This is an HTML version of an attachment to the Freedom of Information request 'Fitness to practise panel: Cosgrove / Christopher Brightmore'.

 
 
 
 
GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
Monday, 19 January 2004 
 
Held at: 
Barnett House 
53 Fountain Street 
Manchester M2 2AN 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day One) 
 
 
Committee Members: 
Professor Norman Mackay (Chairman) 
Mr Christopher Brightmore 
Dr Alison Hamilton 
Mr John Matharu 
Dr Belinda Stanley 
Mr Richard Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
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(Transcript of the shorthand notes of TranscribeUK 
Tel No:  0208 614 5799) 
 
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INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
  CHARGES 
AMENDED 
     1 
 
  CHARGES 
READ 
      2 
 
 
 
APPLICATION to adjourn until 2 p.m. 
 
 
 

 
 
 
DISCUSSION re perceived bias of Panel Member   
 
12 
 
 
 
APPLICATION by MR MORRIS to call evidence  
in abuse of process application 
 
 
 
14 
 
 
 
REPLY by MR PEARCE 
 
 
 
 
 
16 
 
 
 
REPLY by MR MORRIS 
 
 
 
 
 
18 
 
  LEGAL 
ASSESSOR’S 
ADVICE 
    23 
 
  DETERMINATION 
      24 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:  Good  morning.  I now formally announce that the case we are about 
 
to hear is that of Dr Cosgrove.  Dr Cosgrove is present and is represented by Mr David 
 
Morris, counsel, instructed by RadcliffesLeBrasseur, solicitors.  Mr Richard Pearce, 
 
counsel, instructed by Field Fisher Waterhouse, solicitors, represents the Council. 
 
 
 
Mr Morris, I understand you wish to make a submission at this point. 
 

MR MORRIS:  Sir, not at this point but very shortly – I think the Inquiry should be 
 
opened by the reading of the charge.  I am looking at Rule 24 of the Rules and it was after 
 
the reading of the charge that I was going to submit an objection on a ground of law to the 
 
charge.  So perhaps at this stage I would invite the Committee Secretary to read the 
 
charge and then I can explain my position.  
 
 
THE CHAIRMAN:  I thought we were, perhaps, considering a request that we had an 

adjournment until 2 pm, but if you want to read the charges... 
 
 
 
MR MORRIS:  I shall be making that submission but it might assist in my explanation of 
 
background to why I am asking for time until 2 pm if at least the charge was read. 
 
 
 
MR PEARCE:  I am content with that way of proceedings.  If you are minded so to 
proceed I do, however, have an application to amend the charge in various, I hope, minor 

ways. 
 
 
 
THE CHAIRMAN:  We will take these amendments at this stage since we are, it would 
 
appear, going to read the charges. 
 
 
 
MR PEARCE:  I am obliged, sir.  Two of them, in effect, are not even amendments to 
what you have in front of you because they have already been altered.  In fact, your copy 

does not reflect the original Notice of Inquiry in two ways:  one is that the original 
 
numbering was wrong and your copy now has been correctly renumbered; secondly, in 
 
the original Notice of Inquiry at charge 9a on the third line of my copy, where it says 
 
“Dr Helen Thomas”, it now says “Chubb”.  Chubb is correct and it ought so to read. 
 
 
The two substantive applications that I have, sir, relate first of all to paragraph 8--- 
 
 

THE CHAIRMAN:  Before we leave 9a, is there another name that is to be changed?  
 
I thought Dr Melinda Thomas was Miranda Thomas. 
 
 
 
MR PEARCE:  Miranda Thomas, sir, yes – I am sorry. 
 
 
On 8a this is where the renumbering of the paragraph caused confusion.  It should say, 

“In the letter referred to in paragraph 7c above”. 
 
 
 
In paragraph 10a, now having seen medical records it is clear that the date of this 
 
appointment with Patient G was 24 February 2003, so rather than reading “in or around 
 
January 2003” I invite you to amend it to say “on or around 24 February 2003”. 
 
 
THE CHAIRMAN:  Thank you.  Can I just check that in head of charge 1 it is the Bristol 

Priority Clinic? 
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MR PEARCE:  Yes. 
 
 
 
THE CHAIRMAN:  Dr Cosgrove, can I ask you to stand, please? 
 
 
 
THE COMMITTEE SECRETARY:  The Committee will inquire into the following 
charge against Patrick Vernon Finn Cosgrove, MB BS 1968 Lond; MRCS Eng LRCP 

Lond 1968 SR: 
 
 
 
 
"That, being registered under the Medical Act, 
 
 
 
 
 
‘1. 
At all material times, you were practising as a Consultant Child and 
 
Adolescent Psychiatrist working in private practice at the Bristol Priority Clinic; 
 

‘2. 
a. 
On 3 May 1996, you saw Patient A, a child who had been 
 
diagnosed as suffering from Attention Deficit Hyperactivity Disorder 
 
(ADHD), 
 
 
 
 
b. 
You prescribed drugs to Patient A as follows: 
 
 
 
i.     between May 1996 and May 1999, you prescribed 

methylphenidate (Ritalin), 
 
 
 
            ii.    by July 1996, you had increased the prescribed dose of Ritalin 
 
to 62.5 mg per day, 
 
 
 
 
iii.   in May 1998, you increased the daily dosage of Ritalin to 
100 mg per day, 

 
 
 
iv.    by May 1999, you had increased the dose of Ritalin to 130 mg 
 
per day, 
 
 
 
 
v.     from July 1996, you prescribed an additional daily dosage of 
risperidone at 1 mg per day, 
 
 

 
vi.    by November 1998, you had in addition prescribed clonidine 
 
as a night time sedative, 
 
 
 
 
c. 
Having so prescribed, your monitoring of Patient A was 
 
irresponsible in that 
 

 
i.     you did not see Patient A in person between May 1996 and 
 
May 1999, 
 
 
 
 
ii.    you did not make an adequate assessment of Patient A’s 
 
weight, 
 
 
 
iii.   you did not monitor Patient A’s growth, 

 
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iv.    you did not warn Patient A’s mother that sudden withdrawal 
 
of clonidine could have a deleterious effect on Patient A’s blood 
 
pressure, 
 
 
 
 
v.     you did not advise Patient A’s General Practitioner (GP) to 
 
monitor Patient A as above; 
 

 
‘3. 
a. 
On 1 December 1999, you saw Mr B as a private patient and 
 
diagnosed that he was suffering from ADHD, 
 
 
 
 
b. 
On 3 December 1999, you wrote a letter about that consultation to 
 
Dr Humphreys, Mr B’s GP, which letter you copied to Dr K Al-Shabner 
 
and to Mr and Mrs B, 
 

 
c. 
In that letter, you stated as follows: 
 
 
 
 
i.     that Mr B had seen a doctor who might have been 
 
Dr Al-Shabner, 
 
 
 
 
ii.    that the doctor whom Mr B had seen had been rude and 
unhelpful, 

 
 
 
iii.   that the doctor whom Mr B had seen had been scruffily 
 
dressed, 
 
 
 
 
iv.    that the doctor whom Mr B had seen knew nothing about 
 
ADHD, 
 

 
v.     that the doctor whom Mr B had seen was guilty of medical 
 
negligence, 
 
 
 
 
vi.    that the doctor whom Mr B had seen had demonstrated 
 
professional incompetence, 
 
 
 
d. 
The comments that you made in the said letter were 

 
 
 
i.     unprofessional, 
 
 
 
 
ii.    unsustainable, 
 
 
 
iii.   likely to cause the reader to doubt Dr Al-Shabner’s knowledge 

and/or skills; 
 
 
 
‘4. 
a. 
On 27 May 1999, you saw Master C, a nine-year old boy, as a 
 
private patient, 
 
 
 
 
b. 
On 29 May 1999, you wrote a letter to Master C’s GP about the 
consultation, sending a copy of the letter to Dr Karin Moses, Consultant 

Child Psychiatrist responsible for the treatment of Master C under the 
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NHS, 
 
 
 
 
c. 
The said letter requested that Master C’s GP prescribe him 
 
risperidone and Ritalin, 
 
 
 
 
d. 
The letter did not contain any advice for Master C’s GP about 
appropriate monitoring of Master C whilst he was taking those drugs, 

 
 
 
e. 
Your failure to provide such advice to Master C’s GP was 
 
 
 
 
i.     irresponsible,  
 
 
 
 
ii.    not in the best interests of Master C; 
 

‘5. 
a. 
On 7 July 1999, you wrote a letter to Dr Karin Moses, which letter 
 
you copied to Master C’s parents and his GP, 
 
 
 
 
b. 
In that letter, you stated 
 
 
 
 
 
i.     that Dr Moses was likely to deny some or all of what Master 
C’s parents had told you about her treatment of Master C, 

 
 
 
ii.    that Dr Moses had seen Master C only once whilst he was a 
 
day patient on the children’s psychiatric unit at St Cadoc’s 
 
Hospital, Caerleon, Newport, during which period Master C was 
 
getting worse and worse when he should have been getting better 
 
and better, 
 

 
iii.   that Dr Moses owed Master C’s parents an explanation as to 
 
why she had not prescribed Ritalin during the time that Master C 
 
was a patient at the children’s psychiatric unit, 
 
 
 
 
iv.    that when Dr Moses first saw Master C he was aged 5 years 
old, and that she made no diagnosis and that she had done nothing 
 
that resulted in alleviating Master C’s malfunctioning, 

 
 
 
v.     that nothing that Dr Moses had done when she saw Master C 
 
aged 5, 6 and 7 years had prevented his behaviour causing him to 
 
be asked to leave two schools and to be admitted to St Cadoc’s 
 
Hospital, 
 

 
c. 
The comments that you made in the said letter were 
 
 
 
 
 
i.     unprofessional, 
 
 
 
 
 
ii.    unsustainable, 
 
 
 
 
iii.   likely to cause the reader to doubt Dr Moses’ knowledge and 

skills; 
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‘6. 
a. 
In or about May 1996 you saw Master D, a ten-year old boy, as a 
 
private patient, 
 
 
 
 b. 
You diagnosed Master D as suffering from ADHD, 
 
 
 c. 
You prescribed Ritalin for Master D, 

 
 
 d. 
Your examination of Master D on that occasion was inadequate in that 
 
 
 
 
 
i.     you did not weigh him, 
 
 
 
 
 
ii.    you did not take his blood pressure, 
 

 
e. 
You subsequently spoke to Master D’s mother by telephone, 
 
following which you prescribed risperidone, 
 
 
 
 
 
 
f. 
You failed to make proper arrangements for monitoring the effects 
 
of the treatment which you provided for Master D; 
 
 
 
‘7. 
a. 
In or around August 2000, Oxfordshire Mental Healthcare NHS 

Trust carried out an investigation into a number of features of the 
 
treatment of a patient of the Trust, Patient E, 
 
 
 
 b. 
On 29 September 2000, Miss Wendy Samways, Complaints Manager at 
 
the Oxfordshire Mental Healthcare NHS Trust, wrote to you requesting 
 
copies of your medical records concerning Patient E and enclosing signed 
authorisation for the release of the records, 

 
 
 c. 
By a letter dated 3 October 2000, you replied to  
 
 Miss Samways that you would not supply the medical records, 
 
 
 
 
d. 
Your failure to supply the notes as requested was 
 
 
 
i.     inappropriate, 

 
 
 
 
 
 
ii.    unprofessional; 
 
 
 
 
‘8. 
a. 
In the letter referred to in paragraph 7c above, you also stated as 
 
follows: 
 

 
 
i.     that Patient E had been given inadequate care by an employee 
 
of the Oxfordshire Mental Healthcare NHS Trust, 
 
 
 
 
 
ii.    that the investigation being carried out might end in a 
 
whitewash of such inadequate care, 
 
 
 
 
iii.   that you believed the investigation to be a cover up of grossly 

inadequate care received by Patient E from the Trust, 
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iv.    that the investigation was programmed to ensure that the Trust 
 
was not criticised at all or only criticised in a minor way, 
 
 
 
b. 
The comments set out in the letter were 
 
 
 
 
i.     unprofessional, 

 
 
 
 
 
 
ii.    unsustainable, 
 
 
 
 
 
iii.   likely to cause the reader to doubt the knowledge or skills of 
 
the employees of the Oxfordshire Mental Healthcare NHS Trust 
 
who treated Patient E; 
 

 
‘9. 
a. 
By a letter dated 17 November 2000, concerning a patient Mr F, 
 
which you sent to his GP, and copies of which you sent to Dr Helen 
 
Chubb, Consultant Psychiatrist at the Cardiff and Vale NHS Trust and 
 
Dr Miranda Thomas, SHO in psychiatry at the same Trust, you stated that 
 
you had diagnosed Mr F as suffering ADHD and that you had prescribed 
 
him Ritalin, 
 

 b. 
That letter did not contain any advice to the prescribing GP about the 
 
monitoring of Mr F, 
 
 
 
 c. 
In the letter, you stated as follows: 
 
 
 
 
 
i.     that Mr F had not felt that Dr Thomas had listened to him 
when he talked about his personal understanding of ADHD, 

 
 
 
 
ii.    that Dr Thomas had stated that a “concentration problem is for 
 
messy kids”, 
 
 
 
 
 
iii.   that the comment alleged to be made by Dr Thomas was an 
ignorant comment, 
 
 

 
 
iv.    that both Dr Thomas and Dr Chubb were arguably guilty of 
 
medical negligence in knowing less about ADHD in adults than 
 
Mr F, 
 
 
 
 
 
v.     that Dr Thomas had made an assertion of “therapeutic 
nihilism” in saying “the consultant thinks that you have got a 

personality disorder which is not treatable”, 
 
 
 
 
 
vi.    that if Mr F responded to treatment for adult-type ADHD, it 
 
would indicate that Dr Thomas and Dr Chubb were negligent in not 
 
listening to Mr F and in not knowing about ADHD as a real 
 
condition in adults, leaving room for formal complaint to the 
Fitness to Practice Directorate of the General Medical Council, 

 
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d. 
The comments that you made in the said letter were 
 
 
 
 
i.     unprofessional, 
 
 
 
 
ii.    unsustainable, 
 
 
 
iii.   likely to cause the reader to doubt the knowledge or skills of 

Dr Chubb and Dr Thomas; 
 
 
 
 
‘10. 
a. 
On or around 24 February 2003, you saw a 4 year old child, Patient 
 
G, as a private patient, 
 
 
 
 
b. 
Thereafter, you prescribed Ritalin and risperidone to Patient G, 
 

 
c. 
By May 2003, you were prescribing 
 
 
 
 
i.     Ritalin at 25 mg per day, 
 
 
 
 
ii.    risperidone at 0.625 mg per day, 
 
 
d. 
Having so prescribed, your monitoring of Patient G was 

irresponsible in that 
 
 
 
 
i.     you did not make an adequate assessment of  
 
 
Patient G’s weight, 
 
 
 
 
ii.    you did not monitor Patient G’s growth, 
 

 
iii   you did not adequately monitor any possible side effects; 
 
 
 
 
 
‘11. 
a. 
On or around 16 July 2003, you saw Patient H as a private patient, 
 
 
 
 
b. 
On 19 July 2003, you wrote to Patient H’s GP, which letter you 
copied to Patient H’s parents and to Dr Dover, a Consultant Psychiatrist 
 
who had treated Patient H, 

 
 
 
c. 
In that letter you stated amongst other things 
 
 
 
 
i.     that, if Dr Dover did not believe in ADHD, he might have 
 
difficulty in being revalidated by the General Medical Council, 
 

 
ii.    that Dr Dover should have studied Patient H’s school reports, 
 
 
 
 
iii.   that Dr Dover had behaved in a professionally unacceptable 
 
manner by not arranging a second opinion when asked to do so, 
 
 
 
 
b. 
The comments that you made in the said letter were 
 

 
i.     unprofessional, 
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ii.    unsustainable, 
 
 
 
 
iii.   likely to cause the reader to doubt the knowledge or skills of 
 
Dr Dover;’ 
 
 
And that in relation to the facts alleged you have been guilty of serious professional 

misconduct.”  
 
 
 
THE CHAIRMAN:  You may sit down, Dr Cosgrove.  
 
 
 
MR MORRIS:  Sir, as I indicated before the charge was read, Rule 24(2) of your Rules 
 
says that: 
 

“After the reading of the charge or charges the practitioner may 
 
submit any objection on grounds of law to any charge or part of a 
 
charge and any other party may reply to such an objection.” 
 
 
 
Sir, I wish in due course to make an application under 24(2) that the Inquiry be stayed 
 
because to allow otherwise and to allow the Inquiry to proceed would be an abuse of 
process of this Committee. 

 
 
I am not in a position now to proceed with that submission. I will tell the Committee why 
 
and explain the indulgence that I seek from them.  May I also add that in addition to that 
 
submission I secondly make an alternative submission, which only arises if you reject my 
 
first submission in relation to the whole inquiry.  The second submission relates to head 
 
of charge 2, which concerns patient A.  My submission in relation to that again is that to 
allow that head of charge to proceed to inquiry would be an abuse of process for the 

reason that the parents of patient A have specifically expressly in writing forbidden or 
 
refused to grant consent to either Dr Cosgrove or those investigating this matter on behalf 
 
of the General Medical Council to have access to the patient’s medical notes.  You will 
 
see the nature of the charge, that it concerns the monitoring of patient A and an allegation 
 
that the monitoring by Dr Cosgrove was irresponsible.   
 
 
My submission, in a nutshell, will be that it would be impossible to allow Dr Cosgrove a 

fair hearing in relation to that allegation without allowing him access to the patient’s 
 
notes, that is to say his General Practitioner notes, the notes made by the doctor who saw 
 
him, Dr Holmes, and Dr Cosgrove’s own private notes in relation to that patient. 
 
 
 
Can I turn back to my first and primary submission, that the whole of the inquiry should 
be stayed?  It arises from a particular head of charge, namely head of charge 6, which 

concerns the patient Master D.  Head of charge 6 originates from information provided to 
 
the General Medical Council by an organisation called the Citizens’ Commission on 
 
Human Rights, whose Executive Director is a Mr Brian Daniels.  The Citizens’ 
 
Commission on Human Rights is an organisation, and I quote from headed notepaper of 
 
that organisation,  
 
 
“…which was established in 1969 by the Church of Scientology to investigate and 

expose psychiatric violations of human rights.” 
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Under the aegis of the Citizens’ Commission on Human Rights information was given to 
 
the General Medical Council about the treatment by Dr Cosgrove of patient D.  The 
 
mother of patient D purported to write to the General Medical Council in the form of a 
 
complaint.  She thereafter signed a letter giving permission for the disclosure of her son’s 
 
medical records.   
 

Sir, I can at this stage help the Committee if I just show you the copy of that letter, 
 
together with, for comparison purposes, letters written by the patient’s mother in 1996 at 
 
a time, as you will see from the charge, when Dr Cosgrove was seeing the patient. 
 
 
 
THE CHAIRMAN:  We will label these D1 and D2.   
 
 
MR MORRIS:  Sir, I think in terms of chronology it would probably make sense if the 

1996 letters were labelled D1. 
 
 
 
THE CHAIRMAN:  Agreed.  (Same handed
 
 
 
MR MORRIS:  You and your Committee may perhaps notice two matters when you 
 
compare the letters written in 1996 and the letter written on 11 December 2001. 
 

THE CHAIRMAN:  The letter I have is August 2000. 
 
 
 
MR MORRIS:  I am sorry, I have got the wrong letter.  It is 18 August 2000.  First of all, 
 
the name of the patient’s mother is spelt differently.  Secondly, from a lay perspective it 
 
would appear that the signatures of the mother on the letters in 1996 are in a different 
 
handwriting to the signature on the letter of 18 August 2000.  We are at this moment 
having an expert look at the handwriting available from the patient’s mother in 1996 and 

the handwriting available for the person who has signed that letter and other documents in 
 
2000 and 2001 in order to get an expert handwriting opinion on whether or not that 
 
handwriting is by the same hand or by a different hand.   
 
 
 
I am confident that I will have information on that before two o’clock this afternoon.  
That is one of the reasons why I am seeking the Committee’s indulgence in this regard.  If 
 
I can put it in a nutshell, the basis of my submission in due course will be that under the 

aegis of the Church of Scientology’s organisation, the Citizens’ Commission on Human 
 
Rights, a complaint or information has been provided which is fraudulent, inasmuch as it 
 
does not come from whom it purports to come from, namely the mother of patient D.   
 
 
 
The knock on effect of that, in my submission, will be this in relation to the whole of the 
notice of inquiry:  that in relation to patients A to F, that is to say all but the last two 

patients, you will note that the treatment dates state 1996, 1999 and 2000, or at least the 
 
dates are 2000.  In relation to those heads of charge, the information or complaints that 
 
were provided to the General Medical Council or derived or originated in 1999 or 2000, 
 
as did the complaint from the Citizens’ Commission on Human Rights.  The complaints 
 
outwith the Citizens’ Commission complaint from A to F effectively lay dormant 
 
thereafter and no action was taken, certainly on the face of the documentation that has 
been disclosed to the defence so far.   

 
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The Citizens’ Commission wrote on a number of occasions to the General Medical 
 
Council culminating with a final letter in August 2002 making inquiries and providing 
 
further information in relation to the information that had originally been given in the 
 
year 2000.  On 26 September 2002 the Solicitor to the General Medical Council wrote to 
 
the Registrar formally notifying him of the information that had been provided in relation 
 
to the heads of charges A to F.   
 

It would appear to the defence that that temporal link between the letter received or sent 
 
in August and, if I may put it in the vernacular, the ball began to roll as far as this 
 
investigation and this inquiry were concerned in the following month of September, when 
 
all the other complaints had remained in a dormant state gives rise to the reasonable 
 
suspicion on the part of the defence that it was as a result of Citizens’ Commission on 
 
Human Rights complaint which we say is of fraudulent origin that the remainder of these 
charges came to be progressed and, on that basis, that it would not be fair, because of the 

manipulation of the investigative procedure of the General Medical Council by the 
 
Commission to allow this inquiry to proceed.   
 
 
 
That, in a nutshell, is the basis of the submission that I will be seeking to make, but there 
 
is the problem of the handwriting evidence that I wish to canvass.  There is also a request 
 
that was made to the Council which has not yet been answered and I am seeking an 
answer, as to the disclosure of any internal documentation within the General Medical 

Council as to what happened following the receipt of the final letter from the Commission 
 
in August 2002, leading up to the letter from the solicitor of 26 September 2002.  Those 
 
two matters obviously are going to cause a hiatus, and it was for that reason that I seek 
 
the indulgence of the Committee to be allowed to delay the beginning of my submission 
 
until 2 pm at the earliest.  I am very much aware that the Committee would not wish to 
 
waste time unnecessarily.   
 

What I can say is that in making the full submission I will be making reference to a report 
 
that was commissioned by Parliament on the Church of Scientology in about 1969, and 
 
the report was written by a Member of Parliament and a Queens Counsel Mr Foster which 
 
became to be known as the Foster report. Members of the Committee may or may not 
 
have heard of it or indeed may or may not be familiar with it.  I will during the course of 
the submission be making reference to passages in that report to seek to explain to the 
 
Committee the nature of the Church of Scientology and its particular attitude to 

psychiatrists to give a necessary background to the submission I make, which otherwise 
 
might appear to be an extraordinary one, namely an allegation of fraud.  It might assist if 
 
the Committee were to have that report, which has been copied now - it is quite a bulky 
 
document – so that they could look at it if they are prepared to grant the indulgence of an 
 
adjournment until 2 o’clock, to be able to look at it in the interim so that time could be 
saved in that way.  It is being copied at this very moment; it is not ready yet.   

 
 
THE CHAIRMAN:   If it becomes available we will label it D3.   
 
 
 
MR MORRIS: When it does come I will hand it to the Committee. 
 
 
 
THE CHAIRMAN:   Mr Pearce. 
 

MR PEARCE: Sir in explaining our position may I simply state in one sentence I hope in 
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response to the outline of the submission that my silence in respect of the response does 
 
not mean that we accept any of the premises that my learned friend has already stated.  
 
However, we perfectly understand the rationale behind the matter being put back to 
 
2 o’clock.  We have no objection to that.  We are currently seeking to establish whether 
 
there is anything previously in the documentation of the type referred to by Mr Morris 
 
and we should have the answer to that clearly before 2 o’clock.  In terms of the Foster 
report I should say I have not had an opportunity to see that and would welcome that 

opportunity.  Thirdly sir may I say this, that anticipating that there were to be submissions 
 
today that were likely to be relatively lengthy and complex, we took the liberty of not 
 
warning witnesses to attend believing that it was unlikely that the Committee would reach 
 
that stage in any event, so you can be comforted in one thing, that they are not 
 
inconvenienced by any delay there may be today. 
 
 
THE CHAIRMAN:   Looking round the panel I suspect there is no problem about 

deferring to 2 p.m.  Legal Assessor? 
 
 
 
THE LEGAL ASSESSOR: The only question I would ask is if in the Foster report there 
 
are there any particular passages that you would like the Committee refer to.  It looks a 
 
rather bulky document, if we can be steered to the relevant part. 
 
 
MR MORRIS: That is what I was going to do. 

 
 
(The Enquiry into the Practice and Effects of Scientology (The Foster Report) was 
 
labelled D3 and handed to the Committee) 
 
 
 
MR MORRIS: One thing will become immediately apparent and it is a regrettable fact 
 
that the report that you have is not paginated.  On the other hand it is broken up into 
sections which are fairly readily accessible, and sir looking at the content sheet at the 

front what I would invite the Committee to concentrate on in terms of the introduction 
 
into the background to the enquiry, a, b and c, with reference perhaps only to (i) Australia 
 
where a significant enquiry was held I think in the state of Victoria preceding the Foster 
 
report, and that came to be known as the Anderson enquiry.   
 
 
Then, to understand the nature of the enquiry that Sir John Foster conducted, if I could 
 
specifically refer you to section 2, and obviously the Committee might be interested in 

section 3 under the heading “What is Scientology?” without perhaps going into the 
 
function of the service with reference to (a) The Founder, (b) The Organisation in the 
 
United Kingdom, and then I think perhaps if I could direct the Committee directly to 
 
section 7, “Scientology and its Enemies” in section 7 at paragraph 174.  That is another 
 
way of navigating around this document.  It is put in paragraphs.  At paragraph 174 which 
is at the beginning of chapter 7 “Scientology and its enemies” they are numbered under 4 

headings: (i) Scientologists who have defected from the cause, (ii) Anyone outside 
 
Scientology who expresses doubt as to its truth, value, efficacy, or sincerity,  
 
(iii) Psychiatrists, (iv) Communists.   I need not concern you with the last category, but 
 
perhaps if the Committee would care to look at the first three categories under that 
 
heading, those are the sections which will be of particular interest.  
 
 
THE CHAIRMAN: Perhaps just for the record I should check that none of the members 

of the panel has links with the Church of Scientology.  There are no links.   We formally 
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now adjourn until 2 p.m. 
 
 
 
(The Committee adjourned until 2 p.m.) 
 
 
 
THE CHAIRMAN:  Mr Morris, just before the break this morning I asked the Members 
 
of the Panel if anyone was a member of Scientology or had links with the Church of 
Scientology.  The answer at that stage was no, but one member of the Panel involved in 

previous employment had cause to look at some work that Scientology was doing in 
 
relation to drug addiction, as I understand it, and had some contacts with Scientology at 
 
that stage and has spoken and referred to the work in subsequent meetings.  That is not 
 
the extent of the links between any Panel Member and the Church of Scientology, but 
 
I thought that for the record and in case there was any perception of bias I should raise it 
 
with both of you just to check if you have any objections we will take them on board and 
if there are no objections then the Panel Member can continue. 

 
 
MR MORRIS:  I am grateful.  We both had notes from the learned Legal Assessor setting 
 
out the nature of the contact.  Perhaps, for the record, I ought to say what I understand, so 
 
I get it accurately, what the nature of the contact was, which was contact with an 
 
organisation called Narconom, which is a subsidiary or an organisation allied to or part of 
 
the Church of Scientology; that the Panel Member, out of his official duties, visited that 
organisation and in particular rehabilitation centre working with addicts and formed a 

favourable view of the work that that organisation was doing with addicts, such that when 
 
he was no longer acting in his official capacity and had retired from that official capacity 
 
he spoke publicly in support of this particular programme at meetings organised by the 
 
organisation or on behalf of the organisation in Germany. 
 
 
 
I have obviously discussed that with Dr Cosgrove and taken his views and the view he 
comes to – and it is a view that I share – is this, that while that information cannot begin 

to ground a suggestion that this particular Panel Member would show or is biased in 
 
relation to the hearing of this case, there is left a perception of bias which can only be 
 
dealt with by the Member stepping down from this particular Committee. 
 
 
 
I am sure you will be advised in due course as to how to approach what is the proper test 
for assessing whether or not there is a perception of bias.  It is, in my submission, where a 
 
reasonably robust member of the public would perceive that there was a risk that if that 

particular person remained on the Committee there would be or there could be said to be 
 
a realistic risk of bias in that Committee’s deliberations resulting from the presence on the 
 
Committee of that person. 
 
 
 
The reasons why it is submitted that there is a perception of bias in this case is that the 
contact that the Committee Member had with this Church of Scientology organisation 

was not limited to purely professional observation.  It went further than that:  he took a 
 
view of that organisation; he took a favourable view and, furthermore, he spoke in favour 
 
of that organisation (the Narconom organisation) in public.  In the context of the overall 
 
organisation, the Church of Scientology, I hope the Committee will accept, having read 
 
parts of the inquiry into that organisation by Sir John Foster that it is an organisation 
 
where the view that is taken by those in power there that “Either you’re with us or you’re 
against us”.  It is in that context that Dr Cosgrove – and I accept and support him in this 

submission – is concerned that by speaking publicly in favour of an ancillary organisation 
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within the umbrella of the Church of Scientology a perception of bias might arise. 
 
 
 
I would only add this, that Dr Cosgrove instructs me that from his perception he too had 
 
knowledge of the Narconom organisation and would not accept that its work is wholly 
 
good and acceptable.  It is for that reason that, regrettably, we have come to the 
 
conclusion that there is a perception of bias here that can only be dealt with by the 
withdrawal of that Committee Member. 

 
 
THE CHAIRMAN:  Thank you very much.  Mr Pearce. 
 
 
 
MR PEARCE:  Sir, may I say first of all that it was, in our submission, quite right that 
 
your Committee Member should draw attention to this matter.  It is a rather, perhaps, in 
 
some ways obscure connection with a particular organisation but in the circumstances of 
this case it was desirable and he did quite properly disclose that information. 

 
 
Sir, our position is this.  It is vitally important, in our submission, that this hearing does 
 
not become, nor should it be seen to be, a trial in any way of the Church of Scientology or 
 
any aspect of that church.  However, it is apparent from what my learned friend has 
 
already had to say and apparent, if I may say so, from those passages of Sir John Foster’s 
 
report to which he has referred us, that his submissions at an early stage are going to 
involve, one may anticipate, a robust criticism of that church.   

 
 
As I say, the Committee may not feel it necessary to itself come to any view upon the 
 
criticism of the Church of Scientology but, be that as it may, it would appear to form part 
 
of my learned friend’s submissions.  He knows how he is going to put his submissions on 
 
the issue of abuse and in that context it seems to us that given the view taken by 
 
Dr Cosgrove and on his behalf by his legal team, it would be wrong of us to seek to 
persuade you that, notwithstanding my learned friend’s submissions, the particular 

Member of the Committee ought to continue to sit.  Therefore, we would invite you, in 
 
the circumstances, to accede to the submission made on behalf of Dr Cosgrove. 
 
 
 
THE CHAIRMAN:  Legal Assessor? 
 
 
THE LEGAL ASSESSOR:  My advice to the Committee is it is ultimately a question for 
 
you to decide.  However, I would urge you to take into account the fact that both parties 

have asked you to come to a conclusion, effectively, that there might be a perception of 
 
bias if this particular Member were to continue sitting.   
 
 
 
The actual test for perceived and opposed to actual bias, I would summarise in this way:  
 
are the circumstances of the case such that would lead a fair-minded and informed 
observer to conclude there was a real possibility that the Committee was biased 

unconsciously in this case?  That hypothetical observer is one, I would suggest, who is a 
 
member of the public, who is well informed, that is not complacent and neither is he 
 
excessively suspicious.  So my advice to you is you should apply that test as to whether 
 
or not this particular Member should continue to sit and hear this case. 
 
 
 
I do stress that nobody is suggesting that the Member is actually biased in any shape or 
form, it is just a question of whether there might be a perception of someone watching 

these proceedings, a danger of unconscious bias. 
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Perhaps the only other point that should be taken into account is the views of the actual 
 
Member himself, which I believe is that he is agreeable to withdrawing if there is 
 
objection by either party, which there has been.  I do not think I need say any more on 
 
that particular point. 
 
