol Children’s Hospital for an operation and first met the doctor, in 2011.
Dr Hughes was then a 23-year-old fourth-year medical student and the pair began an email and direct message-based relationship, which evolved long after the initial weeks that she was under his care in hospital.
The relationship developed into a romantic one when the girl, who cannot be named, was 16, and a sexual one when she was 17, before they had intercourse when she turned 18, in 2015.
Last week, Bristol Live revealed that Dr Hughes had been found guilty of misconduct by the independent tribunal and that his fitness to practice was impaired, and a hearing to decide what sanction he should face concluded that he should not be struck off.
Now, the tribunal has published its reasons for that determination, in a written report outlining why they chose not to strike him from the register permanently.
“The Tribunal determined that Dr Hughes’ misconduct was serious and warranted a significant response to mark its gravity,” the tribunal report stated. “In its findings regarding impairment the Tribunal had found… that members of the profession would find Dr Hughes’ conduct deplorable, in particular that he did not account for Patient A’s vulnerability. The Tribunal further found that members of the public, fully informed of the facts of the case, would be shocked and concerned by Dr Hughes’ conduct,” it added.
READ MORE: Google AI doctor faces being struck off for relationship with Bristol teen patientREAD MORE: Doctor suspended for relationship with Bristol teen patient
“The Tribunal has therefore concluded that Dr Hughes’ conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct. The Tribunal considered that these paragraphs were relevant because Dr Hughes used his professional position to engage in an improper relationship with a vulnerable patient and considered that this required the Tribunal to take serious action.
“The Tribunal considered whether Dr Hughes’ misconduct was so grave that it was incompatible with his continued registration as a doctor. In this regard the Tribunal bore in mind the seriousness of its findings.
But the panel said it also took into account the mitigation put forward by Dr Hughes’ barrister, and their decision in part hinged on an interpretation of Dr Hughes’ actions as he and Patient A embarked on turning their relationship into a sexual one, when she was 17 and he was 27.
Dr Hughes had talked to colleagues about whether he would be breaching GMC guidelines on relationships with former patients, and even the law, because it is a criminal offence for someone in a position of authority – a teacher, doctor, sports coach, for example – to engage in sexual activity with someone in or formerly in their care if they are still under the age of 18.
“The Tribunal considered the GMC’s submission that Dr Hughes had shown a ‘blatant disregard’ for the guidance around inappropriate relationships and that this was a matter which was incompatible with Dr Hughes’ continued registration,” the Tribunal ruling said.
“The Tribunal rejected this submission because its findings at the impairment stage had been that Dr Hughes did consider the guidance at the time he was considering entering a relationship with Patient A, but that he had persuaded himself that the guidance permitted the relationship. The Tribunal accepted Ms Harris’ submission on behalf of the doctor that this was an important distinction, and it concluded that Dr Hughes had not blatantly disregarded the guidance as submitted by the GMC,” it added.
The tribunal had heard that Dr Hughes and Patient A had engaged in sexual activity when she was still 17, but they had waited until she turned 18 before having sexual intercourse.
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The tribunal panel described its decision to suspend or strike off Dr Hughes as ‘finely balanced’, and they were also influenced by the glowing character references about Dr Hughes and his ten years spent working at Google.
“The Tribunal considered that Dr Hughes had abused his professional position and entered into an improper relationship with a vulnerable patient who he had met in a professional capacity,” the tribunal ruling stated. “The Tribunal however, did not consider, bearing in mind the nature of the relationship revealed by the messaging between Dr Hughes and Patient A, that Dr Hughes had exploited Patient A’s vulnerability.
“The Tribunal also bore in mind that the relationship had not developed during Dr Hughes’ professional contact with Patient A – had this been the case, the Tribunal considered that the misconduct would have been more serious. However, the Tribunal also bore in mind the significant impact Dr Hughes’ misconduct has had on Patient A.
“Having carefully considered the options before it, the Tribunal reached the conclusion that the facts of this case were finely balanced and that there were a number of serious factors within the misconduct which could denote that erasure would be the appropriate sanction.
Bristol Children’s Hospital(Image: BPM MEDIA)
“However, the Tribunal bore in mind the mitigating features: particularly Dr Hughes’ admissions and apology; his well-developed insight and remediation and his remorse. The Tribunal accepted Ms Harris’ submission on behalf of Dr Hughes that this was a factually nuanced case and that it could be distinguished from other cases of sexual misconduct where erasure was required.
“Accordingly, having looked at matters in the round, the Tribunal concluded that this case was not one where the misconduct was ‘fundamentally incompatible with continued registration’ and that erasure would be a disproportionate response.
“The Tribunal had further regard to the testimonials which show that Dr Hughes is a highly regarded, well liked and competent doctor. The Tribunal therefore considered that it was also in the public interest to allow an otherwise good and experienced doctor to remain on the register.
“The Tribunal considered that it was essential to maintain the integrity of the medical profession, and Dr Hughes’ behaviour was unacceptable. A strong message must be sent that such conduct was unacceptable, thereby reinforcing the standards expected of medical professionals and ensuring a deterrent for similar behaviour in the future. In light of the above, the Tribunal determined that a period of suspension would be an appropriate and proportionate sanction balancing Dr Hughes’ interests with those of the public.
“This would have the sufficient deterrent effect of sending a signal to Dr Hughes, the profession and the public that his misconduct was unbefitting of a registered doctor and would not be tolerated. The Tribunal determined therefore that an order of suspension was required in this case,” the tribunal statement added.
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