A doctor has failed to overturn a decision by an MPT to erase his name from the medical register in Metastasio v General Medical Council [2023] EWHC 1918 (Admin) (26 July 2023) .

A summary of the case’s background is that, in November 2017, a young woman (‘Patient A’), who was diagnoses of Emotionally Unstable Personality Disorder (‘EUPD’) and Bipolar Affective Disorder, was referred by a Crisis Resolution Team to St Pancras Hospital in relation to risk of suicide, alcohol addiction and use of cocaine.

Shortly thereafter, Patient A was transferred and admitted to Highgate MHC where she was an in-patient between 23 and 30 November 2017. Whilst Patient A was an in-patient, Dr Metastasio was her treating Consultant Psychiatrist where he had four direct interactions with Patient A.

The allegations against the Dr Metastasio arose from his contact with Patient A after she had been an in-patient at Highgate MHC. Patient A, using a pseudonym (which I shall refer to as ‘M’), was working as a sex worker and appearing in pornographic films.

In 2018, Dr Metastasio began following M on social media, he contacted her several times, paid her for sexual services on 14 February 2019, and then sought a further meeting with her in August 2020. Patient A complained to the Trust when Dr Metastasio contacted her again in August 2020.

In short, the Tribunal found that Dr Metastasio had engaged in this conduct knowing that ‘M’ was his former patient. The Tribunal concluded that his fitness to practise was impaired by reason of misconduct and that the only appropriate and sufficient sanction was one of erasure.

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Appeal

The doctor argued, in summary, that the Tribunal’s chain of reasoning “inferred that it was not a coincidence that he found her” because “the Tribunal had already made those findings” and “and as a consequence the whole chain of reasoning breaks down.”
The Hon. Mrs Justice Steyn DBE however said:

“In my judgment, the Appellant’s criticisms are not justified. The Tribunal determined, on the balance of probabilities, that “Dr Metastasio would have been aware of Patient A’s activity as a sex worker whilst she was an in-patient” at Highgate MHC.

“The criticism of the Tribunal is unjustified. The Tribunal was plainly right not to speculate as to the effect of EUPD on a witness’s credibility and reliability, in circumstances where the Appellant had adduced no evidence to support his submission that her diagnosis should be treated as undermining her evidence.”

Dr Metastasio further appealed against the sanction of erasure, submitting that, even if, the facts and finding of impairment are to be taken as found by the Tribunal, nevertheless the sanction of erasure was excessive and disproportionate.

However, Steyn J, ruled that:

On this ground of appeal, the question is whether erasure was “appropriate and necessary in the public interest or was excessive and disproportionate“; and “a court can more readily depart from the [Tribunal]’s assessment of the effect on public confidence of misconduct which does not relate to professional performance than in a case in which the misconduct relates to it.“

Going on to say:

It is not suggested that the Tribunal made any error in their approach to determining the sanction, and it is plain that they did not.

Ultimately concluding that:

Following Patient A on social media, contacting her with a view to meeting for sexual contact, meeting her … and then seeking to do so again, all in the knowledge that she was a vulnerable patient who he had treated in his capacity as a Consultant Psychiatrist, was undoubtedly a serious abuse of his professional position. The Sanctions guidance indicates at §148 that erasure is likely to be appropriate for such conduct.

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