 
THE CHAIRMAN:  Do either of you wish to come back on anything the Legal Assessor 

has said? 
 
 
 
MR PEARCE:  No, sir. 
 
 
 
MR MORRIS:  No, sir. 
 
 
THE CHAIRMAN:  We will now go into camera for a short period and strangers will 

withdraw. 
 
 
 
STRANGERS THEN, BY DIRECTION FROM THE CHAIR, WITHDREW 
 
AND THE COMMITTEE DELIBERATED IN CAMERA 
 
 
 
STRANGERS HAVING BEEN READMITTED
 

THE CHAIRMAN:  Mr Pearce and Mr  Morris, you will notice that we are one down.   It 
 
was considered that it would be better if the member concerned stood down from the rest 
 
of the hearing.  It is the view of the panel that there is no conscious bias on the part of the 
 
person concerned.  Any perception of bias would be in relation to the possibility of 
 
unconscious bias and his words of approval were in relation to the drug rehabilitation 
 
programme, rather than the Church of Scientology itself.  Taking into account all the 
factors before the panel, decision was that it would be wiser if he were to excuse himself 

from the rest of the hearing. 
 
 
 
MR MORRIS:  Sir, I am grateful and I know Dr Cosgrove would wish to associate 
 
himself with what you have said about there being no conscious bias.  Can I update you 
 
on what has been going on this morning during the indulgence you have kindly granted 
us?  A handwriting expert has looked at D1 and D2 and has made an oral report that has 
 
been communicated to us here that there is no evidence to link the handwriting on the 

GMC letter, D2, and the signature on that letter to the handwriting that we see on the 
 
three letters that form part of the 1996 letters or matters that were part of Dr Cosgrove’s 
 
notes. 
 
 
 
When she says that there is no evidence to link them, she is effectively saying that in her 
professional opinion there is absolutely no evidence that the 1996 signatures were written 

by the same person as the author of the 2000 signature, in other words, they are by 
 
different hands.  She says that when using every criterion of professional comparison, 
 
whether it is proportion, shape or size, everything in her opinion is different.  She further 
 
says that it is highly unlikely that a person of the age that Master D’s mother was at the 
 
time, that is to say, I anticipate, somewhere in her forties, would so radically alter her 
 
signature in that space of time so that it was different in every handwriting aspect.   
 

She is going to prepare a written report to that end, which will be done during the course 
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of today and should be available by the end of today.  The significance of that evidence, 
 
in my submission, is high and it is a matter that the Committee would no doubt like to 
 
investigate further before coming to a conclusion on my abuse submission.  The sort of 
 
investigation that I would anticipate would be appropriate in these circumstances would 
 
be for the person who the Council says is the mother of the patient concerned, who makes 
 
the complaint about Dr Cosgrove, to give evidence in relation to this matter, as well as 
the expert handwriting witness.  The expert handwriting witness is available tomorrow 

and Wednesday, but I understand from Mr Pearce that the purported mother, if I can call 
 
her that from our side, of Master D is not available until Wednesday morning.  
 
 
 
The other development this morning has been the disclosure by the Council of internal 
 
letters and memoranda dealing with the period running up to the letter written the 
 
Council’s Solicitor to the Registrar on 26 September 2002.  On the face of that 
documentation that I and Dr Cosgrove have seen, there is nothing expressly set out there 

which would suggest that there were any steps taken by Mr Daniels or anyone else within 
 
the Human Rights Commission or the Church of Scientology which had an obvious effect 
 
on the decision to reactivate these complaints that have been made in 1999 and 2000. 
 
 
 
What I do say on behalf of Dr Cosgrove is this:  that that on its own is not sufficient.  
 
Because of the nature of the organisation, which I hope you have had a chance to gather 
from your short perusal of passages from the inquiry into the practice and effects of 

scientology, it would be impossible without hearing from this witness, the ostensible 
 
mother of Master D, who is acting, as we know, under the aegis of the Human Rights 
 
Commission, to know what the extent of the Commission’s efforts to influence the 
 
General Medical Council was.  We know that there were many letters from Mr Daniels 
 
and the Commission, although you do not have them before you, to the General Medical 
 
Council chasing up the complaint they made between August 2000 and August 2002.  We 
also know from the Foster report that the organisation, and that must include the 

Commission, which is an essential function within the organisation, is an organisation 
 
that, in order to propagate its views about medicine and psychiatry in particular has 
 
gained membership, if I can put it as neutrally as that, within organisations as set out by 
 
Sir John Foster, namely the British Medical Association and the Royal College of 
 
General Practitioners and is an organisation that is prepared to seek to take over 
wholesale medical organisations.  By way of example, at paragraph 186 in the section 
 
dealing with the enemies of the organisation, Sir John Foster notes, 

 
 
“The scientologists attempted to take over the National Association for Mental 
 
Health, a UK body which is affiliated to the World Federation of Mental Health 
 
by joining it in large numbers with the object of voting a majority of scientologists 
 
on to its council.” 
 

That was an attempt that was exposed.  The Association resisted and the scientologists 
 
took action by seeking injunctive relief to restrain the Association from holding an annual 
 
general meeting.  That legal action was defeated. 
 
 
 
That is the nature of the organisation.  My submission is that it would be impossible to 
 
come to a firm conclusion, a safe conclusion in relation to the possibility that this 
organisation had an improper subversive effect on the Council, whether consciously or 

subconsciously on the part of the Council had an improper subversive effect on it until 
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the evidence is heard from that particular witness.   
 
 
 
In short, given that we have here prima facie evidence – I say that on the basis of the oral 
 
report from our handwriting expert – that there are fraudulent signature or there are 
 
fraudulent signatures in documentation sent to the General Medical Council and that one 
 
of those signatures appears on the actual letter of complaint in relation to head of charge 
D, my submission of abuse should not proceed until we have had an opportunity to hear 

from the witness in question. 
 
 
 
THE CHAIRMAN:  Mr Pearce. 
 
 
 
MR PEARCE:  Sir, I take it at this stage that the issue we are dealing with is as to when 
 
arguments relating to abuse of process ought to be determined.  The reality of the 
situation is that if that is to be after you have had the opportunity to hear from the mother 

of patient D, that must be on Wednesday because that is the only day when she will be 
 
available to attend this week.  To give a little background, she lives and works in a city 
 
some considerable distance from here.  She has child care issues as well and everything 
 
has been organised on the assumption that Wednesday will be the day for her to give 
 
evidence, which was our plan.  That is why that is so.   
 
 
Sir, I do ask you to look with care at the manner in which this submission is being 

structured in order to consider whether in fact you do need to hear from that witness in 
 
order to decide on the submission.  If I follow the submission correctly, it runs in the 
 
following manner:  first of all, it is said charge 4 is, for want of a better expression, 
 
fraudulent, and it is so because it is based upon a complaint which, at least prima facie… 
 
 
 
THE CHAIRMAN:  Is it charge 4 or charge 6? 
 

MR PEARCE:  It is charge 6.   Charge 6 is a fraudulent charge in the sense that it is based 
 
upon a complaint which, prima facie, it is said has been signed by somebody other than 
 
the person who purports to make that complaint.  I draw attention immediately to a 
 
number of points about that.  You will have noted with care the way my learned friend 
 
has recited the report of the handwriting expert.  She has not in fact said in the oral 
conclusions that have been communicated that the letters are not signed by the same 
 
person.  She has said that there is no evidence that they were signed by the same person.  

That may be a distinction that matters.  It may well be that were you to hear from the 
 
parent of Master D there would be a perfectly adequate explanation for why the two 
 
signatures appear sufficiently different to lead to that conclusion.  One only has to 
 
speculate for a moment on a number of possible explanations that are consistent with it 
 
being not in any sense whatsoever fraudulent or dishonest. 
 

Let us assume for a moment, simply for the purpose of this argument, that you were 
 
persuaded, upon hearing from the mother of Master D that that charge is fraudulent in the 
 
sense in which my learned friend suggests it may be.  So what?  Clearly that would affect 
 
you views on that particular charge.  One can well understand that point.  What about the 
 
broader issue of abuse of process?   
 
 
We come to the next stage in the reasoning.  The next stage in the reasoning is, as I 

understand it, that that alleged fraud in relation to that charge, coupled with the nature of 
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the Church of Scientology which has through this Commission a link with the bringing of 
 
that charge, that connection can be taken to be a basis for a conclusion that these charges 
 
in their entirety are only pursued because of fraudulent charge 6.   
 
 
 
That conclusion, if you consider it, will rest upon a number of considerations.  You will 
 
read what the Foster report has to say.  You will have noted the older one gets the less 
distant the 1960s and 1970s seems, but we are talking about a report that is thirty years 

old plus.  We are talking about matters which are historic.  One is only seeing one 
 
viewpoint.  I know I have already said I do not invite you to try the issue of the conduct 
 
of the Church of Scientology, but I know that the Church of Scientology itself would 
 
defend its position and produce literature to seek to defend its position and say, with due 
 
respect, that Sir John Foster got matters wrong in his report.  There are differences of 
 
opinions on those lines. 
 

Even if, purely for the sake of dealing with these submissions, the Church of Scientology 
 
is, as is categorised by my learned friend, an organisation that will use any means to 
 
achieve the end of attacking psychiatry, where does that take us?  Where is the evidence 
 
that the Church has in fact influenced the prosecution of this case?  You make take it 
 
from my learned friend’s submissions and concessions that there is nothing in any 
 
documentation that he has seen that we have been able to disclose to him that suggests 
any such involvement or influence, nor is there any other documentation that we, for our 

part, are aware of that could be disclosed that might possibly reveal any other conclusion. 
 
  
 
MR PEARCE: One has that stage as well.  I invite you to say, how is hearing from D’s 
 
mother assisting in any event in assessing whether there has been as between the church 
 
generally and the commission, the individual author of the letter, there has been some 
 
undue influence upon the GMC?  There won’t be any more evidence once you have heard 
from D’s mother on this particular point, so we say they fail at that stage.  But if I may 

say so sir I am attempting for a moment to deal with the question, not the merits of the 
 
submission, even if my learned friend were to get over that hurdle and were to show that 
 
some pressure unduly in some way influenced the decision to bring these charges, even 
 
then we say that does not mean that it is appropriate to stay the charges.  These are 
 
professional disciplinary charges with individual reasons for each allegation, and in our 
submission the Committee must be able to hear the evidence and determine the facts in 
 
relation to each charge.  Even if it were true that there was in some sense a bad 

motivation or some bad faith, we still submit that that would not be a ground to stay these 
 
proceedings.  It follows from all of that sir that in our submission hearing from D’s 
 
mother will not assist in determining the stay application, save possibly, I conceive this, 
 
in respect of a stay application specific to ground 6 where really the merits of the stay 
 
would overlap so much if you found that that evidence was fraudulent.  You may think 
charge 6 is bound to collapse whether it is stayed or where ever we have to drop the case 

however it is dealt with, and we certainly would not seek to stand in the way of any 
 
renewed application, be it on Wednesday or at any other stage given the specific on 
 
charge 6, but in terms of a stay of the general case in so far as the doctor has a proper case 
 
to put, in our submission it is proper to deal with that submission now and to deal with 
 
that submission and not invite the Committee to hear from D’s mother.  
 
 
Sir, may I raise one very practical issue about this, that this should not, if you are 

otherwise persuaded by what my learned friend has to say, this should not dissuade you 
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from doing what he says but if you are minded in the balance this is a proper 
 
consideration for you to bear in mind, the practical consequences of what my learned 
 
friend is suggesting is that there is nothing as I see it for this Committee to do tomorrow 
 
that we are already therefore 2 days down, 6 days left.  From our point of view we have 
 
lined up witnesses with a view to calling D’s mother on Wednesday and also an expert 
 
witness Professor Taylor.  Professor Taylor is only available on Wednesday.  We have 
had great difficulty with his availability but we have ensured he is available on 

Wednesday, and it is our concern I must say that in order to deal with abuse submissions 
 
including evidence from D’s mother, the evidence of D’s mother live as it were actually 
 
on the charges if the case goes ahead and the evidence of Professor Taylor, in my 
 
submission that is a very long day’s work for this Committee.  The chances are that on 
 
Wednesday I would be in a position to say to the Committee from our point of view we 
 
ask you to do it because we have no other way of ensuring that these witnesses can be 
heard and accommodated, so that is a practical consideration about effectively not 

wasting a day and creating difficulties on Wednesday but on the merits and the substance 
 
of it, for the reasons I have said in my submission, you will not be more assisted by an 
 
application to stay than from hearing it from the documents as are. Unless I can assist 
 
further.   
 
 
 
MR MORRIS: Briefly if I can respond, in relation to the nature of the evidence from the 
hand writing expert, I think my learned friend is perhaps taking a semantic point of view 

when he says that the report that there is nothing to link the two signatures is not to say 
 
that they were not made by one and the same person.  Obviously she is unable to say that. 
 
 I suppose it is possible that the person may have changed her signature so radically in 
 
that period of time. I don’t suppose the hand writing expert could exclude that as a 
 
possibility, but I think she would characterise it as a very remote possibility and of course 
 
one has to factor in my submission the fact that that signature where there is no evidence 
of connection between it in handwriting terms between that and the earlier 1966 

signatures, is spelt differently itself, a significant fact in itself.      
 
 
 
Turning to the consequences if it is accepted that there is a prima facie case that the 
 
submission of the complaint in charge 6 is fraudulent, my learned friend asked whether or 
 
not there is any connection between that and the decision to proceed with the other 
charges outside head of charge 6. He is right in saying that there is nothing on the face of 
 
the documentation that I have been provided with, but I submit that he is bold in 

suggesting that there will be nothing from the person who is going to come on 
 
Wednesday to give evidence purportedly as the mother of Master D. If that person can 
 
throw light on to the circumstances that surround the putting to paper of a fraudulent 
 
complaint, made fraudulent by a fraudulent signature, we say given the nature of the 
 
organisation under which the aegis of which that complaint was made, who can say as to 
what light may not be cast as to the efforts of that organisation in bringing the remainder 

of the charges to life in relation to Dr Cosgrove?  It would be dangerous in our 
 
submission, given the nature of that organisation, without hearing all the appropriate 
 
evidence to come to that conclusion about which you must be sure before deciding to 
 
proceed without that evidence to hear this submission.  And then my learned friend goes 
 
on to say and even if it is established that there is some bad faith here which lies behind 
 
the bringing of the other charges, that is not sufficient on its own to found a basis for 
submitting that there should be a stay of the whole enquiry.  I don’t accept that as a 

matter of law and I am happy to take the Committee to passages in Archbold in relation to 
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that. Perhaps I should at this stage if I can take the learned legal adviser to paragraph 4-54 
 
of the 2004 edition if he has it. 
 
 
 
THE LEGAL ASSESSOR: I have edition 3.   
 
 
 
MR MORRIS: It is 4-54.  There has been no change I am glad to say between that and the 
2004 edition.  The authors there are saying, this is the principles governing the exercise of 

the jurisdiction of the abuse of process, and if I can just go back to the heading which in 
 
the 2004 edition is at 4-48, abuse of process jurisdiction, the general setting for it is set in 
 
Connelly against DPP 1964 House of Lords decision, Lord Devlin added a fifth ground to 
 
the list set out in another case where particular criminal proceedings constitute an abuse 
 
of the court’s process.  What all their lordships do seem to agree upon is that the court has 
 
a general and inherent power to protect its process from abuse. This power must include a 
power to safeguard an accused person from oppression or prejudice.  The views 

expressed in Connelly were considered Obiter in DPP v Humphrys in 1977, again a 
 
House of Lords case, only Lords Dilhorne, Salmon and Edmund-Davies considered the 
 
point. Lord Salmon and Lord Edmund-Davies concurred with the views expressed by 
 
Lord Devlin and Lord Pearce in Connelly while Lord Dilhorne supported the narrower 
 
approach adopted by Lord Morris.  Lord Salmon was then quoted: 
 
 
“I respectfully agree with my noble and learned friend, Viscount 

Dilhorne, that a judge has not and should not appear to have any 
 
responsibility for the institution of prosecutions; nor does he have 
 
any power to refuse to allow a prosecution to proceed merely 
 
because he considers that, as a matter of policy, it ought not to have 
 
been brought. It is only if the prosecution amounts to an abuse of the 
 
process of the court and is oppressive and vexatious that the judge 
has the power to intervene.  Fortunately such prosecutions are hardly 

ever brought, but the power of the court to prevent them is, in my 
 
view, of great constitutional importance and should be jealously 
 
preserved.  For a man to be harassed and put to the expense of 
 
perhaps a long trial and then given an absolute discharge is hardly 
 
from any point of view an effective substitute for the exercise by the 
court of the power to which I have referred.” 
 
 

And if I can take you back to the principles governing the exercise at 4-54, The power to 
 
stay proceedings for abuse of process has been said to include the power to safeguard  an 
 
accused person from oppression or prejudice – that is Connelly – and has been described 
 
as a formidable safeguard developed by the common law to protect persons from being 
 
prosecuted in circumstances where it can be seriously unjust to do so.  An abuse of 
process was defined in the case of Ho Chi Min v R 1992 – a Privy Council case – as 

something so unfair and wrong that the court should not allow a prosecutor to proceed in 
 
what in all other respects is a regular proceeding.   
 
 
 
It says that in Baring plc, a case of 1999 decided in the Court of Appeal (Civil Division), 
 
it was said: 
 
 
“In the context of proceedings under section 6, the Company 

Directors Disqualification Act of 1986, that a court may stay 
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proceedings where to allow them to continue would bring the 
 
administration of justice into disrepute among right thinking people, 
 
and that this would be the case if the court was allowing its process 
 
to be used as an instrument of oppression, injustice or unfairness.” 
 
 
 
If I can just take the learned Legal Assessor to paragraph 4-56. I hope that is the same in 
his edition. 

 
 
THE LEGAL ASSESSOR: The majority decision of R v Horseferry Magistrates Court ex 
 
p Bennett
 
 
 
MR MORRIS: Thank you.  That decision has now made it clear that the doctrine of abuse 
 
of process is not limited to situations where the defendant could not receive a fair trial.  
The accused in that case has been brought to this country as a result of collaboration 

between authorities here and abroad, and in disregard of extradition procedures.  The 
 
doctrine was held to apply in such a situation even though the matters complained of 
 
would not prevent a fair trial and even though it would not be unfair to try the accused if 
 
he had been returned to this country through lawful extradition procedures, Lord Griffith 
 
said that the court had the power to interfere with the prosecution because the judicial 
 
acceptance of responsibility for the maintenance of the rule of law embraces a willingness 
to oversee executive action and to refuse to countenance behaviour threatened by the 

basic human rights and the rule of law.  It was the function of the high court to ensure that 
 
executive action was exercises responsibly as Parliament intended.  If therefore it came to 
 
the attention of the high court that there had been a serious abuse of power it should 
 
express its disapproval by refusing to act on it.  Lord Bridge said there is no principle 
 
more basic in any proper system of law than the maintenance of the rule of law itself.   
 
 
In the R v Mullen [1999], again a Court of Appeal decision, it was said that the speeches 

in ex parte inclusively established that proceedings may be stayed in the exercise of the 
 
court’s discretion not only where a fair trial is impossible but also where it can be 
 
contrary to the public interest and the integrity of the criminal justice system that a trial 
 
should take place.  Guidance was also given as to the sort of matters that may affect the 
 
exercise of discretion.   
 
 
Sir what I submit in the light of that is if indeed there is bad faith demonstrated in relation 

to the bringing of the charges other than head of charge 6, there is ample authority in my 
 
submission for that granting properly a stay on the grounds of abuse of process, and that 
 
lack of bad faith doesn’t have to be found in the heart of the prosecuting body; it can take 
 
effect even if the body itself is an unwitting victim of that bad faith in my submission, 
 
and that is established at paragraph 4-63a.  Again I hope it is the same in the learned 
Legal Assessor’s edition. It is headed “Matters relating to complainant or witnesses.” 

 
 
THE LEGAL ASSESSOR: Yes it is the same. 
 
 
 
MR MORRIS: Under that heading matters relating to complainant or witnesses, the 
 
orders say this: 
 
 
“An abuse of process exists where the plaintiff in civil proceedings 

is in effective control of criminal proceedings against the same 
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defendant to the extent that the prosecution are unable to exercise 
 
independently their prosecutorial duties” 
 
 
 
And two cases are cited there.  Then another example is given: 
 
 
 
“If a bank is the ultimate complainant and ‘prosecutor’, there is a 
heavy burden on that bank to make available to the prosecution, for 

onward disclosure to the defence (including privileged documents) 
 
relevant to the issues, and failure to do so might well compromise 
 
the ‘integrity of the proceedings’; where necessary the prosecution 
 
can produce documents that have been suitably sanitised so as to 
 
preserve customer confidentiality.”   
 
 
So what my submission is, that if a complainant is exercising an effect on the prosecuting 

body, and the comparison here would be between Mr Daniels and the Commission as the 
 
complainant, and the GMC as the prosecuting body, if it is having such an effect on that 
 
body that itself can amount of an abuse of process which merits the staying of the 
 
enquiry. My submission is that if such bad faith can be established, and I accept that the 
 
burden is on the defendant, the burden and the standard of proof on the balance of 
 
probabilities, if that can be established, that affords good grounds for a stay.  It is 
impossible in my submission to come to a firm conclusion on that issue until such time as 

we have heard the evidence in relation to that particular issue.  That will include the 
 
person who signed that document or whose name was purported to have signed it.   
 
 
 
Can I turn to the practical issue?  I accept that it may cause difficulties on Wednesday.  It 
 
may lead to a long day in order to accommodate Professor Taylor if it is necessary to call 
 
him.  That is a hardship in my submission that the Committee and everyone appearing 
before it should be prepared to face in order to give proper justice in this case to 

Dr Cosgrove. 
 
 
 
THE CHAIRMAN:  Legal Assessor?  
 
 
 
THE LEGAL ASSESSOR:  I must confess I do find this a little difficult.  My 
understanding is that both counsel are agreed that the burden is on the Respondent to 
 
make out a case on abuse of process.  As I understand it, the application is that this 

witness can be called, presumably by the GMC, on the question of whether there is in fact 
 
an abuse of process in bringing the whole inquiry.  Am I still with everybody here? 
 
 
 
The question I am going to ask, Mr Morris, is are you going to call any evidence to prove 
 
that there has been some, albeit unwittingly, influence on the General Medical Council in 
proceeding with these charges on the question of abuse of process?  Forgive me if I am a 

little confused on this, but I do want to make it clear where we are actually going. 
 
 
 
MR MORRIS:  I am not proposing to call any evidence over and above the witness; I am 
 
not proposing to adduce any evidence beyond the evidence that would be adduced should 
 
the mother, or purported mother, of Master D give evidence.  So what I am saying is that 
 
within her evidence there may be some light that can be cast upon the role of the 
Commission over and above that which is available on the documents.   On the basis of 

the documentation that we have so far, we have evidence of the complaint and of it being 
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pursued on a regular basis with the Council.  Beyond that, I am not going to call any 
 
further evidence. 
 
 
 
There is documentation that is not yet before the Committee, which I do propose to put, 
 
dealing with such issues as, for example, the fact that the issue about the apparent 
 
difference in handwriting between the signature of the complaint made by the ostensible 
mother of Master D in August 2000 and the handwriting of the patient’s mother in 1996, 

together with the fact that the name in that signature was spelt differently was brought to 
 
the attention of the Council on 25 January 2001 when Mr Panting of the Medical 
 
Protection Society wrote to the General Medical Council about it and asked for 
 
investigations to be made.  Those investigations were not made for 21 months and there 
 
was no response to that letter.   
 
 
So whether or not any conclusion can be drawn from that is a matter for the Committee, 

obviously, but that is an item of additional documentary evidence that I will be putting 
 
before the Committee in due course during the hearing of this, but as far as live oral 
 
evidence, the answer is no – apart, of course, from the handwriting expert. 
 
 
 
MR PEARCE:  Could I just come in on that point, sir?  I appreciate, given where it is 
 
agreed the burden of proof lies that one does get into a difficult area here, but for our part 
our inclination, I have to say – and I do not think this is necessarily assisted by any 

textbooks or authority – our information is that if you thought that that witness might say 
 
something that might assist my learned friend’s case we would be minded to say we 
 
ought to call her – to concede, effectively, what my learned friend says. 
 
 
 
Our reasoning, if I may say so, is quite simply this.  If it were not dealt with in that way, 
 
she might in any event say something in the course of ordinary evidence that supported 
the contention for a submission and in that supposed scenario you would be in a position 

of having rejected my learned friend’s submission, then finding later on further down the 
 
line that there was in fact relevant material and you might need to reconsider it.  If you 
 
think she is capable of saying something that will enlighten your assessment of the 
 
submission, then we would be minded to accept that we ought to call her and that my 
 
learned friend should cross-examine her. 
 
 
THE LEGAL ASSESSOR:  I am grateful for that.  The reason I raised it was that 

because, if you accept the burden is on you, ordinarily it would be for you to call the 
 
evidence.  I was a little confused when the Council were talking about it, but Mr Pearce, 
 
very fairly, is saying he is prepared to call the witness so she can be cross-examined by 
 
Mr Morris. 
 
 
MR PEARCE:  Yes. 

 
 
THE CHAIRMAN:  So basically what Mr Pearce is conceding is that your request that 
 
we postpone any further discussion until Wednesday morning goes ahead. 
 
 
 
MR PEARCE:  I was not conceding that, sir, I am sorry.  What I was conceding was that 
 
if you took the view that that lady’s evidence might help you then I do concede, 
effectively, the adjournment until Wednesday morning.  I remain of the view, for the 

reasons I have said already, that it will not help you, whatever she says, even if my 
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learned friend establishes the height of the case, as he put it, is not going to assist you on 
 
the terms of the stay. 
 
 
 
THE CHAIRMAN:  Legal Assessor? 
 
 
 
THE LEGAL ASSESSOR:  I must say I do find this difficult.  I understand the arguments 
of both sides.  I can see the advantage to the defence, as it were, to have the chance to 

cross-examine this lady.  I would really like a few minutes to think about this because 
 
I am finding it a little difficult.  The only other question I was going to ask was this.  We 
 
have been provided with the Foster Report, which is very full and comprehensive but it 
 
was written in 1971, which is quite a long time ago.  Do the General Medical Council 
 
accept that the aims of the Church of Scientology as described in that report are those that 
 
they have today? 
 

MR PEARCE:  I have no case on that, sir, one way or the other.  I noted that it was a non-
 
judgmental report; it made recommendations but did not make judgments.  In the large 
 
part, it does not make judgments about the Church, though quotes at very great length the 
 
Foster Report which certainly did make a judgment on the Church of Scientology.  But 
 
no, sir, I am not in a position to accept anything – nor, if I may say so, do I think I could 
 
ever be.  It is not a question of not having enough time.  I do not think we could ever be 
in a position in which we would want to take a stance in respect of an organisation such 

as this.  I cannot imagine so. 
 
 
 
THE LEGAL ASSESSOR:  Mr Morris obviously has no objection to the Foster Report 
 
going before the Committee, but given it was such a long time ago are you saying that 
 
nothing has changed since 1971? 
 
 
MR MORRIS:  Sir, I am.  I can present to the Committee some newspaper coverage of 

actions taken by the Citizens’ Commission on Human Rights that postdate 1971, but 
 
I thought out of fairness I ought to show those to my learned friend before I submit them 
 
to the Committee.  My instructions are that the attitude of the Church and the 
 
Commission in particular has not changed. 
 
 
THE LEGAL ASSESSOR:  Thank you.  I would like a moment to think about this 
 
because I am finding this difficult. 

 
 
THE CHAIRMAN:  We will adjourn until roughly 3.30. 
 
 
 
THE LEGAL ASSESSOR:  Thank you. 
 
 
(The Committee adjourned for a short time) 

 
 
THE CHAIRMAN:  I will turn to the Legal Assessor to give his advice before the 
 
Committee go into camera. 
 
 
 
THE LEGAL ASSESSOR:  Mr Chairman, I am most grateful for the time I have been 
 
given to think about this.  As I have indicated, I have found it quite difficult.   
 

Mr Morris wishes to make an application to stay these proceedings and, as I understand 
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it, he wishes to have the opportunity to cross-examine Master D’s mother with a view to 
 
eliciting evidence that would support his contention that these proceedings are an abuse 
 
of the process. 
 
 
 
The burden is upon the practitioner to prove that these proceedings are such an abuse.  
 
However, as I understand it, on this occasion Mr Pearce, for the GMC, concedes that if 
D’s mother can assist he is willing to call that witness so that Mr Morris may elicit 

evidence in support of his application.  The question, therefore, is can D’s mother provide 
 
any relevant and probative evidence that would assist in advancing Mr Morris’s 
 
submission? 
 
 
 
On the face of it, the most that can be achieved is that the information she provided to the 
 
General Medical Council is false and that this of itself would fall short of evidence of 
oppressive behaviour or otherwise bad faith by the General Medical Council in 

prosecuting these proceedings.  However, given the width of the category of conduct 
 
which can be described as being abusive, coupled with and, in my view, the very fair 
 
attitude of counsel for the GMC and  – perhaps this is the important part – the uncertainty 
 
of what may be elicited in the cross-examination of D’s mother, my advice on the 
 
particular facts of this case is that Mr Morris should have the opportunity to 
 
cross-examine that particular witness.   
 

That is my advice.  As you are aware, of course, it is only advice, but that is, in my view 
 
the fair way to proceed under Article 6 of the European Convention of Human Rights as 
 
incorporated into our law, which requires that the practitioner has a fair trial.  I have 
 
taken into account the authorities as to what conduct and circumstances may render a 
 
prosecution an abuse, which are set out at paragraph 4/56 of the 2003 edition of 
 
Archbold’s Criminal Pleadings, Evidence and Practice.   
 

It will be obvious to you all that I have read from a prepared note.  I hope I have made my 
 
reasoning clear on the facts of this particular case. 
 
 
 
THE CHAIRMAN:  Did you wish to come back on anything the Legal Assessor said, 
 
Mr Pearce? 
 
 
MR PEARCE:  No, sir. 

 
 
THE CHAIRMAN:  Mr Morris? 
 
 
 
MR MORRIS:  No. 
 
 
THE CHAIRMAN:  At this point, the Committee will go into camera and strangers will 

withdraw. 
 
 
 
STRANGERS THEN, BY DIRECTION FROM THE CHAIR, WITHDREW 
 
AND THE COMMITTEE DELIBERATED IN CAMERA 
 
 
 
STRANGERS HAVING BEEN READMITTED
 

THE CHAIRMAN:  Mr Morris, the panel has considered your request and has agreed that 
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we can have an adjournment to allow time for you to bring the handwriting expert and to 
 
allow you to cross-examine or examine Master D’s mother.  The question I have to put to 
 
you is when do you want that to be?  I know that Mrs D cannot be here before 
 
Wednesday morning.  I do not know if you want to do anything tomorrow with the 
 
handwriting expert, or do you want to do everything on Wednesday morning?  There may 
 
be minimal advantage in having the handwriting expert tomorrow, but I thought I would 
make that over to you. 

 
 
MR MORRIS:  It would obviously help in terms of timing, but the thought occurs to me 
 
that it might be helpful for the expert, as she will be an expert, to hear what the lay 
 
witness has to say.   
 
 
 
MR PEARCE:  I must say it strikes me that, if Mrs D has an explanation, the expert will 
need to know what it is.  I could not put to the expert a purported explanation, because I 

do not know what, if any, explanation there might be.  I also suspect the handwriting 
 
expert evidence would not be long in any event. 
 
 
 
THE CHAIRMAN:  We will go ahead at 9.30 on Wednesday morning, so there will be no 
 
hearing tomorrow. 
 
 
MR PEARCE:  Would the Committee consider sitting at nine o’clock on Wednesday?  I 

suggest it only to try and maximise the available time.  Perhaps it does cause 
 
inconvenience. 
 
 
 
THE CHAIRMAN:  It certainly does not cause inconvenience at this end of the table.  I 
 
do not think it causes inconvenience round the table.  We have always got to be mindful 
 
we do no go on too long, otherwise we could be subject to criticism.  Nine o’clock on 
Wednesday morning. 

 
 
(The Committee adjourned until Wednesday, 21 January at 9 a.m.
 
 
 
 
 
 
 
 
 

 
 

 
 

 
 
 
 
 


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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
Wednesday, 21 January 2004 
 
Held at: 
Barnett House 
53 Fountain Street 
Manchester M2 2AN 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Two) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of TranscribeUK 
Tel No:  0208 614 5799) 
 
-------------------------------------- 
 
 
 
 
 

 
 
 
INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
  PRELIMINARY 
MATTERS 
     1 
 
  MRS 
D, 
Sworn 
 
 
 
Examined by MR PEARCE   
 
 
 

   Cross-examined 
by 
MR 
MORRIS 
   3 
 
 
 
Re-examined by MR PEARCE 
 
 
           30 
   Further 
cross-examined 
by 
MR 
MORRIS 
  36 
 
 
 
FIONA ELIZABETH MARSH, Sworn 
  Examined 
by 
MR 
MORRIS 
    38 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:  Good  morning.  We have a little bit of ordering to put into place in 
 
that one of the witnesses who, technically in the body of the hearing would have been a 
 
GMC witness, but really is attending at the request of Mr Morris.   
 
 
 
MR PEARCE:  Sir, may I explain the position here?  The witness who I propose to call to 
 
tender to Mr Morris to cross-examine is, to the best of our knowledge, in a cab 
somewhere in Manchester on her way here.  We are expecting her arrival at any moment. 

 
 
I know that the handwriting examiner who we referred to on Monday is in the building 
 
and my learned friend, understandably, wishes to speak to her briefly before the evidence 
 
starts.  There are certain documents, it became apparent yesterday, we do not have copies 
 
of but I think my learned friend does, so he is going to provide us with copies of those. 
 
 
If I may add all of that together, the best laid plans of mice and men often go awry and 

I should not have suggested nine o’clock. 
 
 
 
THE CHAIRMAN:  That is a very appropriate quotation for Burns week! 
 
 
 
MR PEARCE:  If I suggested we started at 9.30 perhaps we would not have been ready 
 
until 10 o’clock, whereas this way what I propose to you – I think my learned friend is in 
agreement – I propose to invite you, subject to there being any hiccups, to retire now and 

reconvene at 9.30. 
 
 
 
THE CHAIRMAN:  Mr Morris? 
 
 
 
MR MORRIS:  I entirely support that. 
 
 
THE CHAIRMAN:  We agree to that, so we will troop out again. 

 
 
(The Committee adjourned for a short time) 
 
 
 
DR COSGROVE:  May I make a brief point?  I understand very few people can hear 
 
Mr Pearce at the back and this is a public inquiry.  Could you ask him to hold his 
microphone up to his face as he speaks? 
 
 

MR PEARCE:  I shall try to speak louder, sir. 
 
 
 
THE CHAIRMAN:  Mr Pearce. 
 
 
 
MR PEARCE:  Sir, I think we have reached the stage now where I shall call the witness 
to whom reference has been made.   

 
 
May I make one point, sir?  It will be apparent to the Committee and those members  
 
of the public who have heard the charges being read that throughout patients have been 
 
anonymised by the use of letters for their names.  In the case of the patient and the 
 
patient’s mother, whom I am now going to call for the purpose of this part of the case, it 
 
seems to me that it will almost certainly be the case that we will have to refer, before the 
Committee, to at the very least the full name of the patient’s mother and, realistically 

speaking, it is probably unlikely that the full name of the patient will not also be referred 
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to. 
 
 
 
It seems to us that at this stage the Committee has three choices:  it might consider 
 
whether it ought to sit in camera in order to protect anonymity; it might do nothing and 
 
allow such reporting as may be considered appropriate, or it might invite those members 
 
of the press who are present or who are represented here in any way, shape or form to 
respect the anonymity of the patient and the patient’s mother.  So we do not invite you to 

go into camera.  It seems to us in this particular case and in these circumstances the 
 
interests of fairness and of all involved are best dealt with by you taking the third course 
 
of action to which I have made reference.  Therefore, on behalf of the Council, I invite 
 
the Committee to consider taking that action in order, as I say, to seek to protect 
 
anonymity if that can be done. 
 
 
THE CHAIRMAN:  I had anticipated that the witness would be referred to as Mrs D and 

she would identify herself by writing her name on a slip of paper and passing it to both 
 
legal teams and to members of the panel.  It can occur on occasions that a name could slip 
 
out and I certainly would ask, if we do decide to continue in public as you suggest – I am 
 
looking round members of the Panel; I think we have got their agreement for that – 
 
I would ask members of the press and the public to respect anonymity and confidentiality 
 
if, by mistake, her name slips out. 
 

Mr Morris? 
 
 
 
MR MORRIS:  Sir, I entirely agree that we should make an effort to anonymised and 
 
invite the press to resist that and anonymity should be kept. 
 
 
 
MR PEARCE:  I am obliged, sir.  With that, I call the witness, Mrs D.  I should say that 
I propose simply to ask Mrs D to write down her name and address for the assistance of 

the Committee and that thereafter I will tender Mrs D to my learned friend for cross-
 
examination. 
 
 
 
THE CHAIRMAN:  Would it be appropriate for her to sign the paper as well? 
 
 
MR PEARCE:  Why not? 
 
 

MRS D, sworn 
 
 
 
THE CHAIRMAN:  Good morning, Mrs D.  We are referring to you as Mrs D because 
 
we wish to protect patient confidentiality and anonymity, so we shall try to refer to that 
 
protocol during the hearing.  We are not taking all of your evidence at the present time 
but we will be asking some questions of you. 

 
 
Examined by MR PEARCE 
 
 
 

If I might add, Mrs D, to what has been said, that we propose to refer to your son 
 
as D.  Can I invite you, Mrs D, to write on the paper to your right your name and address 
 
and to sign that document for the benefit of the Committee?   
 

(The witness wrote on a piece of paper, which was handed to counsel and the Committee) 
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THE CHAIRMAN:  Just for clarification purposes, you have got your name.  Is your 
 
name your signature?  Do you see what I am getting at?  That is the way you would 
 
normally sign your name, is it? 
 
A Yes. 
 
 
MR PEARCE:  As I said a moment ago, I tender Mrs D to my learned friend for cross-

examination. 
 
 
 
Cross-examined by MR MORRIS 
 
 
 

Mrs D, I would like you to look at some documents, please, and first of all I 
 
would ask you to look at a document called D2 and also, I think, D1.  Before I ask you 
any questions, I want to add some further documents to those two sets of documents you 

have there.  (Same handed) 
 
 
 
THE CHAIRMAN:  This bundle will be D4. 
 
 
 
MR MORRIS:  First of all, could you look at D1, which has handwriting on? 
 
A Yes. 
 


You will see there three letters in handwriting and the top one in my copy is dated 
 
September 23, 1996 addressed to Dr Cosgrove with a signature over the page.  Is that 
 
your signature? 
 
A Yes. 
 
 
 

Did you write that letter? 
A Yes. 

 
 

Turning on, and in fact going back in time to Monday, 27 May 1996, again a letter 
 
to Dr Cosgrove with what has your name at the top and a signature at the bottom.  Is that 
 
your signature? 
 
A Yes. 
 
 

And did you write the rest of that letter? 

A Yes. 
 
 
 

Finally the first letter in time, 26 April, again to Dr Cosgrove, with your name at 
 
the top in capital letters? 
 
A Yes. 
 


And a signature at the bottom? 
 
A Yes. 
 
 
 

Is that your signature? 
 
A Yes. 
 
 

Did you write the rest of the body of that letter? 

A Yes. 
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I want you to look, please, at D2, which is a typewritten letter to the General 
 
Medical Council dated 18 August 2000 and at the top it has typed a name.  Is that your 
 
properly spelt name? 
 

Some people spell it with a “p”, some people do not spell it with a “p”.  It has got 
 
to the point with me spelling my surname now that either it is with the “p” or without the 
“p”.  If it happens to be written with a “p” in it, I will sign my signature with a “p”; if not, 

I will sign my signature without the “p”. 
 
 
 

As far as you are concerned, how do you sign your name, with a “p” or without a 
 
“p”? 
 

Without a “p”. 
 
 

Did you type that letter? 


A friend did it on a computer.  I wrote the letter and a friend put it through the 
 
computer for me. 
 
 
 

Who was the friend who wrote the letter for you? 
 

A neighbour of mine just across the back from me. 
 
 

Can you give us her name or his name? 


Why?  Why should I involve someone else who is not present here to defend 
 
themselves?  Can I ask you that? 
 
 
 

You can ask the question. I can’t answer it.  I seek the permission of the 
 
Committee to have the question put and the question answered. 
 
 
MR PEARCE: At least in the first instance I would invite you to ask the witness to write 

the name down rather than give the name orally, and if you need to consider whether it 
 
needs to be given openly you can no doubt do so when you see where this line of 
 
questioning is going. 
 
 
 
THE CHAIRMAN:  Mrs D, would you like to write the friend’s name on a piece of 
paper? 
 
 

(Witness wrote the name down.  Same handed to Mr Morris, Mr Pearce and  
 
the Chairman) 
 
 
 
THE CHAIRMAN:   Mr Morris have you seen the name?  Do you wish to pursue your 
 
line of questioning as to revealing the identity? 
 

MR MORRIS: I would like to have the friend’s address written down as well. 
 
 
 
THE CHAIRMAN:   Would you be prepared to do that Mrs D? 
 

No I am not.  I am not obliged to do that.  That is a friend of mine who did a letter 
 
for me as a favour, and why should she be brought into this if she is not here?  If you can 
 
give me a reasonable answer to that question then go ahead. 
 

MR MORRIS: I would like to know how close to this witness the friend lives. 
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THE CHAIRMAN:   Would you like to phrase the question along that line? 
 
 
 
MR MORRIS: Mrs D, is this a neighbour or someone from outside Glasgow? 
 

It is a neighbour. 
 
 

How close in terms of being a neighbour? 


Ten minutes’ distance from me. 
 
 
 

If I could continue with the documentation, when you are given a letter like that to 
 
sign which you say was typed by a neighbour friend of yours, you see that your name has 
 
been spelt incorrectly. 
 
A Yes. 
 


Do you seek to correct it? 
 

Not all the time. 
 
 
 

How well did this neighbour know you before she typed the letter for you?  How 
 
long had she known you? 
 

She has known me for about six years. 
 


Did she know your name and how it was spelt? 
 

It is a question that has never arisen. 
 
 
 

Were you with her when she typed the letter? 
 
A No. 
 
 

How did she know what to write? 


Because I had pre-written it for her and then she put it on to the computer for me. 
 
 
 

You had pre-written it? 
 
A Yes. 
 
 

How had you spelt your name on the pre-written piece of paper? 
 

Without a “p”. 

 
 

And was it exactly in this form that we see on the document? 
 
A Yes. 
 
 
 

So at the top of the handwritten letter that you had drafted there was your name 
spelt without the “p”, your address. 

A Yes. 
 
 
 

The address to which it was going and everything else that we see in this letter? 
 
A Yes. 
 
 
 

And at the bottom had you written your name? 

I signed that yes. 

 
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No I am talking about the handwritten draft. 
 

Yes it was handwritten yes. 
 
 
 

And at the bottom you had put your name in handwriting. 
 
A Yes. 
 
 

And again was that spelt without a “p”? 

A Yes. 
 
 
 

Did you find it strange that despite the fact that you had written a handwritten 
 
letter for her to transcribe, she mistakenly transcribed your name? 
 

No because it is very common. 
 
 

Even when the proper name is written out and available to the person transcribing 

it? 
 

Yes.  I have various documentation with me spelling the name with an “m” and 
 
with a “p” and the Human Resources manager who filled in my expenses claim has spelt 
 
my surname with a “p”.  My contract of appointment is spelt without a “p”.  My Human 
 
Resources manager knows me very well. You can look at the pieces of paper that I have 
 
brought down.   
 


Did you sign that letter in anyone’s presence? 
 
A No. 
 
 
 

Can you look please at D4 now? 
 
A Yes. 
 
 

And first in time a letter dated the 21st of June 2001. 

A Yes. 
 
 
 

It is the second page of D4.  This is a letter again to the General Medical Council 
 
with your name properly spelt at the top, and at the bottom - again this is a printed typed 
 
letter -typed with the correct spelling and there is the signature there. 
A Yes. 
 
 


Is that your signature? 
 
A Yes. 
 
 
 

You put it there did you? 
 
A Yes. 
 


Who typed this letter? 
 

Mr Brian Daniels. 
 
 
 

Mr Brian Daniels, is he as you describe him of the Citizens Commission on 
 
Human Rights? 
 
A Yes. 
 


Is he the executive director of that organisation? 
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I couldn’t tell you.  I have no idea. 
 
 
 

It reads as follows, doesn’t it? 
 
 
 
“Mr Brian Daniels, Assistant Commissioner on Human Rights, has 
 
contacted me after speaking with you on Tuesday morning. He has 
informed me that the procurement of my son’s medical records may 

have been delayed due to a possible confusion over names.” 
 
 
 
THE CHAIRMAN:   Careful with the names. 
 
 
 
MR MORRIS: Thank you sir.   
 
 
”In reviewing my previous letter to the General Medical Council 

I have spelt my surname with a “p” as opposed to without a “p”.  
 
This may have caused some confusion for Dr Cosgrove, so I felt that 
 
I should write to provide you with evidence to confirm the correct 
 
spelling. I enclose a copy of my driving licence for proof of my 
 
surname. I hope this will resolve any misunderstanding.” 
 
 
So there is no issue is there that the correct spelling of your name is without a “p” and that to 

spell it otherwise is incorrect? 
 

Yes.  My son’s surname has never been spelt wrongly, and I rather think the case is 
 
about him and not my surname, is it not? 
 
 
 

If you look at D2, your son’s surname has been spelt incorrectly hasn’t it? 
 

Right enough that one has yes. 
 


So please be careful before making assertions. 
 

I am not making assertions. I am just wondering where this is going.  I am wondering 
 
where this line of questioning is going with the “p” and without the “p”. 
 
 
 

I am afraid it is not for you to wonder but just to ask the questions and if I am going 
in the wrong direction I will be told.  All right?  Just going back to that letter of the 18th of 
 
August, whose idea was it to give written consent to facilitate the disclosure of your son’s 

medical records? 
 

Could you explain the question as in whose idea was it? 
 
 
 

You say you wrote a letter in handwriting along these lines.  What prompted that? 
 

The Overload Network in Edinburgh.   
 

THE CHAIRMAN: I am sorry, we cannot hear at this end.  Could you perhaps pull the 
 
microphone towards you and if the microphone would maybe be a little towards your left 
 
because you tend to turn your head towards Mr Morris. That is fine thank you.  Would you 
 
like to repeat the question Mr Morris? 
 
 
 
MR MORRIS: My question was who invited her to draft this letter.  I think her answer was 
the Overload Network in Edinburgh. 


That is correct. 
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Are you sure somebody at the Overload Network in Edinburgh did not draft this 
 
letter for you to sign? 
 
A No, 
positive. 
 
 
 

I want you to tell us please about the Overload Network in Edinburgh and I hope 
 
I might be able to help you.  This letter, giving consent for disclosure of records, we 
know is dated the 18th August 2000.  Am I right in saying that as is shown in D1 you say 

you had been, in that letter, the hand-written letter is 1996, it is clear that your son had 
 
been having treatment under Dr Cosgrove’s care, is that correct? 
 

That is correct. 
 
 
 

And he had been prescribed two drugs, Ritalin and what you describe as Risperdal 
 
in the letter of the 23rd September? 

That is correct. 

 
 

And you say in that letter: 
 
 
 
 
“I am writing to you to apologise for the delay in sending your fee.  I have 
 
recently moved house and changed my doctor and things are a bit hectic at the 
 
moment.  D is doing very well with both drugs, Ritalin and Risperdal.  My new 
doctor, whose name and address is Dr Spence in Glasgow is very helpful and has 

no objection to prescribing the drugs.  Not on the telephone, but would hope to be 
 
in the near future.  I wish again to thank you so very much for your help.  If it had 
 
not been for you, I think [D] would probably be …”  - sorry, I do apologise – “D 
 
would probably be in care.  I do not want to break contact with you and I will 
 
send your money as soon as possible”. 
 
 
And then you give an old address and a new address: 

 
 
 
“Thank you so very much and I hope to be able to speak to you soon”. 
 
 
 
Is it right that after that and after you moved to your new address you did not have any 
 
further contact with Dr Cosgrove? 

That is right. 
 
 


But your son remained under the care of Dr Spence? 
 
A Yes. 
 
 
 

And he continued prescribing Ritalin and Risperdal? 
 
A Yes. 
 


And that continued until 1999? 
 
A Yes. 
 
 
 

And then in 1999 did you come to hear about the organisation called Overload in 
 
Edinburgh? 
 
A Yes. 
 


Was that an organisation that in your view, and according to what they told you, 
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took another approach to the treatment of Attention Deficit Hyperactivity Disorder? 
 
A Yes. 
 
 
 

Is that the condition that your son was suffering from? 
 

That is what Dr Cosgrove diagnosed him as having. 
 
 

And was that a condition that Dr Spence also continued to treat your son for? 


Dr Spence continued to treat [D] on the grounds that Dr Cosgrove was the expert. 
 
 Dr Spence was by no means an expert in ADHD and took advice from Dr Cosgrove. 
 
 
 

Who did you speak with at Overload Network? 
 
A Janice 
Hill. 
 
 

And what did you discover about the organisation Overload Network from Janice 

Hill please? 
 

I initially had read a story that Janice had published in the Evening Times in 
 
Glasgow regarding Ritalin and the availability of it on the streets for young kids to get 
 
hold of and I read her story about her daughter who was roughly the same age as [D] 
 
undergoing similar problems and once I had read her story I decided to contact Janice to 
 
see what offer of help that she could give me rather than medicate my son, which by this 
point his behaviour was starting to deteriorate and Janice had suggested instead of putting 

chemicals into my son’s body to try vitamin tablets, such as the fish oils, vitamin B 
 
complex, a range of various multivitamins. 
 
 
 

And as a result of seeing her did you take your seen to see Professor Steven 
 
Baldwin? 
 
A That’s 
correct. 
 


Was he a professor in psychology at the School of Social Psychology at Teeside 
 
University, Middlesbrough? 
 
A Yes. 
 
 
 

I wonder if some documentation could be shown to you please?  (Same handed) 
 
 
THE CHAIRMAN: This will be D5. 

 
 
MR MORRIS: (To the witness)  Mrs D, let me just, so there is no mystery about this, 
 
these are letters that have been extracted from your general practitioner records, the 
 
records kept by your general practitioner, who at the time was Dr Spence, all right? 
 
A Yes. 
 


And, I think, actually chronologically we start at the back of the document, which 
 
is a letter of referral from Dr Spence to Professor Baldwin; do you see that? 
 
A Yes. 
 
 
 

Where he tells the Professor that over the last few years we have been treating D 
 
as having ADHD and he sets out the problems that your son had had and the fact that he 
had been on Ritalin mixed with Risperidone, which I think is another name for Risperdal 

on the instructions of Dr Cosgrove of Bristol and that had been stopped, various other 
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things had been tried and at the time he was on no medication.  Was that decision to stop 
 
the Ritalin a decision taken by your son or by Dr Spence, can you recall? 
 
A By 
myself. 
 
 
 
Q By 
yourself? 
 
A Yes. 
 


And then, just running through the documents, on the 3rd February --- 
 
 
 
THE CHAIRMAN: The middle part of this page and the next page has not come out very 
 
well on the photocopy? 
 
 
 
MR MORRIS: It has not, sir, you are right, and we do not have the originals.  I do not 
know whether the Council have the originals; I do not think the originals are available, 

but it perhaps need not trouble you too much, but it is a request to the practice manager at 
 
Gilbertfield Medical Centre, which is where Dr Spence practises, or used to practise, 
 
seeking information --- 
 
 
 
MR PEARCE: I am terribly sorry to interrupt.  We do think we have the originals, we are 
 
just seeking them out. 
 

MR MORRIS:  … seeking information as to where to send invoice for the consultation 
 
with the Professor. 
 
 
 
(To the witness)  That letter appears actually to have been copied in the records, the next 
 
document at page 62 and then at page 61, the 11th February, Dr Spence writing back a 
 
response: 
 

 
“With regard to your letter of the 3rd February regarding D and an assessment 
 
carried out by Professor Baldwin.  First of all, I never requested this assessment, I 
 
think it was organised by his mother through some organisation in Edinburgh.  
 
We have never received an invoice for any form of patient care from a University. 
 
 Presumably if this is the routine event, then you will know that it may have to be 
sent to Greater Glasgow Health Board.  Otherwise this letter just leaves me 
 
confused”. 

 
 
That organisation, is that the organisation Overload? 
 
A Yes. 
 
 
 
Q. 
And then, finally, 29th February 2000, a letter from Dr Spence to Overload 
Network for the attention of Janice Hill: 

 
 
 
“Mrs D attended you with D and subsequent to this she asked me to write a 
 
referral letter to Professor Steven Baldwin at your request as a matter of courtesy. 
 
 As a result of this, I have received a bill from Professor Baldwin, which is 
 
obviously something general practitioners in Glasgow are very unused to, but 
 
Professor Baldwin seemed extremely surprised at my reaction, particularly as I 
had written a referral letter”. 

 
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Having seen Professor Baldwin with your son and spoken with Janice Hill, how did you 
 
come to make contact or be in contact with Brian Daniels of the Citizens Commission on 
 
Human Rights? 
 

Janice Hill forwarded my letter to Brian Daniels. 
 
 
 
THE CHAIRMAN: (To the witness)  I am sorry, we are having trouble hearing you? 

Sorry.  Janice Hill from Edinburgh forwarded … asked, was quite concerned 

about the drugs that [D] was prescribed by Dr Cosgrove and was concerned enough to 
 
inform Brian Daniels from the Citizens of the Human Rights, who in turn contacted 
 
myself. 
 
 
 
MR MORRIS: (To the witness)  And what did you learn from Mr Daniels when he 
 
contacted you? 

Could you explain that further; in what way? 

 
 

Yes.  He contacted you? 
 
A Yes. 
 
 
 

What did he say to you, did he write to you or did he telephone you? 
 

He wrote to me. 
 


Do you have the correspondence? 
 

Not with me I do not. 
 
 
 

What did he say in his letter? 
 

That he had been contacted by the Overload Network in Edinburgh and was 
 
concerned by the issues raised by Janice Hill in accordance with [D] and the medication 
he had been given by Dr Cosgrove and I cannot remember exact word for word what 

actually Brian had written in the letter, but basically from that point on I started 
 
correspondence with Brian, because I was concerned when I found out more about the 
 
drug Risperidone and the effects that it can have on children and decided to take the 
 
matter further and Brian was the one that helped me get to this point. 
 
 

Did he tell you that the Commission of which he was the director had been 
 
established by the Church of Scientology? 

A Yes. 
 
 
 

To investigate and expose psychiatric violations of human rights? 
 
A Yes. 
 
 

And after that first letter to you, you say you got into correspondence with him? 

A Yes. 
 
 
 

Tell us, please, the gist of the correspondence and how matters developed with the 
 
Commission? 
 

Matters developed in a way that I should say Brian was the Scientologist – I am 
 
not a Scientologist, I am a Roman Catholic and I have been baptised and made my holy 
communion and married in the chapel.  I have nothing whatsoever to do with the 

Scientology.  I was concerned, however, about finding out more, as I said before, about 
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the drug treatment that Dr Cosgrove undergoes, the way he sends private prescriptions 
 
through the post and does not inform the patient of what the drug is about; any of the side 
 
effects regarding the drug.  So my main concern was, in line with Brian, to stop this man 
 
from doing this any more.  So Brian and I corresponded with each other simply to do with 
 
the drugs that [D] had been prescribed, on my own initiative. 
 
 

Did it come to the stage where he made a complaint to the General Medical 

Council about an aspect of Dr Cosgrove’s care of your son, D? 
 
A Yes. 
 
 
 

Did he tell you anything about other complaints against Dr Cosgrove? 
 

No.  Overload told me about other complaints.  Overload had a child in 
 
Edinburgh.  I do not know the person. 
 


Overload had a child in Edinburgh? 
 
A Yes. 
 
 
 

Who had been under the care of Dr Cosgrove? 
 

As far as I am aware. 
 
 

They told you about that? 

A Yes. 
 
 
 

The complaint that was forwarded to the General Medical Council by Brian 
 
Daniels, did you authorise the sending of that complaint? 
 

Yes, I did. 
 
 

As part of the authorisation of that complaint you told us that you signed the letter 

that we see in D2 on 18 August 2000, is that right? 
 
A Yes. 
 
 
 

Are you sure that that is your handwriting and the signature there? 
 

I am positive that is my handwriting. 
 
 

If that is your handwriting, Mrs D, are you sure that the letters we see at D1 are 

your letters, written and signed by you, the 1996 letters? 
 
A Yes. 
 
 
 

I suggest that those letters in 1996 were signed by somebody different from the 
 
person who signed the letter on 18 August 2000? 

You can suggest what you want, but I signed all the letters that are in front of me. 

 
 

Again looking at D4, the signature on 11 December 2001 letter and the 31 June 
 
2001 letter, again I would suggest that those signatures were not written by the same 
 
person as wrote the letters and signed the letters in 1996? 
 

As I said before, you can suggest what you want.  If you want me to write the 
 
signatures now, in front of the people sitting here, I will do that. 
 


You have given a signature just now? 
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I will give you a signature to the one I have written in 1996 if you like, if that is 
 
where the confusion is coming from. 
 
 
 

We may come to that, but leave it for the moment.  Again, just to make my 
 
position absolutely clear, the letter of 21 June enclosed a copy driving licence? 
 
A Yes. 
 


That has got a signature on it.  Is that your signature? 
 

What copy is that? 
 
 
 

It is the back page, last page of the bundle D4.  It is attached to the letter of 21 
 
June 2001? 
 

Yes, that is my signature. 
 


Do you have that driving licence available? 
 

Unfortunately, I do not, no.  The driving licence was destroyed. 
 
 
 

Why was the driving licence destroyed? 
 

It was torn up by mistake, along with some other documentation.  It was not in its 
 
proper folder, it was in amongst some documentation I was throwing out, so the driving 
licence was initially torn up.  That has never, ever been replaced again because initially I 

had the old-fashioned driver’s licence, which was the paper one; the new one, as you 
 
know, is a card where you have a photograph taken.  I do not have a car at the moment so 
 
I do not need a driver’s licence, so I have not gone to the bother of getting a picture taken 
 
and applying for a driver’s licence. 
 
 
 

Again, I suggest that whoever wrote that signature is not the same person who 
wrote the 1996 correspondence? 


You can suggest what you want. 
 
 
 

So can you help us, please, with what your understanding of Overload’s attitude 
 
to Dr Cosgrove was?  I think you said it was their intention to stop him treating him this 
 
way? 

Did I say that? 
 
 


I do not know; I may be incorrect.  What is your understanding of what 
 
Overload’s ambitions were in relation to Dr Cosgrove? 
 

Initially to Dr Cosgrove but not just Dr Cosgrove, to any doctors or psychiatrists 
 
out there who think they can medicate children and give them mind-altering drugs, and 
 
especially drugs that are not licensed for the specific ADHD as [D] was diagnosed by 
Dr Cosgrove. 

 
 

What was their plan in order to prevent this as far as Dr Cosgrove was concerned? 
 

To follow complaints by people that came forward to them that we were not 
 
happy with Dr Cosgrove’s treatment or follow-up treatment. 
 
 
 

What about the Citizens Commission for Human Rights? 

What about them? 

 
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You had correspondence with Mr Daniels, did you not? 
 
A Yes. 
 
 
 

Did you meet him? 
 
A No. 
 
 

Did you speak to him? 


I have spoken to Brian, yes. 
 
 
 

When did you first speak with Brian? 
 

When I initially went to Overload, which was four years ago. 
 
 
 

And when you spoke to him there was he present? 

No.  How could he be present if I have not met him? 

 
 

Did you speak to him on the telephone? 
 
A Yes. 
 
 
 

Was that at Overload’s offices? 
 

No, it was my home. 
 


Did he telephone you? 
 

Yes, he telephoned me after Janice Hill had said she was going to write to Brian 
 
and would I mind forwarding my home telephone number in order that he would be able 
 
to contact me and I said “Yes”. 
 
 
 

What were Brian’s plans for Dr Cosgrove? 

Brian was of the same opinion as myself, that Dr Cosgrove was giving out 

medicines to children, quite flippantly, to be honest with you.  What doctor sends a 
 
prescription through the post, a private prescription through the post to a patient who he 
 
has seen for 25 minutes and has offices down at Bristol, and gives you a second line drug 
 
over the telephone, not telling you what the drug is, only to tell you on the telephone that 
 
this second line drug will be introduced to take away any of the side effects that the first 
line drug, which was methylphenidate, commonly known as Ritalin, given to [D], this 
 
will take away [D]’s not being able to eat, not being able to sleep; not giving me any 

information at all about the drug, not telling me it was a drug for manic depressives or 
 
schizophrenics, not telling me it was a drug that was not licensed for children under 16 – 
 
and [D] was 10 years old at this point – and this was sent through the post to me. 
 
 
 

That information that you have just given us, where did you get all that from? 

I can read. 

 
 

Where did you read it? 
 

I had various papers that Overload had regarding the drug. 
 
 
 

So this was documentation that came from Overload? 
 
A Yes. 
 


So what did you understand Brian Daniels was proposing to do about 
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Dr Cosgrove? 
 

Expose his treatment of over-medicating young children. 
 
 
 

And how was he going to do that? 
 

Specifically write to the GMC. 
 
 

So he was going to write to the GMC not only in relation to your child but in 

relation to other children? 
 

I cannot answer for other children. 
 
 
 

Is that your understanding? 
 

I can only speak for myself, but I have no knowledge of other children Brian was 
 
acting for. 
 


I know you have no knowledge yourself, but was it your understanding (I think 
 
you said) that Brian Daniels was going to write to the GMC about your child and other 
 
children? 
 

Did I say other children? 
 
 
 

I think you did.  I will be corrected if I am wrong. 

I do not know if I said other children – I did not.  I said my son. 

 
 
MR MORRIS:  I do not want to take a bad point.... 
 
 
 
THE CHAIRMAN:  What I noted down was his intention was to expose Dr Cosgrove’s 
 
prescribing and over-medicating of young children. 
 
 
MR MORRIS:  Thank you. 

 
 
MR PEARCE:  My note closely agrees with yours. 
 
 
 
MR MORRIS:  That is what is recorded that you said, Mrs D, that it was Brian Daniels’ 
 
plan to expose the over-medication of young children.  Was that right? 

Yes, I would say so. 
 
 


Can I just ask you again to write down on a piece of paper, please, Mrs Daniels, 
 
the full name of D’s father? 
 
 
 
(The witness wrote on a piece of paper, which was handed to counsel and the Committee) 
 
 
MR MORRIS: Just some more information I would like you to write down on a piece of 

paper. I think in the correspondence.  Actually it may not be necessary.  No it will not be 
 
necessary.  Can I ask you this, has D your son had German measles? 
 
A  
Yes. 
 
 
 

 Has he suffered any broken bones? 
 
A Yes. 
 


Can you tell us which? 
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He had broken his wrist a few times.  He has been at the hospital with staped 
 
ankles.   
 
 
 

With what ankles? 
 

He has staped his ankles when he has fallen off things.   
 
 

You used a word that as I don’t come from Glasgow I didn’t understand about 

your son’s ankle. 
 
A Yes. 
 
 
 

Staped?   
 

Yes.   
 
 

What does that mean?  The Chairman is looking extremely knowing and I am in 

ignorance. It may be that some of the Committee, certainly not all of the Committee --- 
 
 
 
THE CHAIRMAN:   Another term would be he had sprained his ankles. 
 
 
 
MR MORRIS: Did he ever suffer a fracture of any bones in his ankle? 
 

Yes he did. 
 


Can you just help us with this please, first of all where did you visit him? 
 

Down in the Bristol Priory clinic. 
 
 
 
THE CHAIRMAN:   Could I check that it is the Priory clinic and not the Priority clinic?  
 
We raised this at the beginning.  It is Priority. 
 

Well Priority.  I know it was like a surgery. I think Dr Cosgrove had one room in 
this.  It was a Health Centre.  Dr Cosgrove had a room in the Health Centre because there 

was a reception desk and I don’t know whether Dr Cosgrove rented the room privately or 
 
not because there were other doctors and patients coming into the room, coming into the 
 
Health Centre. 
 
 
 
MR MORRIS: Can you remember the address of it? 

No I can’t, not off hand. 
 
 


You have described it as a Health Centre. 
 

Yes, that is what I would say it was. 
 
 
 

In which town did you visit Dr Cosgrove? 
 
A Bristol. 
 


Are you sure it was Bristol? 
 

Yes I am sure it was Bristol.   
 
 
 
MR MORRIS:  Yes, thank you. 
 
 
 
MR PEARCE:  Sir, before I ask questions of this witness by way of re-examination, I 
seek if I may through you some clarification for the purposes of this stage of where we 

are with the proceedings. A lot is being put to this witness. It is quite clearly being put 
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that there are issues about the signature, and I accept that that is clearly put, but on 
 
Monday my learned friend repeatedly used the expression that this charge was a fraud, 
 
and what I took him to mean by that – maybe I am incorrect – was that either the person 
 
who I was going to call today, the person whom I have called today, was not truly the 
 
mother of the person who had been treated by Dr Cosgrove, and so it was fraudulent in 
 
that sense, or in the alternative that if she was the mother of the person who had been 
treated by Dr Cosgrove, she in fact had no complaint whatsoever against Dr Cosgrove but 

had been put up, for want of a better expression, to complaining by a third party, and 
 
clearly it seemed to me to be being suggested that that was at the commission of Mr Brian 
 
Daniels.  If either of those two or some other interpretation of what a fraud may mean is 
 
part of my learned friend’s case as part of his submission on abuse, then his case in 
 
respect of that fraud should in my submission be put to this witness so that I know the 
 
factual arguments I must meet, and if I may so sir so that you do sir too know what 
actually is being said about this witness, this complaint.  Of course I don’t ask him to put 

his wider submission on the point but on the specific factual matters in so far as the 
 
allegation that this is a fraud is being pursued, what does that mean factually, those points 
 
should in my submission be put to this witness now.   
 
 
 
THE CHAIRMAN:  Mr Morris? 
 
 
MR MORRIS: I quite understand the request, and before I make the position absolutely 

crystal clear I would like to take some instructions from Dr Cosgrove who has listened to 
 
the evidence, if I could be permitted to do that. 
 
 
 
THE CHAIRMAN:   You want a break just now? 
 
 
 
MR MORRIS: A short break. 
 

THE CHAIRMAN:   We will have a break and re-convene at 11.15.  Mrs D, could I 
 
remind you that during the break you remain under oath and you mustn’t discuss your 
 
evidence with anyone. 
 
A: Sure. 
 
 
(The Committee adjourned for a short time) 
 
 

MR MORRIS: Sir, before I put the case that my learned friend invited me to put, quite 
 
understandably, to the witness I do need to show her and ask her about two further 
 
documents. I am afraid they are being photocopied at this very moment but they should 
 
be with us shortly.  Could I ask for the indulgence of the Committee while that takes 
 
place?  Sir I am grateful for the time you have given me.  Mrs D, I want you to have a 
look at two documents to begin with if I can have them. (Same handed) 

 
 
THE CHAIRMAN:  This one dated the 18th of August 2000 would be D6.  This one 
 
dated 31st October 2000 will be D7. (Same handed) 
 
 
 
MR MORRIS: (To the witness)  Mrs D, I think if we look at D6 please.  This is a letter 
 
which has the same date, 18th August, as the letter in D2, which is the letter you say you 
signed and was typed by a friend of yours – a neighbour – on the 18th August 2000.  D6 

is again a letter to the General Medical Council with your name wrongly spelt at the top 
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and on the second page there is your name in type wrongly spelt at the base of the letter 
 
and there is no signature.  What can you tell us about that document, have you ever seen 
 
it before? 
 
A Yes. 
 
 
 

When did you see it first? 

I wrote the letter first.  I had written in my handwriting. 

 
 

You had written it in your handwriting? 
 
A Mm. 
 
 
 

Do you still have the hand-written letter anywhere? 
 
A No. 
 


Who typed it? 
 
A Brian 
Daniels. 
 
 
 

Brian Daniels typed that, but he did not type the letter we see in D2 of the same 
 
date? 
 
A No. 
 


When did you first see the typed version of that letter? 
 

To be honest I can’t remember. 
 
 
 

I suggest you certainly did not see it before it was sent to the General Medical 
 
Council, did you? 
 

I suggest you are wrong. 
 


Because I suggest if you had seen it you would have signed it? 
 

I suggest you are wrong. 
 
 
 

Why did you not sign it if you saw it before it was sent to the General Medical 
 
Council? 

Probably because it was typed out. 
 
 


Because it was typed out you did not think there was any need to sign it? 
 
A No. 
 
 
 

Why did you sign it? 
 

It may have been an oversight. 
 

Q An 
oversight? 
 

Could have been. 
 
 
 

This is a letter of complaint about Dr Cosgrove? 
 

That is correct. 
 
 

To his disciplinary body, is it not Mrs D? 


That is correct. 
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And you think it was an oversight that you did not sign it? 
 
A Yes. 
 
 
 

Before it was sent? 
 
A Yes. 
 


I suggest you never saw it before it was sent? 
 

I suggest you are wrong. 
 
 
 

Look at D7 please, the letter dated the 31st October, again to the General Medical 
 
Council, this time from Brian Daniels? 
 
A Yes. 
 


Which says this, and I will not mention names: 
 
 
 
 
“Re D” – spelt incorrectly. 
 
 
 
That is right, is it not? 
 

Excuse me, say that again? 
 


Your son’s name is spelt incorrectly? 
 

Yes, that is correct. 
 
 
 

“Dr Patrick Cosgrove. 
 
 
 
 
Thank you for your letter of 18th October.  I have contacted Mrs D” – spelt 
incorrectly – “and she has provided me with the following information: 

 
 
 
1. 
D’s date of birth – 12/02/86. 
 
 
 
 
2. 
The exact date that she took D to see Patrick Cosgrove is not known, but it 
 
was in the month of May 1996. 
 
 
 
3. 
The place that she attended with D was the Bristol Priority Clinic in Bath. 

 
 
 
4. 
Here address in September 1996 was …” – an address in Glasgow. 
 
 
 
 
5. 
The name of her GP in September 1996 was Dr John Spence”. 
 
 
Do you recall speaking to Mr. Daniels and giving him that information? 

A Yes. 
 
 
 

Did you tell him that the place you attended with D was the Bristol Priority Clinic 
 
in Bath? 
 
A Yes. 
 
 

And is that what you felt then in October 2000 was the place where you saw Dr 

Cosgrove? 
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A Yes. 
 
 
 

Why is it that today you told this Committee that you saw Dr Cosgrove in Bristol? 
 

It is the Bristol Priority Clinic, so I travelled down to Bristol to see Dr Cosgrove. 
 
 
 

Yes.  You told us that you saw Dr Cosgrove in Bristol at the Bristol Priority 
Clinic? 

A Yes. 
 
 
 
Q But 
here in this letter, according to information you say you gave to Brian 
 
Daniels, you were telling Brian Daniels that the place you attended for consultation was 
 
Bath; can you help us with the disparity? 
 

Disparity is maybe my geography is not that good.  I got a train from Glasgow 
down to Bristol, stayed overnight in a bed and breakfast and went to the Bristol Priority 

Clinic.  If it is in Bath, sobeit. 
 
 
 

You know that Bristol and Bath are two completely separate cities, do you not 
 
Mrs D? 
 

Well why is it called the Bristol Priority Clinic if it is in Bath? 
 
 

Can you answer my question; you know that Bristol and Bath are two completely 

different cities? 
 

Yes, I do, I do. 
 
 
 

I suggest that the person who gave that information to Brian Daniels was not the 
 
mother of D? 
 

So you are accusing me of not being the mother of D? 
 

Q I 
am. 
 

Well can I say that you are a liar and I would --- 
 
 
 
THE CHAIRMAN: (To the witness)  I know that it is difficult for you and it is 
 
frustrating, but could you please respond “Yes” or “No”? 

Okay.  I am Mr D’s mother. 
 
 

MR MORRIS: (To the witness)  Because the mother of Mr D would have known very 
 
well when giving important information in relation to a complaint being made to this 
 
Doctor’s disciplinary body about the place she took her son many, many miles to see Dr 
 
Cosgrove --- 
 
A Yes. 
 


… on only one occasion --- 
 
A That’s 
right. 
 
 
 

… was in Bristol and not in Bath? 
 

I travelled down from Central Station to the Bristol Priority Clinic and went to see 
 
Dr Cosgrove the following morning. 
 


I would like you to look, please, at another document.  (Same handed) 
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THE CHAIRMAN: This will be D8. 
 
 
 
MR MORRIS:  (To the witness)  Mrs D, this is a five page document which is entitled 
 
‘Statement of Mrs D’ and can you look at the last page please?  There is a signature there 
 
over the typed name of Mrs D; is that your signature? 
A Yes. 

 
 

Just have a look, please, at that signature and indeed the signature you wrote on 
 
D2 three years earlier on the 18th August 2000, which you say you deliberately signed 
 
incorrectly with a ‘p’ in? 
 
A Yes. 
 
 

And then just have a look please at the signatures on the three hand-written letters 

of 1996 at D1.  The 1996 signatures look very different from the signatures of 2000 and 
 
2003, do they not? 
 

The one in 1996 the first letter is actually printed rather than the signature if you 
 
look at it.  The other one is a shortened version, the ‘e’ is not signed as in my first name, 
 
as in the next letter. 
 
 

So would you agree with my comment that they look very different from the 

signatures of 2000 and 2003? 
 

I can see the one in 1996 is printed rather than the signature; the rest of them are 
 
the same apart from the ‘p’. 
 
 
 

So you would not call that a signature as such in 1996? 
 

No, because as you can see by the handwriting it was a hectic time, I was moving 
from one place to another and trying to organise, I had lost contact with Dr Cosgrove at 

that time and I wrote this letter and more or less signed it at the bottom, but not as I 
 
would say a proper signature as in a written. 
 
 
 

I think you were asked yesterday on behalf of the General Medical Council and 
 
the solicitors acting for them to bring some hand-written material from that period, 1996 -
-- 
 

Yes, I was already on the train at that time before I could get information from 

any of the solicitors, I was travelling down to Glasgow at that point. 
 
 
 

Are you saying that your signature in 1996 then looked different from what we 
 
see on those three letters? 
 

I am not saying it looked different, I am saying I have signed it differently. 
 


Do you accept it is signed differently? 
 
A Yes. 
 
 
 

If I can just take you to the body of the statement please.  In the first page of the 
 
statement you give an outline of the history concerning your child D, leading up to the 
 
time when we see over the page in paragraphs 8 and 9 you travelled to see Dr Cosgrove; 
is that correct? 

A Yes. 
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And you talk about him being seen at school by the educational psychologist and 
 
you talk in paragraph 7 that you heard about the disorder, Attention Deficit Hyperactivity 
 
Disorder, on a television programme being discussed by a Mr. Christopher Green and you 
 
got in touch with a family support group run by a Jill Meads and you explained that your 
 
son had been seen by a number of general practitioners who were unable to help with his 
behaviour and then the suggestion of seeing Dr Patrick Cosgrove? 


That is correct. 
 
 
 

The child D had not only been seen by general practitioners I suggest, but had 
 
been seen by a consultant psychiatrist before seeing Dr Cosgrove; do you know about 
 
that? 
 
A Correct. 
 


The child D, shortly before seeing Dr Cosgrove, had spent at least two weeks as 
 
an in-patient in a psychiatric ward at the Children’s Hospital? 
 
A Correct. 
 
 
 

None of that information appears in that statement, does it? 
 
A No. 
 


And I suggest that as the mother of D, the mother of D in making such a statement 
 
would have included such information? 
 
A Why? 
 
 
 

In the information; do you accept that or not? 
 
 
THE CHAIRMAN: (To the witness)  Mrs D, could I ask you to answer the questions 

rather than ask questions? 
 

Okay.  Could you ask me the question again? 
 
 
 
MR MORRIS: (To the witness)  Yes.  The mother of D in making a statement about the 
 
treatment her son had received at the hands of Dr Cosgrove and setting out the history, 
his medical history prior to seeing Dr Cosgrove, would have included the important 
 
information that he had been under a child psychiatrist and indeed an in-patient in a 

children’s hospital, I am suggesting? 
 

I understand where you are coming from, but I did not think that was important in 
 
the making of this statement because this statement was about the treatment of Dr 
 
Cosgrove, not the treatment of [D] by the National Health Trust in Glasgow. 
 
 

In the course of making this complaint about Dr Cosgrove you signed an authority 

to disclose his notes? 
 
A Correct. 
 
 
 

Have you seen those notes? 
 
A No. 
 
 

So do you know to whom the notes were disclosed? 


The General Medical Council and parties that were to be covered at the hearing 
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today, as far as I am aware. 
 
 
 

Looking at paragraph 10 please?  The author of that statement, and you say you 
 
are the author of that statement, says that D saw Dr Cosgrove at a hospital in Bristol 
 
where he rented a room.  That, I suggest, is wholly inaccurate, not a hospital? 
 

Correct, a hospital or a health centre.  ‘Hospital’ may have been the wrong word, 
possibly ‘health centre’ should have been written down. 

 
 

So it was not a hospital, you agree that? 
 
A Yes. 
 
 
 

You say that in the statement, which you say is yours, that the consultation lasted 
 
between 15 and 20 minutes, is that right? 

That is correct. 

 
 

The mother of D, I would suggest, would have known that the consultation lasted 
 
at least an hour and probably an hour and a half? 
 

The consultation originally was booked for one hour, which the fee for the hour to 
 
spend with Dr Cosgrove was £160.  Myself and my son saw Dr Cosgrove, we were with 
 
him for between 15 to 25 minutes and then we were released with a private prescription 
in my hand to go to the nearest chemist.  Can I just add that Dr Cosgrove made a remark 

regarding my son saying “They’ve travelled all the way down from Glasgow and this 
 
child hasn’t been able to sit down on the train for all the time they’ve been travelling”, 
 
and he made a joke about it to another patient who was passing by – “She’s travelled all 
 
the way down from Glasgow and this kid hasn’t been able to sit in his seat”. 
 
 
 

Paragraph 18.  The author of this statement says: 
 

“Dr Cosgrove again telephoned me to see how [D] was and I told 
 
him the Risperidone appeared to be helping with [D] eating and 
 
sleeping.  He had become lethargic but I thought that was how he 
 
should be on the medication.” 
 
 
Just to set the picture a little more clear, perhaps I ought to do it chronologically.  If I take 
 
you back to paragraph 13, at the end of the consultation you stated: 

 
 
“Dr Cosgrove informed me he would check on [D]’s progress in a 
 
fortnight by telephone and his fees for this would be £25.00. 
 
 
 
Dr Cosgrove to telephone two weeks after the initial consultation.  
I informed him that I was still having problems with [D]’s behaviour 

and he decided to increase the dose of Ritalin.  A further two weeks 
 
passed and again Dr Cosgrove contacted me by telephone.  By this 
 
time I was very worried about [D] as he was not eating any food nor 
 
was he sleeping and he has lost a lot of weight. 
 
 
 
I told Dr Cosgrove of my fears and felt that the medication was not 
working as well as I had hoped.  At this point Dr Cosgrove told me 

that he was going to prescribe another drug which to the best of my 
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recollection he did not name but did state that it would help [D] to 
 
sleep and eat and would counterbalance the Ritalin and resolve any 
 
behaviour problems.” 
 
 
 
Then 17: 
 
 
“Dr Cosgrove sent me a private prescription for Risperidone which 

I had dispensed at Boots Chemist at the cost of £30.00 for ten 
 
tablets.  I remember when I took the prescription for dispensing the 
 
chemist staff appeared alarmed for what had been prescribed for a 
 
ten year old boy. 
 
 
 
Dr Cosgrove again telephoned me to see how [D] was and I told him 
the Risperidone appeared to be helping with [D] eating and sleeping. 

 He had become lethargic but I thought that was how he should be 
 
on the medication. 
 
 
 
I could not afford to pay Dr Cosgrove for the telephone 
 
consultations and I never heard from him again.  I was also unable to 
 
afford the cost of any further private prescriptions and I went to 
consult my general practitioner.” 

 
 
Just looking at that, and if we take you back, please to D1, the second letter in time dated 
 
27 May 1996? 
 
A Okay. 
 
 
 

If you look at the letter for 27 May: 
 

“I am writing to advise you that [D] started his medication on Friday 
 
24th May.  So far so good, the only side effect I can see at the 
 
moment is his appetite, which you told us about. 
 
 
 
The other thing I need to mention is that my own doctor will not 
prescribe Ritalin for [D].  What they have said to me is that I have 
 
gone outwith the NHS and gone against Yorkhill Hospital, Glasgow 

and I will have to get my prescriptions from you privately.  I would 
 
be most grateful if you could advise me what to do as I do not want 
 
[D] to run out.” 
 
 
 
Then the next letter, September 23: 
 

“I am writing to you to apologise for the delay in sending your fee.  
 
I have recently moved house, and changed my doctor so things are a 
 
bit hectic at the moment.  [D] is doing very well with both drugs, 
 
Ritalin and Risperdal.  My new doctor who’s name and address is 
 
Dr Spence” 
 
 
- I have read this before. 

 
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“I am not on the telephone yet but hope to be in the near future.  
 
I wish again to thank you so very much for your help.  If it had not 
 
been for you I think [D] would probably be in care.  I do not want to 
 
break contact with you and I will send your money as soon as 
 
possible.” 
 
 
That account, do you agree, is wholly different from the account in the statement you say 

you signed on 14 July 2003? 
 

Describe in which way you mean. 
 
 
 

The person who was the mother who wrote the letters, I suggest, in 1996 was 
 
quite happy with the treatment that her son was receiving and felt that but for it her child 
 
would be in care by now and that the only concern was the question of appetite.  That is 
totally different, I suggest, from the account that you have given in this document of 

2003? 
 

Do you want me to answer? 
 
 
 

No mention of sleeping problems, weight loss problems, no mention of lethargy in 
 
your correspondence--- 
 

Excuse me, which one are you talking about?  Letter D1? 
 

Q D8? 
 

Which one are you referring to at the moment? 
 

In D8 you talk about – I will just take you to the paragraph.  14: 
 
 
 
“Dr Cosgrove to telephone two weeks after the initial consultation.  
 
I informed him that I was still having problems with [D]’s behaviour 
and he decided to increase the dose of Ritalin.  A further two weeks 

passed and again Dr Cosgrove contacted me by telephone.  By this 
 
time I was very worried about [D] as he was not eating any food nor 
 
was he sleeping and he has lost a lot of weight. 
 
 
 
I told Dr Cosgrove of my fears and felt that the medication was not 
working as well as I had hoped.  At this point Dr Cosgrove told me 
 
that he was going to prescribe another drug which to the best of my 

recollection he did not name but did state that it would help [D] to 
 
sleep and eat and would counterbalance the Ritalin and resolve any 
 
behaviour problems.” 
 
 
 
Then 17: 
 

“Dr Cosgrove sent me a private prescription for Risperidone.” 
 
 
 
18: 
 
 
 
“Dr Cosgrove again telephoned me to see how [D] was and I told 
 
him the Risperidone appeared to be helping with [D] eating and 
sleeping.  He had become lethargic but I thought that was how he 

should be on the medication.” 
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In the mother’s correspondence in 1996 there is no mention of those problems, the 
 
lethargy, the weight loss or the like, was there? 
 

In D1, no.  There is a mention of [D] not being able to eat and not being able to 
 
sleep and my concerns about that, and that is why the second line drug was introduced, to 
 
combat the side effects of Ritalin. 
 


If you could look at paragraph 26 of D8, the statement: 
 
 
 
“In September 1996 I received some correspondence from a Doctor 
 
Bramble and Dr Cosgrove in relation to a Risperidone survey.  I am 
 
not sure how I came to receive this correspondence as I had moved 
 
from the address I was at when Dr Cosgrove was prescribing to [D] 
and I did not give Dr Cosgrove a forwarding address.” 

 
 
Look, please, at D1? 
 

D1 was written when I received the Risperidone survey through the post.  This 
 
letter was written in response to the survey that I had received from Dr Cosgrove and 
 
Dr Bramble. 
 
 

Just pause there.  In your statement you say: 

 
 
“I am not sure how I came to receive this correspondence [in 
 
September 1996] as I had moved from the address I was at when 
 
Dr Cosgrove was prescribing to [D] and I did not give Dr Cosgrove 
 
a forwarding address.” 
 
 

In the letter of 23 September 1996 the mother of D provided a forwarding 

address? 
 

That is correct, but the survey came through to me at 90 Finlay Drive before I had 
 
written this letter.  That is the reason why I do not understand I received the letter, 
 
because I had moved from Bemerside Avenue in Mansewood to 90 Finlay Drive in 
 
Dennistoun.  This letter came in the post addressed to me.  Whether it was forwarded on 
from my previous address I am not sure, but at that point Dr Cosgrove did not have my 
 
new address when this letter was written in response to the survey I had received this 

letter from Dr Cosgrove and Dr Bramble. 
 
 
 

Dr Cosgrove had the address of 14 Bemerside Avenue back in May? 
 

That is correct, back in Mansewood. 
 
 

And then in September you wrote from 90 Finlay Drive? 

A Correct. 
 
 
 

Stating your old address--- 
 
 
 
THE CHAIRMAN:  I think we are in danger of breaching confidentiality by this use of 
 
addresses. 
 

MR MORRIS:  Yes, you are quite right.  (To the witness)  In the letter of 23 September, if 
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I can call them address 1, address 2 and address 3, perhaps that would be easier, in 
 
chronological order.  In May and April you wrote from address 1? 
 
A Yes. 
 
 
 

In September you wrote from address 2? 
 
A Correct. 
 


Setting out there your address 1 and the new address 3 that you were at that time 
 
at? 
 
A Correct. 
 
 
 

So how can you say in your statement that you had not given Dr Cosgrove a 
 
forwarding address? 

I did not give Dr Cosgrove a forwarding address when I had moved from [address 

1], that is when I initially contacted Dr Cosgrove, when I moved from that one address to 
 
my new address and I had written this letter, I had not informed Dr Cosgrove at that point 
 
that I had moved.  It was only when I received the survey from himself and Dr Bramble, a 
 
questionnaire-type survey, for myself to fill in to check [D]’s progress on the Risperidone 
 
is when I wrote this letter back to confirm my new address, apologies for not informing 
 
him beforehand and not paying his fees. 
 


Mrs D, what I am suggesting to you is that because what I suggest are the 
 
inaccuracies in the statement D8 (14 July), the information provided from you in D7 to 
 
Brian Daniels about the place of consultation, the formulation of a complaint by you 
 
which is typed with your name spelt incorrectly (D6), that all of those are the actions of 
 
someone who was not the person who took D – not the mother of D – to see Dr Cosgrove 
 
in 1996? 

Would you like me to respond to that? 

 
 
Q Please? 
 

I am telling you I am the mother of [D].  I went to see Dr Cosgrove with [D]--- 
 
 
 
THE CHAIRMAN:  I do not think that was actually the question that Mr Morris put, was 
it? 
 

What was the question then?  That I am the wrong person? 

 
 
MR MORRIS:  I am suggesting that the person – and you say it is yourself – who wrote 
 
and were responsible for the statement of 14 July 2003, the information given to Brian 
 
Daniels and repeated in his letter of 31 October 2000 (D7), the letter formulated at D6 
 
and dated 18 August 2000, could not possible have been the person who took D to see 
Dr Cosgrove in 1996? 


No, that was wrong.  I am the person – the person who has written the letters, I am 
 
the person who took D to see Dr Cosgrove and I am the mother of that person. 
 
 
 
MR MORRIS:  Thank you. 
 
 
 
MR PEARCE:  Sir, for the purpose of my re-examination I am going to invite you for the 
first part of that re-examination to sit in camera.  May I explain why?  The application 

itself can probably be made openly with members of the public present.  Sir, I have 
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before me a large bundle of medical documents which are or at the very least purport to 
 
be the medical records of the patient D.  Those records contain a large amount of 
 
information  which the true mother of D, whether it is this lady or somebody else, will 
 
know, and in my submission it is appropriate that you hear questioning, non-leading 
 
questioning I hasten to add, about D’s medical background in order for you to establish, if 
 
necessary by comparison with those medical records, whether indeed in making your 
decision on the issues that arise, you believe  the person before you to be the mother of D. 

  
 
 
 
Sir, those medical records, like anybody’s medical records, contain a large number of 
 
private and confidential matters.  In this particular case they, if I may say so, contain far 
 
more than the average person’s details, very private and personal details, details which if 
 
I may say so again without condescending to any of the particularity at all, relate not only 
to D but also to potentially the mother of D and also potentially to other people.  It would 

be quite inappropriate of me, and I think impossible of me to do the questioning before 
 
the Committee openly with members of the press present, even with the assistance, if 
 
I may put it that way, of the guidance you have already given from the viewpoint of the 
 
Committee, since I am acutely aware of the fact that whatever you have to say about 
 
confidentiality there is nothing binding on those members of the press here present, and 
 
I take the view frankly sir that I couldn’t take this line of questioning at all unless you 
were in camera because it would be quite improper for me to start airing personal and 

private matters in this kind of respect.  I invite you to go into camera for that part and that 
 
part only of my re-examination. 
 
 
 
THE CHAIRMAN:   Mr Morris? 
 
 
 
MR MORRIS: I would have no objection to that course.   
 

THE CHAIRMAN:   The legal assessor wants to speak. 
 
 
 
THE LEGAL ASSESSOR: I have nothing to say about the actual application itself. I just 
 
wanted to come back to Mr Morris’s cross-examination.  I just ask, is it part of your case 
 
that this lady who is in court today was not the lady who went to see Dr Cosgrove? 
 
 
THE CHAIRMAN:  I thought we were going to get clarification of that later on when you 

made your formal submission. 
 
 
 
THE LEGAL ASSESSOR: The reason I raise it is because if it is part of your case that 
 
this lady did not go and visit Dr Cosgrove, this lady who is in court now, I think that 
 
should be put to her. 
 

MR MORRIS: Let me take instructions.  (Takes instructions from Dr Cosgrove)  Sir I 
 
haven’t gone that far and I don’t go that far.  I hoped I had made it clear in my 
 
questioning to her, and I think it is right I make it at this stage so my learned friend can 
 
deal with it rather than in submission at a later stage, what I am saying and suggesting is 
 
that the person – I accept it is the mother of D who took her child to see Dr Cosgrove in 
 
1996 – is not the same person who has written but not signed a letter of complaint of the 
18th of August 2000, who has signed a consent to disclosure of medical records on the 

18th of August 2000, who made and signed the witness statement which you have before 
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you, that person is different from the mother of D.  All I am saying and putting to this 
 
witness is either she is the mother of D and she is not correct when she tells you that she 
 
is also the person who has formulated the complaints and the documentation of 2000 and 
 
onwards, or she is the person who has formulated the complaints and material from 2000 
 
onwards, and if she is then she is not the mother.  I hope I have made the position clear.  
 
Those are the two options. 
 

MR PEARCE: By way of clarification, may I be clear I think it follows from what my 
 
learned friend says that his second case includes the fact both that the person present in 
 
court is not the mother of D, and also the person present in court did not attend the 
 
consultation with Dr Cosgrove in 1996.  That is how I understand it to be, the obverse of 
 
the first. 
 
 
MR MORRIS: If the witness is the compiler of the complaints of 2000 onwards, she is 

not the mother of D who took the child to see Dr Cosgrove in 1996. 
 
 
 
THE LEGAL ASSESSOR: This witness has said that she took her child to see Dr 
 
Cosgrove in Bristol.  Is that evidence challenged or not? 
 
 
 
MR MORRIS: I am not sure I can take it any further than what I said.  If she is saying 
that she is the mother and that she took her child to see Dr Cosgrove in 1996, and she is 

also the person who has formulated the complaint, who has made a witness statement, 
 
who has provided information to Brian Daniels in 2000 and onwards, then I challenge 
 
that.  I cannot challenge baldly and say you are not the mother. 
 
 
 
THE LEGAL ASSESSOR: I have got a record of the witness saying ‘I am the mother of 
 
D.’ 
 

MR MORRIS: If that is what I put I withdraw that. 
 
 
 
THE CHAIRMAN:   As I understand it what you are really saying is that someone took 
 
Master D to see Dr Cosgrove around 1996 and wrote some letters at that time.  Someone 
 
wrote some letters from 2000 onwards and it is your assertion that there are two people 
involved in this, two different people.  
 
 

MR MORRIS: Correct. 
 
 
 
THE LEGAL ASSESSOR: About what you say about your cross-examination I think that 
 
the evidence of this witness is that she is both the mother of D and she went to Bristol. 
 
 
MR MORRIS: That is abundantly clear.   

 
 
THE LEGAL ASSESSOR: The record will show your challenges that have been made.  
 
We will take it from there. 
 
 
 
MR PEARCE:  Sir, may I raise one matter.  Inviting you to sit in camera I didn’t refer 
 
you to the relevant rules.  You might I think properly be referred to the rules simply so 
that you understand your powers, not because I need to make any specific submission in 

respect to those.  Rule 48 I think is the relevant paragraph sir.   
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“(1) Subject to the provisions of rule 50(5), and to the following 
 
paragraphs of this rule, all proceedings before the Professional 
 
Conduct Committee shall take place in the presence of all parties 
 
thereto who appear therein and shall be held in public. 
 
 
(2) (a) If any party to any proceedings or any witness therein 

makes an application to the Committee for the public to be 
 
excluded from any proceedings or part thereof, then if it appears 
 
to the Committee that any person would suffer undue prejudice 
 
from a public hearing or that for any other reason the 
 
circumstances and nature of the case make a public hearing 
 
unnecessary or undesirable, the Committee may direct that the 
public shall be so excluded.” 

 
 
I would invite you to exercise the powers for the reasons I have said.  I think if I may say 
 
so sir, and I am sure you considered this already, but just so that my position is clear on 
 
this point, anything which infringes the prima facie right of the public to be present is a 
 
matter that would be considered carefully, notwithstanding the fact that there may be no 
 
objection to my application, and I am sure a matter you would consider in private before 
coming to any conclusion, even if it was a matter that was briefly dealt with. 

 
 
THE CHAIRMAN:   I had a signal from members of the panel that they would not be 
 
raising any objection to being in private session for the next part of the hearing, and I 
 
haven’t heard any objection from Mr Morris. 
 
 
 
MR MORRIS: No. 
 

THE CHAIRMAN:   So I don’t think we need to retire to consider  it.  We will hear the 
 
next part in private, so the public will withdraw. 
 
 
 
(The proceedings continued in camera – see separate transcript) 
 
 
PARTIES HAVING BEEN RE-ADMITTED
 
 

MRS D 
 
 

Re-examined by MR PEARCE (Continued)
 
THE CHAIRMAN: Perhaps before you begin, I should say that during the In Camera 
 
session we tended to use the patient’s Christian name; we should be careful and go back 

to Mr D. 
 
 

MR PEARCE: (To the witness)  Could I ask you to look at a document please, Mrs D?  
 
(Same handed)   
 
 
 
THE CHAIRMAN: This will be C1. 

 
MR PEARCE: (To the witness)  Could I ask you to just glance briefly over that 
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document?  Have you seen this document before? 
 
A Yes. 
 
 
 

We can read what it says, “Re: Risperidone Survey”, and it makes reference to  
 
Dr Cosgrove, it says: 
 
 
 
“Dr P V F Cosgrove of The Bristol Priority Clinic has been treating your child 

with the drug Risperidone and now has over two  hundred other patients on this 
 
drug”. 
 
 
 
It goes on to deal with the fact that Dr Cosgrove and a Dr Bramble of Nottingham 
 
University Medical School feel that it is appropriate to investigate how effective 
 
Risperidone is; we can see the content as the page goes on.  Mrs D, in what circumstances 
did you see this document, how did you come to see it? 


It was sent through the post to me. 
 
 
 

And, as I understand it, you made reference earlier to a document that, for want of 
 
a better word, triggered your correspondence with Dr Cosgrove in September of 1996? 
 
A Yes. 
 
 
Q Is 
that 
this document? 


This is the document that come through, yes. 
 
 
 

I want to ask you if I may about some more correspondence and in asking you 
 
about these various documents, Mrs D, I am concerned at the moment with the question 
 
of the writing on the document and whether or not it is your writing? 
 
A Right. 
 


I am afraid to say there is a whole string of documents for you to have a look 
 
through, but we will go through them page by page if we may? 
 
A Okay. 
 
 
 

The first bundle we will hand out, this will be C2, sir.  (Same handed)  Mrs D, the 
first document here is dated the 23rd September 1996, it is an address that we have seen 
 
before, a hand-written letter, “Dear Doctor Barton.  I am writing to inform you that I have 

moved from …” and an address is given.  The document runs on and on the second page 
 
of C2, “Kind regards”, and there is there a name written or signed; who wrote that letter? 
 
A Myself. 
 
 
 

And who wrote the name that appears at the bottom of the letter on the second 
page? 

A Myself. 
 
 
 

And who is Doctor Barton please? 
 

John Barton is a consultant child psychiatrist at Yorkhill Hospital. 
 
 
 

Can I ask you to look at the next page, you will see it has got a number at the 
bottom, actually 152, rather surprisingly perhaps, but it has been paginated by somebody 

else in other circumstances.  There is a document here, we see there is a name written, 
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“Date checklist completed: 11th March 1996;  Start or end of assessment: Start;  Date of 
 
birth of child:” a date is given, “Name of person completing checklist:” and a name is 
 
given and in brackets ‘mother’.  Who wrote the things that are hand-written on this 
 
document, Mrs D? 
 

I signed the bottom of it, it is my signature. 
 
 

Did you write the other entries? 


No, I did not. 
 
 
 

The date of birth on that page, is that the correct date of birth of your son? 
 
A It 
is. 
 
 
 

May I ask you to look at the next page of C2, numbered at the bottom 151 headed:  
 

“Royal Hospital for Sick Children, Yorkhill, Glasgow.  Department 
 
of Child and Family Psychiatry.  Permission Slip.  I hereby give 
 
permission for my child  …” – the name is given – “to take part in 
 
any outings which may take place from the in-patient or day units 
 
during the hours of attendance.  Date: 11th March.  Signed”.   
 
 
Now, first of all, who wrote the child’s name there, was it you or was it somebody else? 


It was not me. 
 
 
 

And the date? 
 

That is my signature and the date. 
 
 
 

May I ask you to look at the next document in C2 with number 27 at the bottom, 
dated Thursday the 4th April 1996, it has a name in the top right-hand corner, it has an 

address we have seen before: 
 
 
 
“Dear Mr. Fraser.  
 
 
 
I am writing to you to request a full report regarding my son” – 
name given and there is a little bit more information given – 
 
“Regards”,  

 
 
and a name at the end.  Who wrote that letter? 
 
A I 
did. 
 
 
 

All of it? 

All of it. 

 
 

Including the name or the signature at the bottom? 
 
A Yes. 
 
 
 

Who is Mr Fraser? 
 
A Cannot 
remember. 
 


And the next document, if I can ask you to look at that, number 10 at the bottom.  
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It is dated the 23rd September 1996, it has got an address in the top right-hand corner, the 
 
address we have seen before: 
 
 
 
“Dear Dr Robinson: 
 
 
 
I am writing to you regarding an appointment I missed regarding my 
son D”. 

 
 
It makes reference to travelling to Bristol to see Dr Cosgrove and D was diagnosed as 
 
having ADHD and put on Ritalin.  A little more information there and then at the bottom 
 
it says, “Yours”, and a name appears; who wrote that letter? 
 
A I 
did. 
 
 

Can I ask you to look on the very top of the document, it says ‘25/9/96 clinic’; did 

you write that? 
 

No, I did not. 
 
 
 

Apart from that though, who wrote the rest of it do you say? 
 
A I 
did. 
 
 

And who wrote the name at the bottom? 

A I 
did. 
 
 
 

May I ask you to look at the next page.  (To the Committee)  Sir, there is no 
 
significance in the way this is bundled together I hasten to add, it just happens to be 
 
bundled in this way.  (To the witness)  This is a consent form to the release of medical 
 
hospital records: 
 

“To whom it may concern.  I” – and a name is given – “of” – and an 
 
address is given – “do hereby authorise that the medical and hospital 
 
records of my son” – and a name is given – “be made available as 
 
required to the GMC and to their solicitors” et cetera 
 
 
And at the bottom it is signed and dated.  Now, first of all, the signature at the bottom, 
 
who wrote that? 


It is my signature. 
 
 
 

The date, who wrote that? 
 

I wrote the date. 
 
 

Now in respect of both the name that is or purports to be your name and the name 

of your soon, what has been typed has been crossed out and there is a hand-written 
 
alternative spelling; who wrote that? 
 

That was written by John Hodgkinson, the solicitor that came to interview me. 
 
 
 

And next to it on each occasion one can see two initials; who wrote those initials? 
 

I initialled them. 
 


The next bundle of documents is one that I know those instructing me have copies 
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of here.  Could I ask you to look at this and we will mark this document C3.  (Same 
 
handed)  (To the Committee)  I think for the sake of clarity I should say that in my copy, 
 
and I believe every other copy, the last page is entirely blank and there is no significance 
 
in that, it has simply been photocopied with one extra sheet in and then stapled together 
 
in the same way. 
 
(To the witness)  Mrs D, you were asked about bringing documents to the Committee 
hearing today and you indicated that you had had some contact with the solicitors, but 

that you were already travelling and that you had not therefore been able to bring certain 
 
documents? 
 

Correct, I could not bring documents from 1996. 
 
 
 

But have you brought with you today to this Committee hearing some documents 
 
with your name written on them? 

Yes, I have. 

 
 

And are these photocopies of those documents? 
 

Yes, they are. 
 
 
 

If we can just look through them again just to identify them; the originals are 
 
available, I know.  The first page of C3, whatever it is does not matter, but we see there, 
there is a signature written and the date the 18th September 2003; who wrote that? 


I wrote that. 
 
 
 

On the next page there is a document that I think relates to someone’s report card 
 
and attendance print out.  It is signed, there is a hand-written name of the pupil who is a 
 
tutor group member.  First of all, who signed that? 
 
A I 
did. 
 


Who wrote the name of the pupil? 
 
A I 
did. 
 
 
 

And the tutor group? 
 

That is already there. 
 
 

The third page, which is not terribly easy to read, I think it is one of those copy 

typed documents that does not photocopy very well, but we do have the original of this 
 
carbon copy of the document here, it is some kind of delivery receipt, I think, for a 
 
tumble drier? 
 

That is correct. 
 
 

And just over two thirds of the way down at two boxes it says ‘customer 

signature’ one above the other and we can just about see a signature there; who wrote that 
 
signature? 
 
A I 
did. 
 
 
 

May I then ask you to look at one final bundle of documents and for this, I think, 
 
I would be obliged to those who act for Dr Cosgrove if they could assist us with save 
photocopying, because I believe they have copies of this; I asked for it to be copied and 

I believe it had already been photocopied, and that is documents relating to the Criminal 
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Injuries Compensation Authority.  (Same handed
 
 
 
THE CHAIRMAN: This will be C4. 
 
 
 
MR PEARCE: (To the witness)  And the details of this document do not matter again, 
 
Mrs D, I am concerned only with some hand-writing on certain pages of them.  Page 18, 
which is a consent: 

 
 
“I authorise and request my GP to supply any information 
 
reasonably requested by CICA in connection with this application”. 
 
 
 
Signature and a date.  Who wrote the signature there? 
 
A I 
did. 
 


And who wrote the date? 
 
A I 
did. 
 
 
 

And then if you go to the very back of this bundle, which is clearly something to 
 
do with the claim to an authority arising out of an injury.  Under 13.9, “Signature of 
 
applicant”, who wrote the name that appears there? 
A I 
did. 

 
 

And who wrote the date that appears next to that name? 
 
A I 
did. 
 
 
 

And under 13.10, “Signature of person applying on behalf of injured party”, who 
 
wrote that? 
A I 
did. 

 
 

And the date, who wrote that? 
 
A I 
did. 
 
 
 

May I, I hope now fairly briefly, just ask you about one or two other matters, 
Mrs D?  Can I refer you to D1, I know you have an abundance of paper in front of you; 
 
I can tell you it is hand-written letters, the very first hand-written letters that were 

referred to you.  We know these are in reverse order in terms of time, so can I ask you to 
 
go back to the earlier letters in May of 1996.  The address that appears in the top right 
 
hand corner, which I think we are calling address one, the details do not matter, were you 
 
living at that address at that time in 1996? 
 

Yes, I was. 
 


Would you then go on to the first page of D1 where an address appears.  I thought 
 
there might have been some slight confusion about this, because I thought I understood 
 
Mr. Hughes to call that address three, although I think it is the second address on the file? 
 
 
 
THE CHAIRMAN: I think it was Mr Morris that said there were three addresses. 
 
 
MR PEARCE:  In any event, be that as it may, I do not think it requires any formal 

direction. 
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(To the witness)  The address we see on the top of D1, top right hand corner, again I am 
 
not concerned with the details of the address; was that your address on the 23 September 
 
1996? 
 

Yes, it was. 
 
 
 

Reference is made to Dr Spence in that letter, “My new doctor’s name and 
address”; was Dr Spence your doctor in September 1996? 

A Yes. 
 
 
 

Could I ask you please to go to D4, it is a perfectly reasonable document to go for 
 
to ask you about this, one of the typed letters?  We see a name and address in the top right 
 
hand corner of D4, it is a different address from those two I have just referred to; in 
 
December 2001 was that your address? 
A Yes. 

 
 

May I turn to another matter, please, Mrs D, and that is the attendance that you 
 
say took place at Dr Cosgrove’s clinic.  Can I first of all be clear about where to the best 
 
of your knowledge that clinic was, the clinic at which you saw Dr Cosgrove? 
 

Well I travelled down to the Bristol Priority Clinic. 
 
 

And where do you understand that to have been? 


I was assuming it was in Bristol. 
 
 
 

You said that you stayed in a bed and breakfast? 
 
A That’s 
correct. 
 
 
 

Do you recall where the bed and breakfast was? 

No, but I know it was about five minutes away from the Bristol Priority Clinic. 

 
 

And you have indicated a length of time, 15/20, I think at one stage you said 15, 
 
even 25 minutes; apart from that period of time, have you on any occasion met Dr 
 
Cosgrove? 
 
A No. 
 
 
MR PEARCE: (To the Committee)  Can you just give me a moment please, sir?  (Pause

I am obliged, sir.  I have no further questions. 
 
 
 
Further cross-examined by MR MORRIS 
 
 
 

The last document in D2, Mrs D, is the consent document, the last page of D2 
dated 12 June 2003, giving permission for the General Medical Council and their 

solicitors to have access to your son’s medical records.  Have you seen your son’s 
 
medical records? 
 

No, I have not. 
 
 
 

There would have been nothing to stop you seeing them if you wished to, do you 
 
accept that? 
A I 
would. 

 
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MR MORRIS:  Thank you very much. 
 
 
 
THE CHAIRMAN:  Are there any more questions at this stage from Members of the 
 
Panel?  (No response)  There being no questions, we will break for lunch now.  There is 
 
the possibility that Mr Morris might have some further questions for you after the lunch 
 
break so that we will keep you under oath at the present time and I repeat what I said 
earlier, you must not discuss your evidence with anyone during the lunch break. 

 
 
MR PEARCE:  Sir, may we take stock as to timescales, since at the moment I have an 
 
expert witness sitting in the building waiting to give evidence.  It seems to me that, if my 
 
understanding of my learned friend’s position is correct, we may be hearing some expert 
 
evidence on his behalf for the purpose of his application this afternoon; that thereafter he 
 
and I will have to make our submissions to you and you will have to retire to consider 
those submissions – which, no doubt, will involve the consideration of certain 

propositions of law as well as the factual evidence that you have heard.   
 
 
 
If you rule in favour of staying these proceedings in their entirety than clearly I will be 
 
calling no further evidence and therefore there will be no benefit to the Professor staying. 
 
 If, on the other hand, you were to rule in favour of some or all of the charges continuing, 
 
the next stage in the proceedings would be for me to open the case and thereafter, subject 
to which charges proceed, I would propose to recall Mrs D to give her evidence on the 

substantive issues – and she has travelled here from a distance, always with the intention 
 
that her evidence would be given today and only today. 
 
 
 
It seems to me, unless I am misunderstanding the processes that are now going to take 
 
place, there seems to be no realistic prospect of Professor Taylor giving evidence today.  
 
In those circumstances, I have already made the provisional arrangement that he, 
assuming his evidence is needed, gives evidence by way of the video link equipment on 

Monday afternoon and if my understanding of the timetable is correct I would propose 
 
that I release him now and proceed on the basis that it is then that he will give evidence. 
 
 
 
THE CHAIRMAN:  I am not trying to say what Mr Morris’s case will be but I would 
 
assume that he would be making quite lengthy submissions to strike out all or part of the 
charges and that you would be making a counter submission.  If we continue with any of 
 
the charges or all of the charges, I think it would be highly unlikely that we would be 

starting to take evidence today.  As I understand it, you will be calling an expert witness 
 
and that could take some time.  You will have some idea of the time that your 
 
submissions would require. 
 
 
 
So I think it is safe enough to let Professor Taylor stand down for today.  If we were to 
proceed with some or all of the charges, the first stage would be for Mr Morris to respond 

to the charges as to whether any or all of them are admitted and then you would present 
 
your case.  I think I am safe enough in saying that Professor Taylor can be stood down. 
 
 
 
MR MORRIS:  I respectfully agree with that. 
 
 
 
THE CHAIRMAN:  At this stage we will break and we will return at 2 p.m. 
 

(The Committee adjourned for lunch)  
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Sir, I have no further questions to put to Mrs D. 
 
 
 
THE CHAIRMAN:  I assume you have no further questions either, Mr Pearce. 
 
 
 
MR PEARCE:  No, sir. 
 

THE CHAIRMAN:  You are now excused, Mrs D.  If the case continues then I assume 
 
you will be giving evidence at a later stage.  At this point I would ask you, Mrs D, to 
 
leave the room. 
 
 
 
(The witness withdrew) 
 
 
MR MORRIS:  I call Mrs Marsh. 

 
 
FIONA ELIZABETH MARSH, Sworn 
 
 
 
Examined by MR MORRIS 
 
 
 

Mrs Marsh, are your full names Fiona Marsh? 

Fiona Elizabeth Marsh. 

 
 

And could you give the Committee your professional address, please? 
 

The address is Lapwater Hall, Middle Road, Ingrave, Brentwood, Essex. 
 
 
 

What is your occupation and what are your qualifications? 

I am a question document examiner, otherwise known as a forensic document 
 
examiner.  I have a Bachelor of Science degree, a Master of Science degree, and I was 

trained in the scientific examination of documents and handwriting at the Metropolitan 
 
Police Forensic Science Laboratory. 
 
 
 

How long did you work there for? 
 

I worked there for, I think, eight years. 
 
 

I think you left the Forensic Science Laboratory in 1988.  Since that time, how 

have you worked? 
 

I have worked as an independent document examiner. 
 
 
 

Can you tell us the sort of work you have done and for whom in terms of your 
 
independent career? 

My clients include:  I work for prosecuting bodies, including the Metropolitan 

Police, the City of London Police, various police forces, Trading Standards, Ministry of 
 
Defence, and I have worked for prosecuting bodies abroad, for the Gibraltar Police, 
 
people in Australia, Philippines and various other countries.  I do criminal defence work, 
 
where most of my clients are solicitors but I do some work for private individuals, and 
 
I do civil work which includes work for banks, insurance companies, corporate 
 
businesses, whoever. 
 


I think on Monday of this week, 19 January of this year, it is right that you were 
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shown a number of documents and asked to comment upon them? 
 

Yes, I was. 
 
 
 

I think following your sight of those documents on Monday the 19th you have 
 
compiled a report as to what you have seen and your conclusions about what you have 
 
seen? 

Yes, I did. 

 
 

You have been here today listening to the evidence, during the course of which a 
 
number of other documents have become available within the hearing, is that right? 
 

That is correct. 
 
 
 

Those are identified in two groups, but had you seen those other documents before 
today? 


No, I had not. 
 
 
 

Have you had an opportunity to look at them over the adjournment? 
 

I have made a cursory examination of a number of additional documents. 
 
 
 

I want first then to identify those documents which you were able to see on 
Monday in more leisured circumstances and on which you have prepared a report.  Could 

you have, please, D1, D2 and D4? 
 

These were the documents I examined on Monday. 
 
 
 

Can I just go through these to make sure that you have identified the ones you saw 
 
on Monday?  First of all, looking at D1, did you see the three handwritten letters dated 
 
26 April, 27 May and 23 September 1996? 

Yes, I did. 

 
 

Turning to D2, did you see the letter dated 18 August 2000, which is typed and 
 
signed by Mrs D? 
 

Yes, I did. 
 
 

With the addition of a “p”? 
 

That is correct. 

 
 

Turning to D4, did you see the letters dated 11 December 2001 and 21 June 2001? 
 

Yes, I did. 
 
 
 

Together with the copy driving licence attached to the letter of 21 June 2001? 

Yes, I did. 

 
 

I want you to begin with your views about that documentation first of all and then 
 
I will turn to the additional documentation that you have seen this morning for your views 
 
on that.  First of all, was all the documentation that you saw on Monday original? 
 

No, two of them were copy documents. 
 
 

Are you able to identify which were the copy documents that you saw? 


May I refer to my notes? 
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Just tell us about those notes, please.  When did you make your notes? 
 

They were contemporaneous with my examination. 
 
 
 
MR MORRIS:  (To the Committee)  I wonder if the witness may be allowed to refresh her 
 
memory from her notes? 
 

THE CHAIRMAN:  Yes. 
 
 
 
MR MORRIS:  I am grateful. 
 
 
 
THE WITNESS:  The typed letter dated 18 August 2000 was a copy, as was the driving 
 
licence. 
 

MR MORRIS:  So that is D2 and the driving licence, D4.  I think what is common to all 
 
the documents is that there are signatures on these documents and it was those signatures 
 
that you were asked to make a comparison of, is that correct? 
 

That is correct, yes. 
 
 
 

Before you begin to give evidence about those signatures and your comparison of 
those signatures, I just want you to help the Committee as to any difficulty you might 

have in discussing those signatures if you are asked to maintain the anonymity of the 
 
signatory.  Is this going to cause you problems? 
 

I have never had to give evidence on handwriting before anonymously.  I can give 
 
evidence, I hope, in general terms but if you want any sort of detail of the letters then I 
 
cannot keep it anonymous. 
 
 
MR PEARCE:  If I can just come in there, I make it clear now that if this evidence is 

going in the direction I anticipate it is, then I certainly by way of cross-examination think 
 
I clearly have to ask about details, individual letters and names – matters which would 
 
clearly render the idea of anonymity not workable. 
 
 
 
THE CHAIRMAN:  Basically what you are suggesting to us is we should hear this 
evidence in camera. 
 
 

MR MORRIS:  I feel otherwise the anonymity is inevitably going to be breached. 
 
 
 
THE CHAIRMAN:  We agree to that. 
 
 
 
Sadly, I have to ask the public to leave once again. 
 

(The proceedings continued in camera – see separate transcript) 
 
 
 
 
 
 


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D2/40 

 
  
 
 
GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
Friday, 23 January 2004 
 
Held at: 
Barnett House 
53 Fountain Street 
Manchester M2 2AN 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Three) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of TranscribeUK 
Tel No:  0208 614 5799) 
 
-------------------------------------- 
 
 
 
 
 

 
 
 
INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
  PRELIMINARY 
MATTERS 
     1 
 
  APPLICATION 
by 
MR 
MORRIS 
    3 
 
  APPLICATION 
by 
MR 
PEARCE 
 
    4 
 
 
 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:  Good  morning.  Mr Morris? 
 
 
 
MR MORRIS:  Sir, I think when we parted on Wednesday Mrs Marsh was in the witness 
 
box.  She is sitting at the back of the Committee room.  Before she moves from that 
 
position, I would like to place before the Committee a further report that she has prepared 
 
on the additional material that was submitted to her on Wednesday.  (Same handed) 
 

THE CHAIRMAN:  That will be D10.  Did we have an earlier report? 
 
 
 
MR MORRIS:  No, sir, she gave that report orally and I do not propose to put the earlier 
 
report in.  It is a short report and I propose to read it to you and then to comment to you.  
 
It is entitled “Further Report on Examination of Signatures in the Name of [Mrs D]”. 
 
 
THE CHAIRMAN:  There are members of the public here and we were hearing evidence 

about handwriting in private. 
 
 
 
MR MORRIS:  I think for the purposes of this report I can deal with it in public session. 
 
 
 
THE CHAIRMAN:  Thank you.  It is Mrs D we are referring to. 
 
 
MR MORRIS:  Mrs D. 

 
 
“Further to my report dated 19th January 2004 on the 21st January 
 
2004 I took possession of twelve additional documents each signed 
 
in the name of ET and dated various dates between 1996 and 2004. 
 
 
 
I have examined these additional signatures, fourteen in total as two 
of the documents have been signed twice, in conjunction with the 

seven signatures examined previously and referred to in my report 
 
dated 19th January 2004. 
 
 
 
The seven signatures examined previously could be divided into two 
 
distinct groups with three signatures dated 1996 falling into one 
group and four signatures dated between 1999 and 2001 forming a 
 
second group. 

 
 
The additional fourteen signatures examined extend the range of 
 
variation considerably to that seen in the original seven signatures.” 
 
 
 
Sir, I do not believe as part of the document that you have, you have an additional sheet 
in the form of a template which you  were given last time.  I would ask that that be 

circulated too.  (Same handed) 
 
 
 
THE CHAIRMAN:  D11. 
 
 
 
MR MORRIS:  Having a template may assist in understanding what she is saying here: 
 
 
“The additional fourteen signatures examined extend the range of 

variation considerably to that seen in the original seven signatures.  
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Additional variations include the use of upper case “H” in the 
 
surname of some of the signatures e.g. on the handwritten letter 
 
dated 23 September 96, on the Childhood Behaviour Checklist dated 
 
11th March 1996 and on the consent form dated 17/2/02.  This 
 
feature is also found in the two signatures on the Delivery/Collection 
 
Sheet dated 16 January 16/01/04.  Furthermore, these two signatures, 
dated 16/01/04 are considerably more abbreviated than all the other 

signatures examined.  More significantly some of the additional 
 
signatures cannot be clearly placed into either of the two groups as 
 
before, but show a considerable amount of overlap between the two 
 
groups effectively bridging the gap. 
 
 
 
It is apparent from the handwriting and the signatures on the 
handwritten letters dated 1996 that [Mrs D]’s writing and signatures 

are quite variable.  Having examined additional signatures in the 
 
name of [Mrs D] on a variety of documents and seeing the extended 
 
range of variation it is probably that all the signatures were written 
 
by the same person.  However, as this signature is so variable and 
 
simple in its method of construction it is relatively easy to copy.  
 
Consequently if any of the signatures were to be considered in 
isolation I cannot entirely exclude the possibility that it may be a 

copy of [Mrs D]’s signature.  However, I found no evidence that this 
 
is the case. 
 
 
 
I understand my duty to the court and I have complied with that 
 
duty. 
 
 
I believe the facts stated in this witness statement are true.” 

 
 
She signed that on 22 January 2004. 
 
 
 
Sir, the upshot of this further report and Mrs Marsh’s consideration of the additional 
 
material is set out in her final substantive paragraph, where she says that on seeing this 
extended range of variation it is probably that all the signatures were written by the same 
 
person.  That is her evidence and I do not seek to subvert that evidence and this is an 

agreed document which is now before the Committee. 
 
 
 
In the light of that, neither I nor Mr Pearce would seek to ask her further questions.  
 
Obviously, she is still the Committee’s witness or before the Committee and if the 
 
Committee wish to ask her further questions you must be entitled to do that.  For my part, 
I do not seek to ask further questions and I do not believe Mr Pearce does, but she is here 

and available if questions are required. 
 
 
 
MR PEARCE:  So long as what is said and read out in that report and clearly signed by 
 
Mrs Marsh is taken to be her as though she had given that evidence before you, then I do 
 
not seek to cross-examine her. 
 
 
THE CHAIRMAN:  I assumed that was the position.   

 
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There are no further questions from the Panel, Mrs Marsh, so you can now stand down.  
 
I am sorry you have been brought back for another day.  Thank you very much for 
 
coming down. 
 
 
 
MR MORRIS:  Sir, at this stage, all things being equal, I wish to commence or 
 
recommence (I am not quite sure the best way of putting it) my submission on abuse of 
process.  I regret to say that not all other things are equal and I think the Committee may 

be faced with a further hiatus.  May I explain the position?  In the material that was 
 
disclosed by the Council on Monday, that is to say the internal memoranda which I 
 
sought and which were procured by the Council and disclosed to the defence team on that 
 
day, the prime purpose of which was to see whether there was any express matters that 
 
relate to Mr Daniels and the Citizens Commission on Human Rights and whether there 
 
was any involvement by them in the decision to refer the six original complaints to the 
Registrar at the end of Septembers 2002.   

 
 
It is also apparent from that material that the original six cases, or at least a majority of 
 
them – maybe not all of them but the majority of them – were, in 2001, referred to the 
 
Performance procedures of the General Medical Council.  It is shown that a medical 
 
screener took that decision at the beginning of 2001 and, indeed, that Dr Cosgrove was 
 
notified of that decision in 2001 and probably in May 2001.   
 

It is apparent also from this material that in February 2002 the matters were considered 
 
again by another medical screener of the General Medical Council, who took a different 
 
view, saying that they should be referred to the Preliminary Proceedings Committee and 
 
therefore be sent down the Conduct route.   
 
 
 
There is a suggestion in the various memoranda that went to and fro within the GMC 
about this decision that that decision could be justified on the basis that further 

information had come to light about Dr Cosgrove.  However, on the face of the 
 
documentation that I have all the complaints date from 1999, 2000 or earlier and it does 
 
not appear to me that there was any further fresh information that would justify the 
 
Council in deciding to take a wholly different approach to the treatment of this 
 
information and complaints. 
 
 
If that is right, it would, in my submission, amount to an unfair use of the investigate 

powers of the General Medical Council and would amount to an abuse, which I would 
 
seek to lay before you. 
 
 
 
I have told Mr Pearce about this this morning and, quite understandably, he is not in a 
 
position to deal with my concerns at this stage and he would like time to investigate 
whether there is in fact additional material which would have justified a screener taking a 

wholly different course from the one that was originally promulgated and communicated 
 
to Dr Cosgrove. 
 
 
 
If there is substantive additional material that was basis for that decision then I will not 
 
proceed with any submission based on this point.  If there is not, I would seek to proceed 
 
with this submission and it would not be right or fair to Mr Pearce, I believe, for me to 
begin my submission now and then for us to have a pause while investigations are made.  

I think the view he would take is it would be best if that investigation were done now.   
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I am not sure how long that is going to take him.  I am not sure whether he can assist in 
 
that regard, but I am sorry to put this problem before the Committee, but I must do so. 
 
 
 
MR PEARCE: We may perhaps be fortunate that we have a little leeway in time, sir. Of 
 
course that is no ground on which not to proceed with expedition.  As my learned friend 
 
rightly says, he alerted me to these matters this morning, I have had no more than a 
cursory view of the documents.  His point raises a number of questions, not least the 

fundamental factual question as to whether there was a decision to refer to performance 
 
and then a change of that decision.  Secondly, if there was a change of decision, on what 
 
basis that change of decision was made.  Thirdly, whether that change of decision was 
 
based on fresh information or not could be justified. Fourthly, it seems to me, whether, 
 
even if it could not be justified, it necessarily leads to any unfairness, sufficient to ground 
 
an application for abuse.   
 

Those are each matters that I would need to consider.  The most fundamental of those, it 
 
seems to me, is to seek what decisions were made and the basis upon which they were 
 
made and that will undoubtedly take a little time.  In the light of what my learned friend 
 
has to say I cannot resist his right to raise the argument and in those circumstances it 
 
seems to me I am bound to seek to respond to it by investigating the points he makes.   
 
 
It seems to me the proper way for us to proceed at the moment is for you to allow me 

some time, and I think something like an hour in the first place, in order to give me the 
 
opportunity to see what the point is, speak to those, presumably in London, who may 
 
know the answers, so in about an hour’s time I hope to be in a position to say to you this 
 
is the way it appears to be going.  I am not saying I will have the material, if material 
 
there be that is relevant to it, but at least I hope to be in a position to say I know where I 
 
am going.  I can see a number of possible options, one of which is that I may seek to call 
one or more witnesses.  Those witness will no doubt not be available today.  That may be 

a possibility.  I simply do not know what material there may be, which is why I seek the 
 
indulgence of the time; to try to find out what there is and, I must say, to try to establish 
 
whether there is any authority on this point.  I am not as familiar with the screening 
 
process as perhaps others who work in the GMC are, because I have no part in that 
 
process.  I only come in at this stage when it has already been done.  I have to confess I 
have not had a case where any part of the screening process has been challenged.  It has 
 
been suggested there is one authority, one decision in this area, I think a judicial review 

decision, although I am not sure it has any relevance to this point.  So there are legal 
 
questions as well.  But in the first place I am more concerned to try to understand the 
 
factual position so I can lay at least in bare bones what we will be saying in the point 
 
before you.  We can then take a decision whether we proceed on this.  It is fortunate that 
 
we do have some more leeway of time than we might in another case. 
 

THE CHAIRMAN: I think we are setting a record in GMC terms (Inaudible) but be that 
 
as it may.  We have got to do it appropriately.  So shall we adjourn at the moment until 
 
10.30 and then review the situation thereafter.  Certainly if witnesses have to be called it 
 
is Monday before that can be done, it may very well before Monday before you have your 
 
case ready.  Let us review the situation at 10.30.   
 
 
(The Committee rose for a short time

 
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MR PEARCE: Sir, thank you for the time.  I have had a very lengthy conversation with a 
 
lawyer on the legal issues and, for my benefit, the procedures relating to screening.  It is 
 
not straight forward, it is not easy, like a lot of these matters.  I have also had an 
 
opportunity to look through all of the documents that we have here on the screening 
 
process that took place here and the explanation for some of the issues that my learned 
 
friend either has raised or, I anticipate, will rise is not apparent from those documents.  
There are clearly some substantial unexplained areas.   

 
 
Sir, what I will invite you to do is to retire now and return on Monday morning.  Can I 
 
tell you what I am going to do, if you acceded to my request, between now and Monday 
 
morning; that is that I propose to spend the rest of the day, as long as it takes today in 
 
seeking to identify what, if any, further documents there are and what, if any, further 
 
knowledge there is to explain the screening process that has taken place here with a view 
to putting any documents and, secondly, any information to my learned friend so that he 

can consider whether he proceeds with the point and, if he does, so at the I can seek to 
 
have a available before you on Monday morning all information, be it by way of witness 
 
evidence, documents or whatever else, that I would seek to call to deal with this a point.   
 
 
 
It seems to me, Sir, and particularly, but not only, I have say, having regard to the fact  
 
I believe you are going to rise at 3 o'clock, that by the time I have the answers to these 
inquiries it will be so late that we would frankly feel that it is Monday morning any way, 

at best I will have identified a number of documents that will allow us to start oral 
 
submissions and I anticipate that I will not have that before 2o'clock and whether you 
 
really wish to start hearing an abuse argument application for an hour only.  As I say, 
 
given the circumstances in this case we do have a little indulgence of time, you may well 
 
think the time is better spent that way. The aim is that for us to be ready to go first thing 
 
Monday morning. 
 

THE CHAIRMAN: I think that is perfectly reasonable.  From what you say you will 
 
require significant amount of time to acquire the information, you will have to share it 
 
with Mr Morris.  There is no guarantee that you would be ready by 2o'clock or 3 o'clock.  
 
The issue of witnesses? 
 
 
MR PEARCE: That depends on what the information is.  That depends on who is 
 
available to say what.  There has been some changes of personnel.  It may well be that 

there is no greater information on some of these points than can be discerned from the 
 
documents.  It may be that there are people with knowledge of the decision making 
 
process and can speak for it.  I need to identify what is there is and who there is and I also 
 
need to identify their availability.  My intention would be to line up any evidence that I 
 
seek to call before Monday morning so that we can produce it then and deal with them 
from there. 

 
 
THE CHAIRMAN: I do not think there is any option but to adjourn today and reconvene 
 
on Monday.  Slight worry about Monday and Tuesday, there are forecasts of snow but we 
 
will take that as it comes. Let us not be pessimistic! 
 
 
 
MR PEARCE: It will not snow in Manchester.  If never does, it is too warm! 
 

THE CHAIRMAN: Mr Morris? 
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MR MORRIS: Sir, I have nothing to add.  I am grateful for the steps my learned friend is 
 
taking. 
 
 
 
THE CHAIRMAN: So we will shall adjourn and hopefully reconvene on 9.30 Monday 
 
morning.   
 

(The Committee adjourned for the day to reconvene at 9.30 Monday morning
 
 
 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 

 
 

 
 
 
 
 


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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
Monday, 26 January 2004 
 
Held at: 
Barnett House 
53 Fountain Street 
Manchester M2 2AN 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Four) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
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(Transcript of the shorthand notes of TranscribeUK 
Tel No:  0208 614 5799) 
 
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INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
PRELIMINARY MATTERS                                                                           1 
 
 
ABUSE OF PROCESS ARGUMENT BY MR MORRIS                               1 
 
 
REPLY BY MR PEARCE                                                                              36 
 
 RESPONSE 
BY 
MR 
MORRIS 
     60 
 
 
 
 
 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:  Good morning.  Mr Morris, or is it Mr Pearce? 
 
 
 
MR PEARCE:  I think it is me briefly first, sir.  You will recall we had reached the 
 
position on Friday where my learned friend had raised an argument which I sought your 
 
indulgence to have sufficient time to consider in detail and to take instructions on.  May I 
 
say in the first place that I was not able to take those instructions until well into the 
afternoon due to the non-availability of the appropriate person at the Council offices, and 

so, if I may say so, the decision to put matters back to today was justified in the event. 
 
 
 
Having had the opportunity to take those instructions and to consider the law in respect of 
 
screening, it is not our intention to adduce evidence or documentation in respect of the 
 
screening process that has taken place here.  It is our submission, and no doubt this will 
 
be developed in due course in the light of my learned friend’s abuse of process argument, 
that it is not appropriate for the screening process to be examined or reviewed at this 

stage.   
 
 
 
A decision at the screening stage may very well be capable of challenge by way of 
 
application for Judicial Review, an application that would be dealt with by the 
 
Administrative Court in accordance with its procedures.  This is not the appropriate 
 
forum, we submit, to make any such challenge.  You will no doubt have it firmly in your 
minds that we are dealing with a screening decision taken very close to two years ago 

now, since when these proceedings have followed their usual and, we say, proper process 
 
through the Preliminary Proceedings Committee and into this Committee.  We say to now 
 
seek to challenge that decision, which is an administrative decision that comes before 
 
everything that has happened since, is simply not a challenge that can properly be taken 
 
before this Committee, but is one that, if it were ever to be challenged in any way, should 
 
have been or should be challenged by way of Judicial Review application in the 
Administrative Court. 

 
 
My learned friend has indicated that he will develop his arguments in respect of abuse of 
 
process in this regard and I will no doubt respond to those in due course.  That, in the 
 
short term, is to explain our position today and why we have reached that decision. 
 
 
THE CHAIRMAN:  Thank you very much.  Mr Morris. 
 
 

MR MORRIS:  Sir, I am at long last going to make the substantive submission that I 
 
wished to make early on last week in relation to, it now transpires, three separate matters. 
 
 The first submission is the one I outlined to you last week.  If you have a copy of the 
 
transcript for D1/9 F I outlined there in a nutshell what my submission was going to be, 
 
namely, that under the aegis of the Church of Scientology’s organisation, the Citizens’ 
Commission on Human Rights, a complaint or information had been provided which is 

fraudulent, inasmuch as it does not come from whom it purports to come from, namely 
 
the mother of patient D.   
 
 
 
I am now going to elaborate on that submission beyond saying that that head of charge 
 
should not be allowed to proceed, because it amounts to an abuse of the process of your 
 
Committee, and that it has a knock on effect in relation to the remaining charges.  I am 
also going to be submitting as a result of developments last week and the disclosure of 

documentation by the Counsel that there has been effectively a breach of promise on the 
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part of the Council, inasmuch as in relation to the charges that were notified or heads of 
 
charge that were notified in the rule 6 letter of 1 October 2002, either the doctor had been 
 
given an indication that no further action would be taken in relation to various 
 
complaints, or that the action that would be taken was that those complaints or 
 
information would be considered by the performance processes of the Council and not the 
 
disciplinary conduct processes of the Council.  The breach of that indication or promise 
itself is a free standing abuse of the process of your Committee. 

 
 
My third submission is that because the Council on Friday took the view that no further 
 
disclosure of material was warranted, material that in my submission is relevant to the 
 
conduct of the defence of Dr Cosgrove, that too stands on its own as an abuse of the 
 
process of this Committee. 
 
 
Can I return to the first submission in relation to head of charge 6 concerning patient D?  

It would perhaps assist if at this stage I recapitulated on the law that I set out on the first 
 
day of this inquiry.  It is helpfully set out in the transcript at D1/19 through to D1/21 
 
letter D.  I do not propose to read through it again.  That would be a complete waste of 
 
your time.  I am sure that you will have it fairly well in mind.   
 
 
 
My submission in relation to the law on this matter is as set out at the bottom of D1/19 F. 
  

“Power to stay proceedings for abuse of process has been said to include the 
 
power to safeguard an accused person from oppression or prejudice…” 
 
 
 
That is a reference to the case of Connolly
 
 
 
“…and has been described as a formidable safeguard developed by the common 
law to protect persons from being prosecuted in circumstances where it can be 

seriously unjust to do so.  An abuse of process was defined in the case of Ho Chi 
 
Min as something so unfair and wrong that the Court should not allow a 
 
prosecutor to proceed in what in all other respects is a regular proceeding.” 
 
 
 
That was elaborated in the case of Baring, which was a case under the Company 
Directors’ Disqualification Act 1986 where the Court of Appeal said that a Court may 
 
stay proceedings where to allow them to continue would bring the administration of 

justice into disrepute among right thinking people, and that this would be the case if the 
 
Court was allowing its process to be used as an instrument of oppression, injustice or 
 
unfairness.   
 
 
 
What I submit I did on that first day at D1/20 F to G is that if there is bad faith 
demonstrated in relation to the bringing of charges other than head of charge 6, there is 

ample authority for granting a stay properly on the grounds of abuse of process, and that 
 
the lack of bad faith does not have to be found in the heart of the prosecuting body.  It can 
 
take effect even if the body itself is an unwitting victim of that bad faith.  The body here 
 
is, of course, the Council and it has been, in my submission, a victim of the bad faith of 
 
either the Commission on its own or the Commission together with Mrs D.  There is a 
 
reference there to paragraph 4-63A of Archbold which I need not trouble the learned 
Legal Assessor to look at now.  The reference is set out in the transcript at letters F to G 

on page 20. 
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Can I turn to head of charge 6, patient D?   The effective informant in that case was the 
 
Commission, the Citizens Commission for Human Rights.  My primary submissions was 
 
as succinctly summarised by your Chairman on D2/29E, when he summarised the 
 
position thus: 
 
 
“What you are really saying is that someone took Master D to see Dr Cosgrove 

around 1996 and wrote some letters at that time.  Someone wrote some letters 
 
from 2000 onwards and it is your assertion that there are two people involved in 
 
this, two different people.” 
 
 
 
I say that was a correct way of putting it, in my submission.  
 
 
Notwithstanding the evidence of Mrs D and Mrs Marsh, the handwriting forensic expert, 

I do not resile from that submission.  You are not bound by the evidence of an expert.  It 
 
is opinion evidence and you, the Committee, have to make up your own minds.  I am sure 
 
Mrs Marsh would have been the first to accept that the forensic examination of 
 
handwriting is not able to deliver certainty in its conclusions – not always – and that 
 
additional material can lead to remarkably different conclusions. 
 
 
You had a classic example of that when, on the first day she gave evidence about her 

assessment of the handwriting signatures seen or made in 1996 and those made in 2000 
 
and 2001, where she concluded on the basis of that material that there was no evidence to 
 
connect the two and then, when she returned having seen additional material, she had 
 
come to the conclusion that the range of variation was such that it was probable that all 
 
the signatures were by the same person.  You will have to make up your mind on that 
 
evidence. 
 

I wish to add an alternative submission in this light – I say “in this light” – in the light of 
 
the evidence produced by Mrs Marsh.  If you are not satisfied on the balance of 
 
probabilities - which, in my submission, is the test you have to apply here because the 
 
onus of proof I accept is on the Defendant in this submission – if you are not satisfied on 
 
the balance of probabilities that there were two separate authors to those signatures and 
that they were on balance probably the work of the same hand, then what I submit is that 
 
that author, Mrs D, who gave evidence before you, has been manipulated such that in 

reality the complaints embodied in first of all the letter of August 2000 – D6 - and the 
 
subsequent witness statement of August 2003 – D8 – are not effectively her documents 
 
and they are not made with her authority, notwithstanding her assertion in evidence 
 
before you to the contrary. 
 
 
That complaint as embodied in that letter and witness statement is not her complaint.  It is 

the Commission’s and, in that respect, is a fraudulent complaint. 
 
 
 
I wish to give the Committee the reasoning behind that submission.  The first is to do 
 
with the letter of 18 August, D6, an unsigned letter written in the name of Mrs D, spelt 
 
with a “p”, you will note. 
 
 
You will recall Mrs D’s evidence about that, that that was a letter she had written in 

manuscript in her own hand but that it had been typed by Brian Daniels of the 
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Commission.  My submission is that that letter was not drafted by Mrs D; it was drafted 
 
by Brian Daniels of the Commission, for these reasons. 
 
 
 
One – if he had been given a manuscript by Mrs D with her name spelt correctly, both at 
 
the top and at the bottom where there is space for her signature and her names appears 
 
and if her son’s name had been spelt correctly, then it is inconceivable that Mr Daniels in 
typing that letter up would have mistakenly transcribed that name in three different 

places.  You will see it at the top right of page 1 of D6, you see it in the son’s name when 
 
it was set out in full in the first paragraph of that letter and you see it at the end of that 
 
letter. 
 
 
 
That this is Mr Daniels’ work is further supported, in my submission, by the letter he 
 
wrote to the Council on 28 June 2000.  This is not a letter that you currently have and I 
will hand it to you now. 

 
 
THE CHAIRMAN:  This will be D12.  (Produced
 
 
 
MR MORRIS:  This is the first letter that the Council received and it related to the survey 
 
that Dr Cosgrove was carrying out together with Dr Bramble.  The survey letter you will 
 
see is C1 and it also refers to an article in the Daily Express where Dr Cosgrove is 
quoted. 

 
 
The significance of it, though, from the point of view I am taking at the moment, is that 
 
you will see in this first letter Mr Daniels spells the patient’s mother’s name incorrectly 
 
with the letter “p”.  You will see that in the third paragraph on the first page and you will 
 
see it at the bottom of the second page, at the very bottom where he notes that copy is 
 
being sent to her, “c.c. Mrs D”. 
 

Finally in relation to that letter D6, of course the obvious point that the letter is not signed 
 
by the ostensible author.  
 
 
 
THE CHAIRMAN:  That is D6 you are talking about? 
 
 
MR MORRIS:  D6, I apologise.  Yes, D6.  In my submission it is inconceivable that such 
 
an important document, written in manuscript by Mrs D as she says it was, typed by Mr 

Daniels, sent back to her for perusal before sending – which is what her evidence was, 
 
that she did, indeed, see the typed letter before it was sent out – should not be signed by 
 
her. 
 
 
 
You will recall she gave two explanations as to why it was not signed.  Those 
explanations were, in my submission, contradictory.  First, she said she did not sign it 

because it was typed and there was no need.  One has to ask rhetorically if that is the 
 
case, then why bother to sign the other letter of 18 August giving disclosure, or 
 
authorising disclosure of her records?  That is dated 18 August too and I think that is D2. 
 
 
 
Her second explanation was that it was an oversight.  Neither of those, in my submission, 
 
are realistic and, indeed, they both contradict each other.   
 

The reality is, I suggest, that Mr Daniels drafted that letter and sent it to the Council 
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without it ever being shown to Mrs D, the mother of the patient. 
 
 
 
The second reason why I say that this complaint, Head of Charge 6, is made without the 
 
mother’s authority, is, I suggest, that he drafted and typed the consent letter of 18 August 
 
– that is D2.  That, indeed, is accepted by Mrs D.  You will notice if you compare D2 
 
with D6 - the letter I suggest that Mr Daniels drafted himself and sent without reference 
to the patient – you will notice that the layout of the address of the sender at the top right, 

the address to whom it is going to be sent, the layout of where the date is put and the 
 
reference, are identical.   
 
 
 
You will notice too in D2 that again we have the mis-spelt name and we also have the 
 
assertion that Dr Cosgrove is practising at the Bristol Priority Clinic in Bath, Avon.  
 
Clearly again, in my submission, a document written without reference to the mother of 
the patient. 

 
 
But this is a letter that Mrs D says was not drafted by Mr Daniels.  It was written by 
 
herself in manuscript and typed-up by a neighbour who lived about ten minutes away 
 
from her.  I suggest that is false.  It is clearly written by the person who drafted the letter - 
 
the other letter of 18 August, the letter of complaint - and I suggest that that was Mr 
 
Daniels. 
  

The third reason why I say this Head of Charge is not made with the mother's authority is 
 
Mr Daniels' letter written to the GMC on 31 October 2000 which we see at D7.  This is 
 
giving information that was being sought by the Council.  Mrs D said that this was 
 
information she gave to Mr Daniels.  He again spells her name incorrectly but, much 
 
more significantly than that, he says in answer to the specific question as to where the 
 
treatment took place that it was at the clinic in Bath.  So, again I suggest that this was a 
letter formulated by Mr Daniels without reference to the mother certainly in relation to 

that specific critical issue. 
 
  
 
Mrs D's explanation for that mistake, because it obviously was a mistake by her if she 
 
was giving the information, was that, "My geography was not that good"; in other words 
 
she mistook Bristol for Bath although she accepted that they are completely different 
cities. 
 
  

The real explanation I suggest behind this is that Mr Daniels got that information from 
 
C1, the Risperidone Survey document sent out by Dr Cosgrove, where you see at the top 
 
that the Doctor's address is given, or the Bristol Priority Clinic's address is given, and it is 
 
the correspondence address in Bath.  And Mr Daniels understandably, but wrongly, 
 
assumed that that was where the treatment was taking place. 
  

Mrs D, in my submission, when giving evidence before you, attempted to shoulder all the 
 
responsibility for these errors which continued further into the Witness Statement itself; 
 
for example, when it is stated in the Witness Statement that Dr Cosgrove saw them at a 
 
hospital in Bristol when all agree now that it was not a hospital but that it was a clinic.  
 
And, in shouldering that responsibility, she is trying to conceal the fact that those errors 
 
were Mr Daniels' errors and that he and not she was the effective source of this 
complaint. 

  
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The fourth reason why I suggest that this complaint is made without her authority is that 
 
Mr Daniels and his Commission have demonstrated over a period of time a motivation to 
 
act on matters that concern them without appropriate authority, and this is what happened 
 
here.  This is the way, in my submission, that Scientologists operate. 
 
  
 
You will recall the sequence of events here.  That Mrs D, the mother, got in touch with 
the organisation "Overload" in Edinburgh which was being run by Janice Hill.  

"Overload" and Janice Hill, I suggest, are an organisation and a person who are  
 
sympathetic to the aims of Scientology and sympathetic to the aims of the Commission 
 
such that her organisation, of which I suggest she is the Founder, and her comments on 
 
the Commission are to be found on the Commission's website.  And if I could hand a 
 
copy of that in, please. 
 
  
THE CHAIRMAN:   This will be D13. 

  
 
(Copies of the document were distributed
 
  
 
MR MORRIS:   I am afraid that the photocopying is not brilliant but, on the top left of the 
 
photograph of the page on the Website, there is a logo.  I have got the original here and it 
 
is the logo of the Citizens Commission on Human Rights, although that is not legible 
there

  
 
However, on its website we have the entry for: 
 
  
 
"Janice Hill, Founder of ‘Overload Network’ in Scotland 
 
2000  
 
A network for parents which educates them on the 
stigmatization of psychiatric diagnoses and drugs given 

children", 
 
  
 
where she is quoted as saying: 
 
  
 
"'CCHR is a sane prescription for what ails our children, 
our schools and our communities.  It is a no-nonsense, say-
 
it-the-way-that-it-is. type of group.  I hope that every parent 

will continue to have access to CCHR's outstanding 
 
up-to-date factual data.  I also hope that every parent and 
 
teacher takes CCHR's superb advice to heart.  Do not allow 
 
harmful psychiatric diagnoses, treatment and drugs to ruin 
 
another child's life, another child's future". 
  

Janice Hill here in this case was concerned about the drugs being prescribed by Dr 
 
Cosgrove and was concerned enough to inform Mr Daniels, who in turn, Mrs D said, 
 
contacted herself, and I do not ask you to turn it up but the reference to that in the 
 
evidence is in Day 2 of the transcript, Page 11, Letter B. 
 
  
 
His concern according to Mrs D - that is Mr Daniels' concern - which she asserted that 
she also shared, was and I quote Mrs D's evidence, "To stop this man doing this any 

more", and that is Day 2 at Page 12.  "And that was going to be done ...", and again I 
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quote from her evidence, "... by exposing Dr Cosgrove's treatment of over-medicating 
 
young children ...", plural I emphasise, "... by writing to the General Medical Council", 
 
and that was her evidence at Day 2, Page 15, Letter A. 
 
  
 
I hasten to interpolate here that you will notice from the Notice of Inquiry that that notice 
 
does not allege over-prescribing, or mis-prescribing, of any drug by Dr Cosgrove. 
  

It is my submission that the Commission's methods mirror the Church of Scientology's 
 
approach to psychiatry.  It is perhaps a  little time since you had the chance to look at the 
 
Foster Report, or "Enquiry into the Practice and Effects of Scientology", at D3, but may I 
 
just remind you of what I suggest is the Scientologists' approach to Psychiatrists.  Mr 
 
Foster categorised them at Paragraph 174 in Chapter 7 as representing one of those 
 
groups who seem to have become enemies of Scientology. 
  

And the approach to be taken to criticism made of the organisation is helpfully set out 
 
under Paragraph 181, under the heading "Doubters outside the fold", which is a letter - an 
 
internal letter within the organisation - from Mr Hubbard, the Founder of the 
 
organisation, where he says in the middle of that page: 
 
  
 
"Anyone proposing an investigation of or an 'Enquiry' into 
Scientology must receive this reply and no other proposal:  

'We welcome an investigation into (Mental Healing or 
 
whoever is attacking us) as we have begun one ourselves 
 
and find shocking evidence'". 
 
  
 
And then he goes on to say ... 
 
  
THE CHAIRMAN:   I am sorry, Mr Morris, but where is that? 

  
 
MR MORRIS:   We are at Paragraph 181. 
 
  
 
THE CHAIRMAN:   Right, thank you. 
 
  
MR MORRIS:   It is under a subheading "Doubters outside the fold". 
 
  

THE CHAIRMAN:   Yes, thank you. 
 
  
 
MR MORRIS:   And in response to enquiries, or as he sees it attacks, the correct 
 
procedure he says is: 
 
  
“(1) Spot who is attacking us. 

  
 
(2) Start investigating them promptly for FELONIES or 
 
worse using own professionals, not outside agencies. 
 
  
 
(3) Double curve our reply by saying we welcome an 
 
investigation of them. 
  

Start feeding lurid, blood, sex crime actual evidence on the 
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attackers to the press.  Don't ever tamely submit to an 
 
investigation of us", 
 
  
 
and it goes on in the same breath and manner for the whole of the next page and, indeed, 
 
for the whole of the rest of that letter. 
 
  
He continues to write in that vein if you look under -- well, in fact it is under the same 

paragraph.  If you go on from the end of the letter I have been referring you to for four 
 
pages, you get an internal memorandum dated 9 February 1966, "Secretarial Executive 
 
Director:  Enquiry Rumour UK", and it starts I hope the Committee have it: 
 
  
 
"The 'news' that some lord [Lord Balniel] is 'going to ask a 
 
question in the House as to why the Health Minister here 
does not conduct an Enquiry into Scientology like in 

Melbourne". 
 
  
 
And then he comes up with such comments as: 
 
  
 
"4. Obviously we could have had a ball and put psychiatry 
 
on trial for murder, mercy killing, sterilisation, torture, and 
sex practices and could have wiped out psychiatry's good 

name".       
 
                                                                            
 
Over the page at sub-paragraph 4, 
 
 
 
“Well, scientology isn’t like psychiatry.  In psychiatry they think adultery is a 
 
cure for.”  You guess it.  Curve every answer with answers that make lurid press 
to psychiatrists cost.” 

 
 
At paragraph 184 a few pages on, we come to the category of enemy entitled 
 
“Psychiatrists.”  Mr Foster days this, 
 
 
 
“The Scientology leadership sees in psychiatrists an especially virulent class of 
enemy.  It is certainly true that psychiatrists in general have expressed no approval 
 
of Scientology theories and tend to regard Scientology processing as potentially 

harmful, especially to unstable minds. 
 
 
 
The Scientology leadership has reacted energetically: - ‘Hubbard says more 
 
psychiatrists are nuts than any other section of the community, he is stating an 
 
observable, statistical truth.” 
 

It goes on in that light for further pages.  At paragraph 186, the final heading under the 
 
heading dealing with psychiatrists, there is reference to their attempt to take over 
 
organisations and one is specified here, the National Association of Mental Health, a UK 
 
body, by joining it in large numbers. 
 
 
 
That is the philosophy behind Scientology, a philosophy that is endorsed, in my 
submission, by the Commission.  For example, if you look at the letter heading on D12, it 

is an organisation established by the Church of Scientology to investigate and expose 
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psychiatric violations of human rights.  Copyright is claimed at the bottom of that page,  
 
 
 
“All rights reserved.  Scientology is a trade mark and service mark owned by 
 
Religious Technology center and is used with its permission.  Scientology is an 
 
applied religious philosophy.” 
 
 
Their methods, and when I say “their” I am referring to the Commission’s methods, are to 

make unsubstantiated allegations.  One particular victim of those allegations was 
 
Professor Sir Martin Roth, a Psychiatrist in Newcastle.  Can I hand up material about 
 
that?  (Same handed
 
 
 
THE CHAIRMAN:  This will be D14. 
 
 
MR MORRIS:  There are in fact two pages to D14. 

 
 
THE CHAIRMAN:  We will refer to the newspaper cutting as D14 and the e-mail as 
 
D15. 
 
 
 
MR MORRIS:  This was a defamatory claim, I suggest, that was made in November 1988 
 
against the Professor.  The article containing the libel is set out there in the first and 
second paragraph, 

 
 
“Dozens of people of Tyneside could have brain damage from experimental drug 
 
tests carried out almost 20 years ago. 
 
 
 
The Sussex based Citizens Commission on Human Rights claims Geordie guinea 
 
pigs were tested with the hallucinogenic drug LSD by a team headed by world 
renowned psychiatrist Sir Martin Roth at Newcastle University in the early 

1960s.” 
 
 
 
The upshot of that was, as can be seen in the e-mail setting out a press cutting from the 
 
Northern Echo of 22 June 1990, when the Professor accepted very substantial libel 
 
damages over a highly defamatory newspaper article.  It had suggested that he had been 
involved in experiments on humans that led to many deaths and injuries.  The front page 
 
story in the weekly Newcastle Times was headlined, “Dozens brain damaged by LSD.”   

 
 
“It claimed to be an account of the findings of a report by a group called The 
 
Citizens Commission of Human Rights which is part of the Scientology 
 
organisation.  The November 1988 article made three highly defamatory and 
 
utterly false allegations about Sir Martin.” 
 

I need not go on.  That this particular leopard has not changed its spots, I suggest is 
 
confirmed by the current website for the organisation. 
 
 
 
THE CHAIRMAN:  This will be D16.  (Same handed
 
 
 
MR MORRIS:  This is a print out of the front pages of the Commission’s website.  It was 
taken on 23 January 2004.  Again, its statement is legible on the first page,  “Investigates 

and exposes psychiatric violations of human rights.”  Over the page, and unfortunately it 
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has not come out on the photocopy, there is a black box in the middle where you can 
 
read, “There is no science to psychiatry only …”  In your photocopies what cannot be 
 
read is what appears beneath and this is something that changes every few seconds.  The 
 
words that appear and can be seen on this original print out copy which I will hand up in 
 
due course for your observation, but it can be seen faintly here but clearly.  These words 
 
alternate, 
 

“There is no science to psychiatry only misappropriation. 
 
 
 
There is no science to psychiatry only pretended authority. 
 
 
 
There is no science to psychiatry only betrayal. 
 
 
There is no science to psychiatry only graft.” 

 
 
There are other words that appear there.  These include, 
 
 
 
“There is no science to psychiatry only abuse. 
 
 
 
There is no science to psychiatry only greed.” 
 

Can I hand up the original so that the Committee can see those words that appear in the 
 
black box.  I do not invite them to do so now unless they wish to.  (Same handed
 
 
 
THE CHAIRMAN:  I think this is the same. 
 
 
 
MR MORRIS:  It is D16, but it is the original print out.  The final suggestion, and I only 
make it as a suggestion, or a piece of evidence that I would suggest points to the 

continuing ability of this organisation under its executive director to misrepresent people 
 
is to be found in two letters written by Mr Daniels dated 28 May 2001.  (Same handed
 
 
 
THE CHAIRMAN:  This will be D17. 
 
 
MR MORRIS:  These are two chasing letters to the Council asking what is happening in 
 
relation to the complaints that have been lodged by the Commission.  You will see on the 

left hand side various personnel, clearly part of the organisation of the Citizens 
 
Commission on Human Rights.  You will see there under “Politics and Law” in relation 
 
to both letters – I am not going to say this in public – the name of somebody who was 
 
sitting on your Committee until he stood down from the Committee on the first day.  I am 
 
not certain that those are one and the same person.  I have not been able to make inquiries 
yet as to that fact.  It certainly appears to be the same name.  I do not know whether the 

qualifications match. 
 
 
 
If it is the same name, and if that member of the Committee was correct in describing his 
 
relationship with the Scientologists, and I have absolutely no reason to doubt what he is 
 
saying is correct, then this appearance of his name representing him to be active within 
 
the Citizens Commission on Human Rights is wholly false and wholly misrepresentative 
of his real position.   

 
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For all those reasons, I suggest that head of charge 6 has arisen out of a cruel 
 
manipulation by the organisation of Mr Daniels in particular, of Mrs D in the 
 
promulgation of this complaint.  Unfortunately, it has been added by what I have to 
 
suggest is Mrs D’s own dishonest attempts before you to disguise the Commission and 
 
Mr Daniels’ role in the formulation of this complaint.  That is a matter which I suggest, if 
 
you accept as probably right on the balance of probabilities, is such that it falls into that 
category where it can be said that no right thinking person would approve of this 

Committee proceeding to inquire in relation to that complaint, given the fraudulent 
 
background to it. 
 
 
 
Those are my submissions on head of charge 6.  The question then arises, if you accept on 
 
the balance of probabilities that it would be an abuse to proceed to inquiry into that head 
 
of charge, what effect, if any, does that complaint have, or did it have on the decision to 
proceed with the other charges that were formulated in the letter of 1 October 2002?   

 
 
As I conceded last week, there was nothing explicit on the face of the documentation that 
 
was disclosed to me by the Council and the Council’s Solicitors to suggest any causal 
 
link between the decision to proceed with the matters which, on any view, had been 
 
dormant for a considerable period of time in October 2002.  What I do say is that a 
 
significant index of suspicion is raised by a number of factors.   
 

First, the delay of 21 months by the Council in responding to the inquiry made by the 
 
Medical Protection Society, Dr Cosgrove’s defence organisation, about the identity of 
 
Mrs D.  Secondly, a press release issued by the Commission before any decision had been 
 
taken by the Council to issue the rule 6 letter on 1 October 2002.  Thirdly, the breach of 
 
promise or denial of legitimate expectation that the complaints or informations either 
 
would not be proceeded with at all or would be dealt with under the performance 
procedures.  Fourthly, the refusal to give relevant disclosure by the Council. 

 
 
Can I turn to those in turn?  First, the delay of 21 months in the Council responding to the 
 
inquiry.  You should have the inquiry and the response.  (Same handed).  The first is a 
 
letter of 25 January 2001. 
 
 
THE CHAIRMAN:  Shall we make that D18 and the second one D19? 
 
 

MR MORRIS:  The first letter was addressed by Dr Gerard Panting of the MPS to the 
 
Council on 25 January 2001.   
 
 
 
“You may remember I telephoned you about this case in the middle of 
 
December.” 
 

That would be December 2000. 
 
 
 
“The concern here is that the complainant is not who she purports to be. 
 
 
 
During our telephone conversation you said you would discuss this internally with 
 
the caseworker involved and revert to me. 
 

Dr Cosgrove has had a further communication with the caseworker and has also 
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spoken to her over the telephone.   
 
 
 
The concerns in this case are real in that the signature of the complainant does not 
 
match the signature in previous correspondence and the spelling of the surname 
 
has also changed. 
 
 
Dr Cosgrove argues (in my view, reasonably) that it is essential that we are certain 

of the identity of the complainant to avoid inadvertent disclosure of this 
 
information. 
 
 
 
I look forward to hearing from you in due course.” 
 
 
 
The reply was not given to that until after the issue of the Rule 6 letter in October 2002 – 
9 October 2002, in which a different case worker says: 

 
 
 
“You refer to a letter which you sent to Mr Phillips’ predecessor on 25 January   
 
 
2002.”   
 
 
 
That, I suggest, is a mistake and it was a reference to the letter of 25 January 2001. 
 
 
“I am sorry that due to an oversight we did not respond to your queries about the 

identify of Mrs D.  It appears that our enquiries in relation to this were not 
 
communicated to you.  I now enclose for your information a copy of a letter from 
 
Mrs D enclosing a copy of her driving licence.  I enclose a further letter from Mrs 
 
D to us dated 11 December 2001.”   
 
 
 
Sir, I think you have those letters in your existing exhibits.  So, there was a 21 month 
delay by the Council in relation to what, on all accounts, was an important enquiry. 

 
 
Secondly, the press release, which was published issued by the Commission before the 
 
issue of the Rule 6 letter.   If I can hand that up.  (Produced)  Sir, perhaps the first in time 
 
should be the press release which is headed, “Psychiatrist under Scrutiny for Prescribing 
 
Practices.” 
 
 
THE CHAIRMAN:  We will make that D20 and the newspaper cutting D21. 

 
 
MR MORRIS:  The press release is what formed the basis of the article in the Bath 
 
Chronicle dated Friday September 20 2002.  You will recall that was before the date 
 
when the Council’s solicitors formally wrote to the Registrar on 26 September and before 
 
the Rule 6 letter dated 1 October 2002.  The press release from the Commission displays 
a remarkable knowledge about the state of affairs at the Council in relation to Dr 

Cosgrove, which goes beyond their own complaint: 
 
 
 
“A batch of complaints on Bath-based psychiatrist Patrick Cosgrove may soon be 
 
the subject of a General Medical Council (GMC) inquiry into his practice.  
 
Complaints from all quarters of the medical profession, as well as patients, have 
 
been lodged with the GMC about Dr Cosgrove, who runs his private practice from 
the Bristol Priority Clinic, Bath.  Both his conduct and his performance have come 

under scrutiny and the case is currently at the screening stage with the GMC.” 
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That found its way into print in the Bath Chronicle: 
 
 
 
“A psychiatrist whose work with children has been criticised could face an investigation.  
 
 
 
The Citizens Commission on Human Rights (CCHR) claims complaints about Dr 
Patrick Cosgrove’s conduct and performance have been lodged with the General 

Medical Council” 
 
 
 
and the article goes on. 
 
 
 
The third pointer which raises the index of suspicion as to the effect of Head of Charge 6 
 
is what I have already outlined, I suggest, as a breach of promise or the denial of a 
legitimate expectation as to the way various complaints were going to be dealt with by 

the Council.  Either there was a legitimate expectation that they would not be proceeded 
 
with at all or, there was a promise that they would be dealt with under the Performance 
 
procedures. 
 
 
 
I am going to take you now through what information I have available to me for setting 
 
out the basis on which I make those submissions.  I need to hand you, please, a bundle of 
documentation.  (Produced

 
 
THE CHAIRMAN:  This is D22. 
 
 
 
MR MORRIS:  I think it would be most appropriate and it would make sense – or help to 
 
make sense, perhaps of my submissions – if I just took you through this documentation 
 
and why I say it is relevant. 
 

The first letter – and I hope it goes in chronological order – dated 2 May 2001, is 
 
addressed to Dr Cosgrove and comes from the Fitness to Practise Department and relates 
 
to the complaint that was received from Dr Chubb.  We are dealing here with Head of 
 
Charge 9, which formulates the allegations based on that complaint in that paragraph and 
 
relates to a letter sent by the doctor on 17 November 2000.  It tells Dr Cosgrove what has 
happened: 
 
 

“My colleague wrote to you on 12 February 2001 informing you about a 
 
complaint we received about you from Dr Helen Chubb, Cardiff and Vale NHS 
 
Trust. 
 
 
 
Your complaint has been considered by both a medical and non-medical member 
of the GMC.  They are appointed to decide whether the GMC should take forward 

complaints about the conduct and performance of doctors.  This letter conveys 
 
their decision. 
 
 
 
The members were concerned about the allegations made against you and have 
 
therefore made a decision to refer this matter for consideration under our 
 
performance procedures. 
 

The file on this complaint has now been transferred to the performance team and 
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you will hear from them in due course.” 
 
 
 
Over the page a letter later on that month relating to a complaint received from 
 
Pembrokeshire and Derwen NHS Trust.  That relates to patient B at Head of Charge 3. 
 
 
 
MR PEARCE:  May I interject.  I am sorry to interrupt.  I am not at all clear this is being 
suggested that this is those matters contained in that charge.  If that is about to be 

suggested, I do not think that that is correct.  I just make that point in advance of the 
 
submission. 
 
 
 
MR MORRIS:  I need time to check that, if that suggestion has been raised.  Sir, I think it 
 
is important I get that right and I would not wish to proceed if that is wrong, obviously, in 
 
relation to that particular matter.  I am not sure when you were considering taking a break 
this morning.  I wonder if this might be an appropriate time. 

 
 
THE CHAIRMAN:  I suspect you still have quite a bit to go so that I think this might 
 
very well be a convenient time to have a break and we will reconvene around 11.15. 
 
 
 
The Committee adjourned for a short time 
 
 
MR MORRIS:  Sir, I have spoken with Mr Pearce and I think he accepts now that the 

letter written by the Council on 24 May 2001 in relation to a complaint made by the 
 
Pembrokeshire and Derwen NHS Trust, is the same complaint that features in Head of 
 
Charge 3, which deals with the letter written by Dr Cosgrove on 3 December 1999 to the 
 
patient’s GP, with a copy to Dr Al-Shabnder and the remarks made about Dr Al-Shabnder 
 
in that letter. 
 
 
MR PEARCE:  Yes, sir.  

 
 
MR MORRIS:  Again, this was as letter of 24 May that conveyed the decision of the two 
 
screeners, the medical and non-medical.  It sets out their powers and then says: 
 
 
 
“In this case the members do not consider that the information received 
from Pembrokeshire & Derwen NHS Trust warrants further consideration 
 
under the conduct procedures.  However, they remain concerned about the 

number of complaints they have received about your conduct.  In view of 
 
this they have decided to review this matter for further consideration under 
 
the GMC performance procedures. 
 
 
 
This file will be passed to our performance section who will be in contact 
in due course.” 

 
 
That was May 2001 and we then skip a long period of time and there is incomplete 
 
documentation here in my submission to tell the whole story.  We skip to a memorandum 
 
written by Dr Malcolm Lewis, a medical screener, dated either 24 or 29 February 2002.  
 
 
 
It is headed “This is a screening memo that can be copied into the following four cases 
against Dr Cosgrove.”  It should follow on the letter of 24 May.   

 
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“I have considered the following cases of complaint against Dr 
 
Cosgrove” 
 
 
 
and then various file references are set out there.  
 
 
 
“1. 
It is my view that the nature of these complaints in the 
circumstances of Dr Cosgrove’s practice could not amount to seriously 

deficient performance.  There is a pattern of poor practice but the issues 
 
relating to prescribing would be impossible to prove either way. 
 
 
 
2. 
In particular I feel the most important practice on which this case 
 
must proceed relate to issues of potentially serious professional 
 
misconduct in view of two repeated themes in the various cases.  I have 
highlighted these with purple tabs in most of the files. 

 
 
3.  
The Citizens Commission under Human Rights v P Cosgrove 
 
200/1711.  There is a complaint of inadequate monitoring with lack of a 
 
developed protocol and lack of evidence of shared care and advice to any 
 
general practitioners. 
 
 
4. 
2000/2124 (as above also relates to Master D) 

 
 
5. 
Dr Kurnar v Dr Cosgrove – 2000/0040.  This represents the 
 
second theme developed from the complaints, that is of inappropriate or 
 
disparaging remarks regarding medical colleagues.  There is also a lack 
 
of evidence of any advice or agreement of monitoring of this child 
 
through a shared care protocol. These matters would raise issues of 
potential SPM” 

 
 
Can I say at this stage, sir, I think it will appear in later correspondence that that case was 
 
closed and no action taken against Dr Cosgrove on it. 
 
 
 
“6. 
Pembrokeshire Trust v Cosgrove – 2000/0871.  Issues raised 
suggest inappropriate comments, disparagement raising issues of 
 
potential SPM. 

 
 
7.  
In this case the doctor has been previously informed that this case 
 
would not proceed under the conduct procedures.  However, cases that 
 
have come to light since would enable this case to be resurrected under 
 
the appropriate clause.” 
 

Sir, that is a refrain that you will see further in further documentation.  May I say at the 
 
very outset that in my submission there is no evidence disclosed here or available to the 
 
defence to suggest that there were subsequent cases to the decision to refer to 
 
performance, which was communicated in May 2001.  There was nothing that post-dated 
 
that that could have caused or given good grounds for re-visiting that decision as was 
 
done by this screener in February 2002 or, indeed, subsequent to his letter of February 
2002 and running up through to 1 October 2002 when the Rule 6 letter was issued. 

 
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“8. 
Cardiff and Vale NHS Trust v Cosgrove – 2000/3359.  No advice 
 
regarding monitoring or shared are protocols with a general practitioner, 
 
potential SPM.   
 
 
 
9.  
Moses v Cosgrove – 2000/1390.  I think this may be the same one 
 
as the Pembrokeshire and Derwen Trust.  There are tabs in the page and 
what I would like to say is breach of professional confidence, the letter 

from Dr Moses to Dr Cosgrove was primarily about Dr Cosgrove and not 
 
his patient.  It should have been afforded the confidentiality that Dr 
 
Moses clearly requested in her headed paper.  Also disparagement, there 
 
is a general suggestion that a sub standard level of care was being 
 
delivered at the NHS Trust and finally no advice or instruction regarding 
 
appropriate monitoring by the GP responsible for prescribing, that is no 
shared care protocol. 

 
 
10. 
1997/1376.  Quite a big file, I have stuck a tab in it behind tab 11 
 
which was an original draft Rule 6 letter which came to nothing in the 
 
end.  I think we conceded to his rebuttal by the look of it.” 
 
 
 
This, sir, I think it would be agreed is dealing with Head of charge 2, Patient A. 
 

“Anyway, I think under head 3” 
 
 
 
 - that is presumably clearly a reference to the draft Rule 6 letter – 
 
 
 
“if you add…” 
 
 
and various additions are suggested. 

 
 
That was the screener’s view on February 2002.  It came after earlier screening of the 
 
complaints by another medical screener and a lay member. 
 
 
 
Running through what was disclosed chronologically, we then turn to a memorandum – 
an internal GMC memorandum dated 28 May 2002, between staff at the Council.  I am 
 
not quite sure of their status but they must be case workers or more senior, in my 

submission. 
 
 
 
Dr Moses’ complaint against Dr Cosgrove, you asked for a brief 
 
summary.  I am providing only a brief summary at this stage as it is one 
 
of six current cases involving Dr Cosgrove which I have recently 
inherited.  I am also aware of an imminent joint referral by a Health 

Authority in Wales and the Home office Drugs Inspectorate. 
 
 
 
Background 
 
 
 
In recent years we have received a number of complaints and concerns about Dr 
 
Cosgrove’s activities.  He is a private doctor who specialises in treating children 
diagnosed as suffering from Attention Deficit Hyperactivity”, and goes on to give a 

background of the sort of complaints being made about him: 
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"3.  Dr Cosgrove has robustly defended all complaints 
 
against him, often with the support of parents who consider 
 
that their children have benefited from treatment with 
 
Ritalin.  In the past screeners have concluded that Dr 
 
Cosgrove has acted on the fringes of acceptable practice 
and complaints against him have been closed. 

  
 
However in January 2001 a screener referred a number of 
 
complaints and referrals to the Performance Procedures. Dr 
 
Cosgrove was informed of this decision. 
 
  
 
In February 2002 a number of the cases were re-screened 
by a different screener.  He decided that they should be 

dealt with under the Conduct procedures.  The screener 
 
identified ..." (and that is clearly a reference to Dr Malcolm 
 
Lewis' memorandum) "... two main potential SPM themes 
 
as being the lack of a developed protocol or proper 
 
consultation with other practitioners when treating patients 
 
and making inappropriate and disparaging remarks about 
medical colleagues.  (As I understand it, Dr Cosgrove has 

not been told about this change of decision)", 
 
  
 
and it then goes on to deal with Dr Moses' complaints: 
 
  
 
"Next steps 
 
   
9.  The Cosgrove case is both complex and sensitive.  I 

need to assess all cases to see if they have been dealt with 
 
according to our procedures and to seek legal advice about 
 
the latest screening decision.  I will also need to deal with 
 
the impending referral from Wales which I understand will 
 
include allegations of irresponsible prescribing and may 
include the strongest evidence to date of possible serious 
 
professional misconduct on the part of Dr Cosgrove". 

  
 
Sir, may I just say at that stage - and I shall be corrected if I am wrong - that again my 
 
submission is that there is no evidence that there was a referral from Wales subsequent to 
 
the decision to go down the Performance route and prior to the issue of the Rule 6 letter 
 
on 1 October 2002. 
  

There is then a memorandum from the same staff member, Ann O'Sullivan, to Peter Steel 
 
a solicitor to the General Medical Council: 
 
  
 
"I am referring to you 10 open cases against Dr Cosgrove 
 
for legal advice on a couple of points and a request that you 
 
consider draft charges for the screener to consider for 
referral to PPC. 

  
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Background 
 
  
 
 Please refer to the briefing note I prepared for Christine 
 
Couchman ..." (I think that is the previous memorandum) 
 
"... which provides a very brief summary of the background 
 
to these cases and the issues we need ... I have also 
prepared a table which summarises the stage we have 

reached with each case (flag B)". 
 
  
 
And if you look on, sir, you will see that table set out under the heading "Cosgrove open 
 
cases list" - two pages of table.  We will come to that in due course, but the memorandum 
 
continues: 
 
  
"As my note to Christine explains and the table shows, a 

screening decision was made that the concerns about Dr 
 
Cosgrove should be dealt with under the Performance 
 
Procedures.  This decision was communicated to Dr 
 
Cosgrove in May last year, although no further action was 
 
taken and, as far as I can see, there has been no further 
 
communication with Dr Cosgrove on this. 
  

However, since then, the cases have been reviewed by 
 
another medical screener who considered that the cases 
 
raised issues of SPM and not SDP.  There is no memo. to 
 
the Screener and I understand that Dr Lewis came into the 
 
office to review the files. 
 
  
I now wish to refer the cases formally to a screener with 

draft charges for referral to the PPC.  Before doing so 
 
however, I should be grateful for your view on whether 
 
there will be any  difficulties with changing track on how 
 
we propose to deal with the cases.  In my view we can 
 
argue that the complexion of the case has changed since 
further information has been received from the police - 
 
information which suggests irresponsible prescribing.  This 

information was received very recently and has not yet been 
 
seen by a screener". 
 
  
 
Again, in my submission, there is no evidence of that that postdates the re-screening or 
 
predates the re-screening by Dr Lewis, or indeed postdates his re-screening in February 
2002 and before the Rule 6 letter of 1 October 2002. 

  
 
And then we have the open cases list, which I will come to if I may when I deal with each 
 
of the Heads of Charges that are before you and indeed were listed in the Rule 6 letter. 
 
  
 
If we go on then to the response from Mr Steel, 30 August 2002, to Peter Lynn of the 
 
GMC re Dr Cosgrove: 
  

"Thank you for your instructions to advise on these 
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complicated and long-running matters.  We have of course 
 
spoken about them but here is a short summary with my 
 
advice; 
 
  
 
1. Performance/Conduct? 
 
  
It appears that the files were reviewed by Malcolm Lewis 

27 February 2002 who screened them all down the Conduct 
 
route (I see  his note of even date) despite the fact that some 
 
had already been screened down the Performance route and 
 
Dr Cosgrove had been informed that this was the case.  I 
 
have discussed this with Paul who is of the view that on 
 
policy grounds alone we cannot go behind this decision, 
regardless of whether it was correct in law to do so.  It may 

in fact have been legitimate for the screener to say that in 
 
the light of the further complaints this case was better dealt 
 
with down the Conduct route, but that is perhaps an 
 
academic debate", 
 
  
 
a view I do not share on behalf of Dr Cosgrove: 
  

"I enclose the draft charge, which is the best I can do with 
 
the information available.  I have drafted this in the second 
 
person - you may wish to change it...", etc. 
 
  
 
And the final document, 16 August -- no, I am sorry.  I have got out of sync. 
 
chronologically.  This should come before the 30 August memo. and I apologise.  It is 
again from the solicitor to Peter Lynn: 

  
 
"I think you discussed this doctor Ann O'Sullivan, who 
 
went off on sick leave earlier this week", 
 
  
 
and reference is made to the memo. to Christine Couchman dated 28 May.  I think that 
was one of the earlier memoranda.  Yes, it was one of the earlier memoranda.  It then 
 
refers to the table: 

   
 
"Ann's table had seven cases on it, but there are three 
 
additional cases ... The later two are complaints received 
 
from Dr Cosgrove.  I am sorry that Ann went off on sick 
 
leave before completing the table and finalising her memo.  
However, I hope there is here enough for you to form a 

preliminary view.  I am sorry to burden you with ten files 
 
..." 
 
  
 
Paragraph 4: 
 
  
 
"For my part, I would suggest the suggestion by Ann that 
although there was an initial screening decision to refer 

some matters into performance, it should be open to the 
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Council to decide that the complexion of the case has 
 
changed because of further information, outlining serious 
 
issues, that has continued to arrive. 
 
  
 
I should add that although Ann mentioned PPC in her 
 
Paragraph 6, we should not exclude performance action, 
depending on your advice, and a further consultation with 

Dr Lewis.  However, he clearly felt that this case was now 
 
in the realms of misconduct rather than deficient 
 
performance". 
 
  
 
And again, sir, I submit, or I say, that in relation to the suggestion about "... further 
 
information outlining serious issues..." there has been nothing disclosed to the Defence 
and there is nothing that appears in the Rule 6 letter that suggests  that any information - 

further information - about Dr Cosgrove arrived subsequent to the decision to send this 
 
case down the Performance route. 
 
  
 
THE CHAIRMAN:   I am sorry, did you say the Conduct route? 
 
  
 
MR MORRIS:   No, the first decision taken to send it down the Performance route. 
  

THE CHAIRMAN:   Oh, I am sorry.  Yes, I follow what you are saying.  Thank you. 
 
  
 
MR MORRIS:   Can I turn then to the Heads of Charge that you have before you, sir, and 
 
the first one Head of Charge 2 dealing with Patient A.  It might help if you have the table 
 
- the "Cosgrove open cases list" table - open and available to you. 
 
  
This is the patient who was being cared for at one time by Dr Holme and he is the 

Complainant in relation to that case. Dr Holme, Salisbury Healthcare NHS Trust, and you 
 
will see that in the first box for 1997.  And you have got there, taking you across the top, 
 
the identification of the Complainant, or the referrer.  Well, it is the case reference first of 
 
all and then the Complainant or referrer.  It is then the date the case was opened, which 
 
would appear in each case to be very shortly after receiving the written complaint; then 
the nature of the case; whether the complaint had been disclosed to the doctor; the  
 
decision and the date when the decision was taken first by the Medical Screener and 

secondly by the Lay Screener and whether or not the Lay Screener agreed with the 
 
Medical Screener and the date of the Lay Screener's decision; whether or not then, in the 
 
next column, the decision was notified to the doctor and the date upon which it was 
 
notified; and then a final column "Rescreened as conduct?  Any other comments?" 
 
  
In relation to that first complaint then, Head of Charge 2, Patient A, Dr Holme, there are 

two entries in that box under the same case reference "1376" - "04" and "06" - and there 
 
is a reference to "HO", presumably Home Office, Drugs Inspectorate. That was a case 
 
opened on 1 October 1998, although it appears that the information was received on the 
 
22nd -- 22 July 1999 in my submission relates to the date of the Complainant's letter - Dr 
 
Holme's letter. 
 
  
The Home Office Drugs Inspectorate referral is, in my submission, a case that was closed 

and no action has been taken against the Doctor.  It certainly did not appear in the Rule 6 
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letter and it does not appear in the charges before you.  And, importantly, in any event it 
 
predates the decisions of the first Screener which were taken towards the end of 2000 and 
 
the beginning of 2001 in relation to all the other complaints. 
 
  
 
In relation to the Dr Holme complaint, though, at Paragraph 2 in that box, dealing with 
 
the chronology of it, the complaint was  received from Dr Holme on 22 July 1999.  
Professor Taylor, you will see in the final box where it is mentioned that, "There is an 

expert report by Professor Taylor re matters raised at /04 and  /06".  Professor Taylor's 
 
report I can tell the Committee is dated 22 October 1999 and Dr Cosgrove was informed 
 
of the existence of the complaint from Dr Holme on 18 November 1999 and you can see 
 
that in the relevant column. 
 
  
 
Dr Cosgrove responded to that complaint on 6 December 1999.  It does not appear in the 
table there, but it is clear on documents disclosed earlier that there was such a response or 

rebuttal. And, sir, that is a reference to -- that is referred to in Dr Lewis' memorandum 
 
about this Head of Charge or complaint. 
 
  
 
You can see at Paragraph 10 of his memorandum the reference "197/1376", which is the 
 
reference we are dealing with now, where he said: 
 
  
"There was an original draft Rule 6 letter which came to 

nothing in the end.  I think we conceded to his rebuttal by 
 
the look of it", 
 
  
 
and that in my submission is a reference to Dr Cosgrove's rebuttal, but then he makes 
 
proposals for amending that draft Rule 6 letter. 
 
  
Now in relation to this complaint, although the Doctor was  informed about it on 18th 

November 1999, he received no formal response from the Council until the Rule 6 letter 
 
of 1 October 2002; nearly three years from the date when Dr Cosgrove was informed of 
 
the existence of the complaint. 
 
  
 
The Medical Screener's decision of 16 August 2000 and 31st August 2000 has not been 
disclosed despite a request by the Defence.  In my submission, that would be a relevant 
 
disclosure and it might cast light on what happened to the case and why it came to 

nothing and no action was taken until the Rule 6 letter. 
 
  
 
But this case falls in my submission into the category -- and perhaps I should have 
 
prefaced my remarks by saying there are two categories of case here, in my submission.  
 
Those where the Doctor was given a legitimate expectation, or is entitled to a legitimate 
expectation, that the cases would not be proceeded with, and the second category is those 

where he was given a promise that they would be dealt with under the Performance 
 
procedures. 
 
  
 
I say that that legitimate expectation arose, sir, and it arose for the reason that he was told 
 
nothing and was given no information as to what had happened to that complaint during 
 
the three-year period that elapsed from being told about the existence of that complaint to 
the Rule 6 letter on 1 October 2002. 

  
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 The second Head of Charge that comes into that category is in fact Head of Charge 6, 
 
Patient D.  You will see that on the open cases list at the bottom of the first page under 
 
reference  "2000/1711 Complainant Citizens Commission on Human Rights", and that 
 
runs over.  I think it should read "about" and then there are two names there, one of which 
 
is Mrs D. 
 
  
The first complaint that was made by the Commission was dated 28 June, sir, and you in 

fact now have that at D12.                                   
 
 
 
There was a further complaint dated 2 October 2000 which I do not believe you have.  
 
(Pause)  Sir, I can tell you that if you do not have documentation about I do not propose 
 
to give it to you, but it was a complaint about a report in a newspaper in which Dr 
 
Cosgrove is reported as describing his use of the drug Ritalin. That was complained about 
to the Council.  I can tell the Council (sic) did not feature in the rule 6 letter and it does 

not feature in the complaint under head of charge 6.  Again, importantly, it predates the 
 
first screener’s view of cases in 2001 or late 2000. 
 
 
 
Although it is stated that it is not clear whether Dr Cosgrove was made aware of those 
 
complaints, he clearly was made aware of those complaints, because we have the letter 
 
written by Dr Gerard Panting of the MPS at D18 on 25 January 2001, where he mentions 
talking to the GMC in the middle of December, so some time before December 2000 we 

know that the doctor was made aware of that complaint.   
 
 
 
Thereafter, nothing was communicated formally to Dr Cosgrove until the rule 6 letter of 1 
 
October 2002, in other words for at least 21 months, during which time there was 
 
complete failure to respond to Dr Panting’s letter of January 2001.  Again, in my 
 
submission, that lapse of time gave rise to a legitimate expectation in the mind of Dr 
Cosgrove that nothing further would be done in terms of GMC action in relation to that 

case.   
 
 
 
Finally, in this category is head of charge 4, patient C, which is information sent by Dr 
 
Moses.  You will see that on the second page of the table under the reference 2000/1390, 
 
Dr Moses of Gwent Health Care NHS Trust.  Information was sent by her, I can tell the 
Committee, in a letter dated 2 August 1999, although it appears that the case was not 
 
opened until 6 June 2000.  The nature of the complaint is set out in the next column.  Y 

indicates that the doctor was informed about the complaint on 9 August 2000.  The 
 
medical screener’s decision was made on 19 January 2001 and was that the case – and in 
 
my submission the letters SDP must stand for seriously deficient performance – was a 
 
decision, one can infer, that the case should be referred to the performance procedures of 
 
the GMC.  That was ratified by the lay screener on 1 February 2001.  The defence have 
asked for and have been refused access to those screener’s memoranda. 

 
 
Significantly, though, it appears that the doctor was not informed about that decision.  
 
You see the “no” in the next column, and so again this is a case where, having been told 
 
about the complaint’s existence on 9 August 2000, the doctor heard nothing more until 1 
 
October 2002, that is two years and two months later when he received the rule 6 letter.  
 
Again, in my submission, because of that period of time a legitimate expectation arose in 
Dr Cosgrove’s mind that he would not be proceeded with, because of the absence of any 

information about that matter.   
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That is the first category.  The second category is where the doctor was specifically told 
 
that these matters were going to be dealt with under the performance procedures.  The 
 
first of those is head of charge 3, which is the letter about Dr Al-Shabner.  It is the 
 
Pembrokeshire and Derwen NHS Trust.  You will see it on the first page of the table 
 
under reference 2000/0871.  The complaint letter is dated, I can tell the Committee, 23 
March 2000, although the case is opened on 1 April.  The nature of the letter is made 

clear.  It was disclosed to the doctor on 7 August 2000.  The medical screener saw it on 8 
 
November 2000 and determined that it should be referred to performance.  That was 
 
ratified by the lay member on 29 January 2001.  That decision was disclosed to the doctor 
 
on 24 May 2001 and you see that second letter in your bundle at D22, where it is said that 
 
the members, that is the two screeners, do not consider the information received from the 
 
Trust warrants further consideration under the conduct procedures.  They have decided to 
refer the matter for further consideration under the GMC performance procedures.  

Again, those original screeners’ memoranda of November 2000 and January 2001 had 
 
been requested, but their disclosure has not been granted to the defence.   
 
 
 
In my submission, therefore, that letter sets up not only a legitimate expectation that the 
 
matter would be dealt with under the performance procedures.  It effectively amounted to 
 
a promise that that was what would happen to that complaint.   
 

The next head of charge is 7, which is patient E.  That is the Oxfordshire Mental Health 
 
Care NHS Trust.  The complainant was Miss Wendy Samways.  You will see the 
 
reference to that in the open cases table at 2000/3017, three down on the first page.  The 
 
complaint letter itself is dated 23 October 2000.  The case was opened on 3 November 
 
2000.  The nature of the complaint is made clear.  It went to the medical screener on 24 
 
May 20001.  I am sorry. It was disclosed to Dr Cosgrove on that date.  It had been before 
the medical screener on 15 February 2001, who had decided that it should go down the 

performance route.  That was ratified by the lay screener on 26 February.   
 
 
 
The doctor was notified about that on 24 May.  That is the first letter.  No, it is not.  You 
 
do not have the letter notifying the doctor about that.  Unfortunately, the doctor does not 
 
still have it in his possession.  I have asked for disclosure of that.  I do not think there is 
any objection taken by the Council for disclosure of that letter, but it does not appear to 
 
have been found as yet.  Clearly, according to this memorandum and this table, the doctor 

was told about the decision that his case or the complaint from Oxfordshire Mental 
 
Health Care Trust should go down the performance route. 
 
 
 
Finally, head of charge 9, patient F.  This is Cardiff and Vale NHS Trust.  That you see 
 
on the second page of the table under the reference 2000/33.  The complaint from Dr 
Chubb was dated 28 November 2000.  The case was opened on 12 December.  The nature 

of the complaint is set out there.  It was disclosed to the doctor on 12 February 2001.  
 
Again, it was screened on 23 March 2001.  The decision was taken to go down the 
 
performance route.  It does not appear to have been or there is no evidence that it was 
 
referred to or seen by a lay screener, although it must have been so done, in my 
 
submission, before a letter was sent out on 2 May 2001 telling the doctor of the decision.  
 
We can see that letter.  It is the first document in that bundle.  It states, 
 

“Your complaint has been considered by both the medical and non-medical 
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member of the GMC.” 
 
 
 
If that letter is correct, that entry in the box “no” under lay screener seems to be an error.  
 
The decision of the two screeners was, 
 
 
 
“They were concerned about the allegations made against you and therefore made 
a decision to refer to this matter for consideration under our performance 

procedures.” 
 
 
 
In very lengthy exposition those are the matters that come under the third category of 
 
matters that raise the index of suspicion as to the possible effect of head of charge 6, if 
 
you find that was probably a fraudulently promulgated charge.   
 
 
The fourth heading whereby the index of suspicion has been raised is the lack of 

disclosure.  The Council, as from Friday afternoon, are now declining to give any 
 
disclosure in relation to matters about which help or assistance was sought by the 
 
defence, in particular, in relation to the original screener’s decision memoranda, both 
 
medical and lay, where on the one hand we have disclosed to us the subsequent screener’s 
 
decision, Dr Malcolm Lewis, but we are deprived of the original decisions suggesting that 
 
this case was a performance case and making that decision. 
 

We have not been given any disclosure as to what happened once these cases went to 
 
performance.  We have not been given any disclosure as to the circumstances that led to 
 
and the reasons for these matters being re-screened by Dr Lewis in February 2002.  Those 
 
matters that were re-screened were patient B, patient C, patient E and patient F.   
 
 
 
That material, in my submission, would be highly relevant and may well assist the 
defence and undermine the Council in promulgating this abuse of process argument, both 

in relation to the effect of head of charge 6 and also in relation to the separate free 
 
standing submission that there has been a breach of promise or a thwarting of legitimate 
 
expectation as a separate head of abuse, apart from the fact that it would also, in my 
 
submission, be relevant material in terms of dealing with the substance, if we get to that 
 
stage, of the particular cases and allegations made, because obviously if a screener has 
taken the view and given reasons as to why these matters should not come under the 
 
heading of conduct, those reasons might well give avenues for the doctor to explore with 

his legal team, which currently they do not know. 
 
 
 
Those are the indices of suspicion which are raised on the material that you now have 
 
before you and the defence now have as to whether or not Head of Charge 6, if 
 
improperly brought, has had a knock-on effect in relation to the other Heads of Charge. 
 

In my submission those indices can help you to come to the conclusion on the balance of 
 
probabilities that they have corrupted those remaining Heads of Charges and that those 
 
remaining Heads of Charges, therefore, ought to be stayed as a result of those matters 
 
flowing from Head of Charge 6. 
 
 
 
Can I just deal with the last two complaints which post-dated the Rule 6 letter of 1 
October 2002 and those are Heads of Charge 10 and 11 dealing with patients G and H.  

Obviously I cannot submit that Head of Charge 6 had any effect on those two charges, 
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because obviously they post-date it.  What I do say, though, is that if as a result of Head 
 
of Charge 6 the earlier matters have all gone to conduct whereas otherwise they would 
 
have remained in performance and/or perhaps not been dealt with at all, then in my 
 
submission it is quite probable that these two further complaints when they came in 
 
would have been sent down that same route and not have been referred as conduct 
 
matters.  They are of a similar nature to the earlier six matters. 
 

Can I turn finally to the breach of promise point which, even if you do not accept that as 
 
one of the indices of suspicion does not help in relation to Head of Charge 6 and the 
 
effect that has on the remaining charges, even if you reject that, in my submission there is 
 
a free-standing abuse here in relation to breaches of promise and the thwarting of the 
 
legitimate expectation that I have set out to you. 
 
 
I need to justify that legally and I wonder if I can assist the Legal Assessor in that regard 

by taking him to paragraph 462 of Archbold.  I believe he has now got an up-to-date 
 
edition. 
 
 
 
The sub-heading here is, “Prosecution going back on promise” etc.  It comes as one of a 
 
number of headings under the major heading, under Abuse of Process at 448 it comes 
 
under the general heading of “Application of the Principles”, that is sub-paragraph D to 
be found at the top of page 336 in paragraph 457. 

 
 
THE LEGAL ASSESSOR:  In bold type “Misuse and Manipulation…” 
 
 
 
MR MORRIS:  Exactly.  It is one of the sub-headings under “Application of the 
 
Principles” and under “Misuse and Manipulation etc Process of Court and Unfairness”, 
 
we come to, “Prosecution going back on promise”.  What the editors say there is that: 
 

“The prosecution of a person who in exchange for his co-operation has 
 
received an undertaking, promise or representation from the police that 
 
he would not be charged with an offence, is capable of amounting to an 
 
abuse of process.  It is not necessary for the applicant to show that the 
 
police had the power to make the decision not to prosecute, nor is it 
necessary for him to show that the case was one of bad faith.” 
 
 

The leading case cited there is the one of R v Croydon Justices, ex parte Dean, a copy of 
 
which I think the Legal Assessor has.  That is a Divisional Court case of 1993.   Perhaps I 
 
can just read the headnote to that case and take you and the Committee – I think it would 
 
be unfair to the Committee if they did not have the case as well, so can I hand round 
 
copies of the case.  (Produced
 

THE CHAIRMAN:  That will be D23. 
 
 
 
MR MORRIS:  The facts are set out in the headnote: 
 
 
 
“The applicant, aged 17, and two other men, G and B, were arrested by 
 
the police in respect of a murder investigation. The applicant did not take 
part in the killing but after it had taken place he assisted in destroying the 

victim’s car.  When interviewed by the police he made statements 
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containing potentially important evidence against G.  The applicant 
 
agreed to be a prosecution witness and by the time he had left the police 
 
station he had in effect admitted doing acts with intent to impede the 
 
apprehension of G and B, but was not then charged.  The same evening, 
 
G and B were charged with murder.  Five days later the applicant again 
 
went to the police station where he admitted for the first time that G and 
B had driven him to the scene of the crime and shown him the victim’s 

body.  At the end of the interview he was informed that he was a 
 
prosecution witness and had the protection of the police.  He later went 
 
with the police to the scene of the crime and described how the victim’s 
 
car had been destroyed.  Thereafter, the Crown Prosecution Service 
 
decided, after a conference with the police, that the applicant should be 
 
charged under section 4(1) of the Criminal Law Act 1967 with assisting 
in the destruction of the victim’s car, knowing that it was evidence, with 

the intent to impede the apprehension or prosecution of G and B, 
 
knowing or believing that they were guilty of murder or some other 
 
arrestable offence.  Before he was charged, the applicant made further 
 
statements to the police identifying articles belonging to G and B which 
 
he had seen in the victim’s car.  He was then charged.  At the committal 
 
proceedings the justices rejected a submission that they should not act as 
examining justices to inquire into the offence on the ground that it would 

be an abuse of process and also refused to adjourn the proceedings 
 
pending an application to the High Court for a stay.  The applicant was 
 
committed for trial and applied for judicial review of the justices’ 
 
decision and the committal.  On the question whether judicial review 
 
proceedings were appropriate, and, if so, had there been an abuse of 
 
process” 
 

and there were rulings.  Can I take you to the second ruling, really, which concerns us, 
 
which is in relation to abuse of process.  Under the heading over the page: 
 
 
 
“(2) The prosecution of a person who had received a promise, 
 
undertaking or representation from the police that he would not be 
prosecuted was capable of being an abuse of process.  On the undisputed 
 
evidence in the instant case the applicant was given to understand for a 

considerable time that he was to be a prosecution witness, from which it 
 
almost certainly followed that he was not himself to be prosecuted for 
 
any offence in connection with the murder; but that undisputed evidence 
 
did not show that he received any express promise, undertaking or offer 
 
of immunity; nevertheless in the quite exceptional circumstances of the 
case, having regard to the applicant’s age at the time, the assistance he 

gave to the police for over five weeks, it was clearly an abuse of process 
 
for him to be prosecuted subsequently.  Accordingly, the application 
 
would be granted.” 
 
 
 
In the heart of the Judgment given by Lord Justice Staughton at page 82, under the 
 
heading Abuse of Process, he says half way down that passage: 
 

“We were referred to three cases which suggest that abuse of process in 
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this context can only exist where there is (i) delay, or (ii) manipulation or 
 
misuse of the rules of procedure” 
 
 
 
and authorities were cited there.  The Lord Justice went on to say: 
 
 
 
“But there is high authority that the concept is wider than that.   In 
Hunter v Chief Constable of the West Midlands Police [1982] Lord 

Diplock spoke of: 
 
 
 
‘the inherent power which any court of justice must possess to 
 
prevent misuse of its procedure in a way which, although not 
 
inconsistent with the literal application of its procedural rules, 
 
would nevertheless be manifestly unfair to a party to litigation 
before it, or would otherwise bring the administration of justice 

into disrepute among right-thinking people.  The circumstances in 
 
which abuse of process can arise are very varied…’ 
 
 
 
Then Lord Devlin in Connelly is cited: 
 
 
 
‘Are the courts to rely on the Executive to protect their process 
from abuse?  Have they not themselves an inescapable duty to 

secure fair treatment for those who come or are brought before 
 
them?  To questions of this sort there is only one possible 
 
answer.’ 
 
 
 
His final settled Judgment over the page at 83, just above the conclusion: 
 
 
“In my judgment the prosecution of a person who has received a promise, 

undertaking or representation from the police that he will not be 
 
prosecuted is capable of being an abuse of process.  Mr Collins was 
 
eventually disposed to concede as much provided (i) that the promisor 
 
had power to decide and, (ii) that the case was one of bad faith or 
 
something akin to that.  I do not accept that either of those requirements 
is essential.” 
 
 

In his conclusion he went to apply those principles to the facts of that particular 
 
case and decide that the proceedings would have to be quashed as an abuse. 
 
 
 
The editors of Archbold continue at 462: 
 
 
“Breach of a promise not to prosecute does not necessarily and ipso facto 

give rise to abuse but the longer that a person is left to believe that he will 
 
not be prosecuted” 
 
 
 
- and I rely on that –  
 
 
 
“the more unjust it becomes for the prosecution to renege on its promise 
that any manifest prejudice to him resulting from his co-operation will 

make it inherently unfair to proceed” 
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and there is a reference to R v Townsend 1997. In a Privy Council case, The 
 
Attorney General of Trinidad and Tobago v Phillip 1995, it was said that: 
 
 
 
“It could well be an abuse of process to seek to prosecute those who have 
 
relied on an offer or promise of a pardon and complied to the conditions 
subject to which that offer was made, even though the path was invalid.” 

 
 
They go on: 
 
 
 
“Where a defendant had received a letter constituting a ‘final decision not 
 
to prosecute’ in respect of an allegation of sexual offences against a ten-
 
year old boy, the reinstitution of proceedings many years later could not 
be justified by reference to the fact that a second boy had more recently 

made a complaint, nor by reference to the fact that the original decision 
 
had been taken in the light of the then rule of evidence requiring 
 
corroboration.  The prosecution should have been stayed as an abuse and 
 
the conviction was quashed as unsafe on account of the prejudice arising 
 
from the non-availability of various materials from the original 
 
investigation.” 
 

That is the case of R v D reported in Archbold News in the year 2000. 
 
 
 
There is then a case called R v Bloomfield – copies again I would like to give to 
 
the Committee.  
 
 
 
THE CHAIRMAN:  This will be D24.  (Produced
 

MR MORRIS:  If I can read you the headnote.  This is a Court of Appeal 
 
decision in 1996: 
 
 
 
“The defendant was charged with possession of a Class A controlled 
 
drug.  At a plea and directions hearing at the Crown Court prosecuting 
counsel indicated to defence counsel that the Crown wished to offer no 
 
evidence because it was accepted that the defendant had been the victim 

of a set-up.  Owing to the presence in court of certain people it would 
 
have been embarrassing to the police and prosecution if no evidence were 
 
offered that day so counsel spoke to the trial judge in his room.  An order 
 
was then made in open court to adjourn the case and relist it ‘for 
 
mention’.  The Crown Prosecution Service subsequently arranged a 
conference with new prosecuting counsel and thereafter informed the 

defence solicitors that the Crown intended to continue the prosecution.  
 
An application at the trial to stay the proceedings as an abuse of process 
 
having failed, the defendant pleaded guilty and was sentenced to three 
 
months’ imprisonment. On appeal against conviction on the question (1) 
 
whether it was an abuse of process for the Crown to revoke a previous 
 
decision, communicated to the defendant and the court, to offer no 
evidence and, if it could be an abuse of process, whether (2) it made any 

difference if prosecuting counsel had made that decision and 
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communicated it to the defendant and the court without authority.” 
 
 
 
The appeal was allowed: 
 
 
 
(1) that whether or not there was prejudice to the defendant, it would 
 
bring the administration of justice into disrepute to allow the Crown to 
revoke its original decision without any reason being given as to what 

was wrong with it, particularly as it was made coram judice in the 
 
presence of the judge; and  
 
 
 
(2) that neither the court nor the defendant could be expected to enquire 
 
whether the prosecuting counsel had authority to conduct a case in court 
 
in any particular way and they were therefore entitled to assume in 
ordinary circumstances that counsel did have such authority. 

 
 
On the final page of Lord Justice Staughton’s judgment he sets out his 
 
conclusions, page 143: 
 
 
 
“Looking at the case in the round, it seems to us that this is an unusual 
 
and special situation.  The decision to defer the trial on December 20 was 
taken for the benefit of the prosecution in order that they would not be 

embarrassed when it was said in court that no evidence was being 
 
offered.  The statement of the prosecution that they would offer no 
 
evidence at the next hearing was not merely a statement made to the 
 
defendant or to his legal representative.  It was made coram judice, in the 
 
presence of the judge.  It seems to us that whether or not there was a 
 
prejudice it would bring the administration of justice into disrepute if the 
Crown Prosecution Service were able to treat the court as if it were at its 

beck and call, free to tell it one day that it was not going to prosecute and 
 
another day that it was. 
 
 
 
Of course the circumstances of each case have to be looked at carefully, 
 
and many other factors considered.  As the Court said in the Mahdi 
decision, we are not seeking to establish any precedent or any general 
 
principle in regard to abuse of process.  We simply find that in the 

exceptional circumstances of this case an injustice was done to this 
 
appellant.  In those circumstances the appropriate course is to allow the 
 
appeal and quash this conviction.” 
 
 
 
Sir, in my submission those cases and the guidance given by the editors of 
Archbold are wholly appropriate to what has happened in this case. The analogy 

is valid, that you have here on the one hand a promise - a clear indication - that 
 
the cases are going to be dealt with by Performance, and on another you have 
 
through lapse of time - that in one case extended, I think, to three years - a 
 
legitimate expectation that nothing further was going to happen in relation to 
 
complaints made against the Doctor. 
 
  
There is no evidence certainly not disclosed to me, or the Defence, or in the Rule 6 letter, 

or in the Heads of Charge, that there was any other complaint or material that came to the 
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attention of the Council that might begin to justify the Council going back on its promise, 
 
or revoking the expectation that had been allowed to grow in Dr Cosgrove's mind.  For 
 
those reasons I submit that on its own, out with any concerns arising out of Head of 
 
Charge 6, certainly in relation to those cases covered by the breach of promise and the 
 
expectation or legitimate expectation, which is all the charges up until the Rule 6 letter 
 
but does not include the subsequent two charges -- in relation to those six charges in my 
submission it would be an abuse on this ground to allow those cases to proceed. 

  
 
The third freestanding ground upon which I submit abuse is in relation to the failure of 
 
the Council to make proper disclosure. I have outlined the sort of disclosure that one 
 
could expect and the documentation that one could expect.  It, in my submission, clearly 
 
or most probably exists.  One can divine that from the bundle of documentation that has 
 
been disclosed - D22. 
  

As to whether non-disclosure can amount to abuse, can I refer you to what I hope is a 
 
helpful passage and again there are copies for the Committee.  I hope there are enough to 
 
go round. 
 
  
 
THE CHAIRMAN:   This will be D25. 
 
  
(Copies of the document were distributed

  
 
MR MORRIS:   I think that the learned Legal Assessor should already have one. 
 
  
 
THE LEGAL ASSESSOR:   I have not got it with me, but I will give my copy back. 
 
  
 
MR MORRIS:   You have not got it with you, right.  Let us see how we go then. 
  

This is an extract from a textbook called "The Abuse of Process in Criminal 
 
Proceedings", by David Corker and David Young, and it is the second edition dated 2003. 
 
 I am not going to take you through all of this, but the opening paragraphs under 
 
"Non-disclosure Abuse" are informative: 
 
  
"It is trite law that an accused's right to fair disclosure is 
 
regarded as inseparable from his right to a fair trial.  An 

accused must be in a position to fairly advance his 
 
arguments by  way of fair disclosure of material in the 
 
Crown's possession.  In R -v- Togher the Court of Appeal 
 
held that where an accused's right to a fair trial was vitiated, 
 
for example because of non-disclosure, this would almost 
invariably result in the quashing of the conviction.  Woolf 

CJ held 'If they could establish an abuse, then this court 
 
would give very serious consideration to whether justice 
 
required the conviction to be set aside’. 
 
  
 
Recent developments have underlined that the right to 
 
disclosure is regarded as a fundamental condition or 
hallmark of fairness. The Attorney-General's Guidelines on 

the disclosure of information in criminal proceedings were 
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introduced in an attempt to improve the operation of the 
 
current statutory disclosure regime". 
 
  
 
Those guidelines, for the assistance of the Legal Assessor, are set out in the first 
 
supplement to the 2004 Edition of Archbold at Paragraph A/242. 
 
  
THE LEGAL ASSESSOR:   Thank you. 

  
 
MR MORRIS: 
 
  
 
"The opening paragraph declares: 
 
  
 
'Every accused person has a right to a fair trial, a right long 
embodied in our law and guarantee under article 6 of the 

European Convention on Human Rights.  A fair trial is the 
 
proper object and expectation of all participants in the trial 
 
process.  Fair disclosure to an accused is an inseparable part 
 
of a fair trial'. 
 
  
 
These laudable words are followed up in para 5 of the 
guidelines, with an unequivocal warning to investigators 

and disclosure officers namely: 
 
  
 
'A failure to take action leading to proper disclosure may 
 
result in a wrongful conviction.  It may alternatively lead to 
 
a successful abuse of process argument or an acquittal 
 
against the weight of evidence'", 
  

and it goes on to say why the guidelines were produced in that it was: 
 
  
 
"... in response to concerns about the operation of the 
 
disclosure provisions in the Criminal Procedure and 
 
Investigations Act 1996 ..." 
  
 
And then over the page, under "The CPIA 1996; prosecution failures to comply with the 

service of 'primary' and/or 'secondary' disclosure", I do not want to get into the technical 
 
detail of that but what is clear is that the prosecution are under a duty to disclose any 
 
material that might be reasonably expected to assist the accused's defence and you can see 
 
that in  the opening sentences of Paragraph 4.59.  That is particularly the case where the 
 
line of defence has been identified by the Defendant, sir, as Dr Cosgrove has done in this 
particular case: 

  
 
"Clearly those accused ..." (it goes on to say) "... who have 
 
set out their defences in interview, have served full defence 
 
case statements ... followed up by chasing letters to the 
 
prosecution in correspondence, are in the best position to 
 
maximise their disclosure opportunities". 
  

And then under the heading "Examples of non-disclosure giving rise to abuse", I will not 
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cite them all but the first one: 
 
  
 
"In R -v- Blackledge following pleas of guilty to breach of 
 
export controls concerning arms to Iraq, it transpired via the 
 
Scott Inquiry that exculpatory material had been withheld 
 
from the defence.  This material, whilst not affording a 
defence to the offence charged, would have enabled the 

accused to mount a probably unassailable abuse 
 
application; that the exports of weapons had been secretly 
 
approved or deliberately overlooked by the DTI.  The Court 
 
of Appeal promptly quashed the convictions of all accused 
 
on the grounds of non-disclosure". 
 
  
And if I can then take the Committee to the impact of the European Convention of 

Human Rights and Article 6, under 4.68 and 4.69 there is cited there a case of Kaufman 
 
-v- Belgium
 
  
 
"'everyone who is a party to ... proceedings should have a 
 
reasonable opportunity of presenting his case to the court 
 
under conditions which do not place him at a substantial 
disadvantage vis-à-vis his opponent'. 

  
 
In Jespers -v- Belgium the Commission stated that the now 
 
enshrined 'equality of arms' principle imposes on 
 
prosecution and investigating authorities an obligation to 
 
disclose any material in their possession.  The obligation is 
 
applicable to any material to which they could gain access 
which may assist the accused in exonerating himself.  The 

duty is said to be necessary to remedy the inequality of 
 
resources between the prosecution and defence, and the 
 
principle applies equally to material which might 
 
undermine the credibility of a prosecution witness". 
 
  
I ought for completion to go to 4.72: 
 
  

"Whilst the European Court of Human Rights has made it 
 
clear in the Edwards -v- United Kingdom decision, and in a 
 
string of subsequent cases, that article 6 generally requires 
 
the prosecution to disclose to the defence all material 
 
evidence for or against an accused, nevertheless, it is also 
clear that the entitlement to disclosure of relevant evidence 

is not an absolute right.  In Van Mechelen -v- Netherlands 
 
the court adopted a principle of 'strict necessity' in this 
 
regard; one which permits on necessity grounds some 
 
non-disclosure of otherwise disclosable material.  
 
Justifications which have been accepted as falling  within 
 
this include national security, the protection of vulnerable 
witnesses and the keeping secret of police methods of 

investigation.  Clearly this principle is analogous to our 
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domestic doctrine of public interest immunity.  So far as 
 
European Court of Human Rights is concerned, in Fitt -v- 
 
United Kingdom the court held that the ex parte system did 
 
not contravene the defendant's right to a fair trial", 
 
  
 
and I think that is a reference to whereby the prosecution go on its own to a judge to get 
permission not to disclose material. 

  
 
In my submission here, sir, there is nothing along those sorts of lines which would justify 
 
the Council in refusing to disclose the sort of material that has been sought from it on 
 
behalf of the Defence in the context of this abuse application.  No reason has been given 
 
except that, as I understand it, it is a wrong procedural route that I am embarking on, but 
 
that in my submission does not begin to give any defence for the non-disclosure of what 
may be relevant material. 

  
 
In my submission the non-disclosure here is serious, it is substantial and on those grounds 
 
alone a separate abuse exists which would justify on the balance of probabilities this 
 
Committee ordering a stay.  Again, I confine that submission in relation to the first six 
 
charges.  The last two charges would fall outside the bounds of that submission. 
 
  
And finally, sir, can I come to a last separate alternative submission which I flagged up 

on the first day of this hearing which is a submission in relation to Head of Charge 2 only. 
 
 This is the case you will recall in relation to Patient A, sir, in which the parents of the 
 
child patient concerned have expressly refused consent to the disclosure of their child's 
 
notes. 
 
  
 
The nature of the charge, as you can see, is a failure properly to monitor the patient once 
those prescriptions which are listed there had been made and that there was irresponsible 

monitoring in the way set out there. 
 
  
 
The nature of the defence to the charge as currently given by Dr Cosgrove, I hope my 
 
learned friend does not mind my putting in a document that he has kindly provided me 
 
with this morning. Well I am not sure I need put it in and I am not sure whether he 
intends to put it in, but it is a response to the Rule 6 letter, dated 13 November 2002, and 
 
it deals with the original Head of Charge that was communicated to the Doctor in the 

Rule 6 letter. I do not think it has been substantively altered between that and its 
 
appearance in the Notice of Inquiry before this Committee. 
 
  
 
It states that: 
 
  
"It is admitted that by May 1999 Dr Cosgrove prescribed 

Risperidone and clonidine to the Patient DB to be taken 
 
with 130 mgs of Ritalin daily", 
 
   
 
and it goes on to say: 
 
  
 
"Dr Cosgrove strenuously rejects any suggestion that his 
prescribing for the patient was irresponsible or 

inappropriate. Dr Cosgrove was in regular communication 
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with Dr Holmes, Consultant Community Paediatrician at 
 
Salisbury, who was doing the monitoring of DB on behalf 
 
of Dr Cosgrove who was consulting in Bristol.  The GP 
 
knew that Dr Holmes was monitoring DB". 
 
  
 
I think it would be fair to say that that version of events is challenged by Dr Holmes in 
the Witness Statement he has made in relation to this matter. 

  
 
My submission is that the Doctor is fatally hamstrung in not being able to refer and have 
 
access to the patient's notes in order to assist him in mounting that defence, because it 
 
would obviously be appropriate and helpful in asserting that he had properly monitored 
 
this patient to have access to, not only Dr Holmes' notes, but be allowed to deploy his 
 
own private notes and indeed to have access to the patient's General Practitioner Notes.  
That is a flaw which, if it is not subject to remedy, in my submission makes it unfair and 

again an abuse that the Committee should proceed to hear that particular case. 
 
  
 
I am sorry that I have been so long in developing those submissions, sir, but those are the 
 
submissions I make on behalf of Dr Cosgrove. 
 
  
 
                                         
THE LEGAL ASSESSOR:  Mr Morris, could I ask you a couple of questions that have 

arisen?  In the course of your submission on legitimate expectation you referred to the 
 
delays that had occurred. 
 
 
 
MR MORRIS:  Yes. 
 
 
 
THE LEGAL ASSESSOR:  Do you want to say anything to the Committee on Dr 
Cosgrove’s right under article 6 to have a trial in a reasonable period of time? 

 
 
MR MORRIS:  I am not advancing a submission that there is abuse arising out of delay.  
 
There has been delay here, but the criteria for establishing abuse purely as a result of 
 
delay are ones I do not seek to meet on behalf of Dr Cosgrove. 
 
 
One of the matters that needs to be established in order to cite delay as a reason for 
 
staying a hearing is that the doctor has thereby been prejudiced, and this is whether it 

comes under article 6 or the common law by virtue of the delay.  Clearly, there is an 
 
element of prejudice here for two reasons, firstly, the lapse of time and the failure of 
 
memory that that inevitably causes, but, secondly, and perhaps more importantly in the 
 
context of this case, is that there was delay between the time when he was either told that 
 
he was not going to be subject to disciplinary procedures in relation to three of the cases 
or between the arising of the legitimate expectation he was not going to be dealt with by 

way of disciplinary or any other proceedings, inasmuch as, once those promises had been 
 
made or that expectation had arisen, he was entitled, and did to some extent, to sit back 
 
and not to commence the preparation of any defence to any disciplinary charge. 
 
 
 
THE LEGAL ASSESSOR:  The other point is the burden of proof.  The burden is on you. 
 
 The standard of proof is the balance of probabilities? 
 

MR MORRIS:  Yes. 
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THE LEGAL ASSESSOR:  Can I make sure I have understood your argument on a 
 
particular point correctly?  As a free standing challenge you are saying, in relation to the 
 
counts where there has been an express communication saying that the count will be dealt 
 
with under the performance procedures, that it is an abuse of process to go back on that 
 
express communication. 
 

MR MORRIS:  Yes. 
 
 
 
THE LEGAL ASSESSOR:  Have I understood you correctly that that stands separately 
 
from the general abuse argument that you have mounted, that the breach of the letters 
 
which say that charges are going to be dealt with under the performance procedures go to 
 
show that the whole prosecution is an abuse? 
 

MR MORRIS:  Yes.  That is separate from those matters contributing to what I would 
 
call the index or indices of suspicion in relation to the effect of head of charge 6. 
 
 
 
THE LEGAL ASSESSOR:  I am just checking here, rather than making any assertion.  
 
This is the second category of breach of promise where there has been an express 
 
communication.  As I understand it, it is charge 9, charge 7 and charge 3. 
 

MR MORRIS:  In 3, 7 and 9 there were express promises that they would go to 
 
performance. 
 
 
 
THE CHAIRMAN:  These were the category 2 charges. 
 
 
 
MR MORRIS:  That is right, but equally in relation to my breach of promise argument is 
the other category where a legitimate expectation arose, in my submission.  Those are 

heads of charge 2, 6 and 4. 
 
 
 
THE LEGAL ASSESSOR:  Do you have any authority which relates directly to the GMC 
 
procedures?  I understand you have authorities which relate to the criminal jurisdiction.  
 
Do you have any authorities which relate to the specific jurisdiction? 
 
 
MR MORRIS:  No, I do not. 

 
 
THE LEGAL ASSESSOR:  Can I say that I cannot think of its name, but I am aware of 
 
an authority which says that the GMC, or I have read an authority whose name I cannot 
 
now recall, but it was reported in the last eighteen months to two years, which says that 
 
the GMC is under a duty corresponding to the duties placed on the prosecution in a 
criminal trial? 

 
 
MR MORRIS:  I am not aware of it. 
 
 
 
THE LEGAL ASSESSOR:  I cannot remember its name, but it was reported in the Times 
 
Law Reports, certainly within the last two years.  I remember noting it, that there is an 
 
express statement that the GMC, as the prosecuting body, is under a similar duty to that 
which the Crown Prosecution Service would be under vis a vis disclosure. 

 
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THE CHAIRMAN:  In the absence of that authority, would it not be incorrect to take this 
 
into account at the present time? 
 
 
 
THE LEGAL ASSESSOR:  This is what I am canvassing with learned Counsel.  
 
 
 
MR MORRIS:  I will certainly see if I can dig anything up over the adjournment on that.  
I have always rather assumed that that is the approach that has been taken by all Conduct 

Committees and it really arises out of rule 50, dealing with the receipt of evidence, which 
 
makes specific reference to the receipt of evidence admissible in criminal proceedings, 
 
allied with the fact that the nature and procedure of Conduct Committees is clearly 
 
disciplinary.  The burden is on the Council.  The standard of proof is the criminal 
 
standard of proof.  For that reason, the approach in criminal courts is analogous and 
 
useful and authoritative in guiding the Conduct Committee.   
 

THE LEGAL ASSESSOR:  Perhaps I can summarise it by saying I believe there is an 
 
authority which expressly says that. 
 
 
 
THE CHAIRMAN:  Thank you very much.  It is now nearly one o’clock. 
 
 
 
MR PEARCE:  Sir, I was going to rise to say that my learned friend’s very detailed 
submissions referring to a large number of documents, some of which we have seen 

before, some of which I have and you have and some of which I have not seen before, 
 
clearly will require some detailed response by me.  I had anticipated many of the lines he 
 
was going down.  I have to say I had not anticipated all of them.  If come, let us say, two 
 
o’clock I am close to but not ready to start, which I fear may be the position, I wonder 
 
whether you would grant me an indulgence.  I am not suggesting this will take a very 
 
long period of time, but I do feel an hour might be a little tight. 
 

THE CHAIRMAN:  I can see no objection to that.  We will agree to it.  The panel will 
 
rise.  We will reconvene at two o’clock or shortly thereafter.   
 
 
 
(The Committee adjourned for lunch
 
 
THE CHAIRMAN:  I assume you have nothing further to say just now. 
 
 

MR MORRIS:  I have not, sir. 
 
 
 
THE CHAIRMAN:  Mr Pearce. 
 
 
 
MR PEARCE:  Sir, my submissions this afternoon are intended to persuade you that the 
application to stay these proceedings on the grounds of abuse of process, whether in 

whole or in part, is misconceived, that the facts and matters drawn to your attention by 
 
my learned friend provide no proper basis for staying these proceedings on the grounds of 
 
abuse, again whether in whole or in part, and, in addition, to seek to persuade you that, 
 
insofar as it is relevant to your determinations, the GMC has behaved properly throughout 
 
this case in its obligation to disclose relevant documentation. 
 
 
In so submitting to you I seek to deal with matters in the same order as my learned friend, 

I anticipate, although I am often proved wrong, rather more briefly than my learned 
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friend.  That is not to criticise his length, but to indicate to you that I will not, in the 
 
course of my submissions, need to deal with matters, in particular in respect of the 
 
Church of Scientology, but also to some extent in respect of the history of the various 
 
complaints and charges in the notice of inquiry, at quite the same length as my learned 
 
friend has done. 
 
 
May I then turn specifically to what I understand to be the first of my learned friend’s 

submission?  That is the submission that charge 6 is a fraud, for want of a better way of 
 
putting it, and that, it being a fraud, that taints the entirety of the rest of the charges before 
 
you.  As I have submitted before, and I think as is clear, the suggestion that this is a fraud 
 
really amounts to one of two alternative positions on behalf of Dr Cosgrove.  The first is 
 
that Mrs D is indeed the mother of a child, D, and presumably the mother of a child who 
 
was treated by Dr Cosgrove, but that she does not genuinely instigate the complaint that 
appears in charge 6, or, in the alternative, that if she does genuinely instigate that 

complaint, she is not genuinely the mother of child D.   
 
 
 
The logic of this seems to us to be one of two things:  either that the person who gave 
 
evidence last Wednesday, being the true mother of child D, but not being the genuine 
 
complainant, lied in adopting the complaint that is put in that letter of complaint.  In other 
 
words, although she was not genuine when she started the complaint, she does now 
complain against Dr Cosgrove.  She is part of some conspiracy, therefore, against Dr 

Cosgrove, whatever the reasons for the complaint being instigated in the first place.  That, 
 
put simply, we submit is madness.   
 
 
 
Alternatively, she is lying when she says that she is the genuine mother of D and in 
 
describing his health.  Sir, you heard me re-examine Mrs D on issues relating to her son’s 
 
medical history.  I seek to put before you as an exhibit on behalf of the Council a bundle 
of medical records.  This is the bundle.  (Same handed)  I have not photocopied them, 

either in whole or in part, because there is a large number of documents.  I seek to invite 
 
you to look at ten specific documents that I have flagged up with Post-it notes, but at the 
 
same time invite you to bear in mind the entirety of any documentation that you may see 
 
within these medical records.  It is not necessary for my submissions for me to go into 
 
detail that infringes any issues of confidentiality here.  The point can simply be made, in 
my submission, that if you look at these records, look at simply those ten flagged 
 
documents or any other documents you choose to look at, but the ten flagged documents, 

I submit, make the point very straightforwardly, it is clear, firstly, that when she gave 
 
evidence Mrs D knew a great deal about the medical history of the child who is described 
 
here. 
 
 
 
It is clear, secondly, that the child to whom these medical notes relate was diagnosed as 
suffering from ADHD.  It is clear, thirdly, that this child was treated by Dr Cosgrove.  I 

submit those are points that can be made simply by reading the ten flagged documents, 
 
but would be confirmed by further reading of the file from beginning to end if you chose 
 
so to do.  I produce that bundle to the Committee.  As I say, I apologise for it being in 
 
original form but it seemed more sensible than any other route.  I think that is C5. 
 
 
 
THE CHAIRMAN:  It would be C5.  I think we could look at that when we go into 
camera. 

 
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MR PEARCE:  Precisely so, sir.  I think that would be sensible. 
 
 
 
MR MORRIS:  For my assistance, I do not suppose the original bundle is paginated. 
 
 
 
MR PEARCE:  It is not.  Would it assist if I had those ten marked documents 
 
photocopied?  I did not do it in advance because I did not want it to seem as though we 
are selectively taking documents out of a body of medical records.  We say they are only 

illustrative.  If my learned friend wishes those ten documents, certainly… 
 
 
 
MR MORRIS:  The problem is I have not had a chance to look at these ten documents.  I 
 
do not know which have been flagged up. 
 
 
 
THE CHAIRMAN:  It would be only proper that Mr Morris should see that.  The two 
options are that we allow you a few minutes just now or we get them photocopied. 

   
 
MR MORRIS:  I certainly do not want to interrupt my learned friend.  I suggest we 
 
proceed and they could be photocopied and I can look at them in due course. 
 
 
 
THE CHAIRMAN:  They should be photocopied.  I do not think that should hold us up. 
 
 
MR PEARCE:  No, I think not, sir.   

 
 
In my submission it will be abundantly apparent to you, if it was not from her evidence 
 
last Wednesday, that the person who gave evidence is, indeed, truly the mother of a child 
 
who had ADHD and who was treated by Dr Cosgrove.  What is the attack upon that?  Sir, 
 
I will not labour the point about the handwriting evidence.  The point there is abundantly 
 
clear.  Mrs Marsh quite rightly conceded, having originally suspected that there was a 
difference in writing between various signatures, she quite rightly conceded on seeing a 

larger number of documents that there were similarities – similarities not just sufficient to 
 
make her retract the original opinion that on balance she thought the documents were not 
 
signed by the same person, but, as it were, to swing the other way and to say that on 
 
balance she thought they were.  You have copies of the signatures.  If you wish to be – 
 
and I say so with respect – amateur handwriting experts, you may do so and look at them 
but you do not think that you need any more than Mrs Marsh’s evidence to be convinced 
 
that the entirety of those documents were, indeed, signed by one and the same person. 

 
 
Sir, that for the moment is to make submissions relating only to evidence independently 
 
of Mrs D, but what of Mrs D herself?  You heard her give evidence.  You may think that 
 
she was honest and convincing in what she had to say and that at no point in seeking to 
 
cross-examine her did she behave in a manner in Mr Morris’s cross-examination that 
would suggest to you that she was anything other than a straightforward and honest 

witness who appeared before you. 
 
 
 
My learned friend has, I think, identified four points today that may cast doubt upon her 
 
honesty or genuineness.  The first is the confusion between Bath and Bristol.  Well, you 
 
heard what Mrs D had to say about that.  I cannot put it any more vividly than she did.  
 
She said she was not good at geography.   I do not dispute my learned friend’s contention 
that Bath and Bristol are different cities.  However, in my submission, geographically 

close, perhaps for someone who does not know that area at all and then a confusion as to 
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where she may have gone, perhaps encouraged by documents, some naming the Bristol 
 
Priority Clinic, some naming an address in Bath.  Who knows?  You may think her 
 
explanation for that was thoroughly convincing. 
 
 
 
Secondly, sir the confusion between a hospital and a clinic.  Well, I ask you to consider 
 
whether that is in any sense a meaningful confusion that casts any doubt upon her 
genuineness or honesty.   

 
 
Thirdly, the variable spelling of the surname.  That does undoubtedly raise a question in 
 
one’s mind.  Most of us, I venture to suggest, spell our surnames consistently one way or 
 
another, but bear in mind here for a moment what Mrs Marsh had to say in her evidence.  
 
She said that signatures signed with the “p” and without the “p” are both, in her opinion, 
 
signed by the same person. 
 

If Mrs Marsh is right, there is someone out there – and presumably it was the Mrs D who 
 
was before us but there is somebody out there – who alternately spells their signature 
 
with or without the letter “p”.  If that be so – and Mrs D says to you firmly, “Yes, they are 
 
all my signature” – if that be so, then it may not for a moment matter why she spells her 
 
name differently in different circumstances.  She gave you an explanation – “It depends 
 
how other people address me, it depends on the document.”  Whatever the explanation 
was, you may think that does not in any way, shape or form undermine her honesty or 

genuineness before you. 
 
 
 
You might also bear in mind that on this point as well as the handwriting evidence, the 
 
various documents from which those signatures are drawn all again clearly relate to the 
 
same person and the same mother, so again there is independent evidence from Mrs D 
 
that the same person is signing the signature but in different ways. 
 

The fourth point is that the letter of complaint dated 18 August 2000 that you have seen is 
 
unsigned.  Well, I hear what my learned friend has to say about that point.  Signed or not, 
 
it is a document that Mrs D has adopted before this Committee and you may think that 
 
there is no basis whatsoever for any suggestion that that was not genuinely intended to be 
 
her witness evidence and genuinely signed on that basis. 
 
 
Her evidence was detailed.  It was detailed in terms of the circumstances of the 

consultation, it was detailed in terms of her son’s condition, it was unshaken by cross-
 
examination. 
 
 
 
Document C1 – that is the document, if you recall, that was signed by Dr Cosgrove and 
 
Dr Bramble relating to Risperidone.  That was a document that Mrs D said had come into 
her possession.  How does it come into her possession unless she is genuinely a mother of 

a child treated by Dr Cosgrove? 
 
 
 
Frankly, sir, if Mrs D is not genuinely who she says she is, why does she come to this 
 
Committee to lie?  Why does she put herself in this situation?  I suspect at this stage one 
 
moves on to the second area of my learned friend’s submissions on this first point, which 
 
is the role of the Church of Scientology and the Citizens Commission on Human Rights 
and Mr Daniels.  Implicit, I suspect, in the submission, is that Mrs D, if she is a fraud, is a 

fraud because of her allegiance to or sympathy with the Church of Scientology.  You 
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heard her deny being a scientologist and you heard the terms in which she denied it – 
 
baptised, taken first Holy Communion in the Roman Catholic Church, married in Chapel. 
 
 You may think again that evidence rang true and was forceful evidence, but that, I 
 
suppose, does not of itself mean that she could not have sympathy with the Church of 
 
Scientology or its aims. 
 
 
At this point I want to address you on the documentation about the Church and the 

Citizens Commission that has been produced.  In this respect I start off by repeating 
 
submissions that I made to you earlier.  I neither accept nor reject the accuracy of 
 
anything stated in the Foster report.  I see the contents of other documents that clearly 
 
come from the Church or from the Commission, that have been provided.  One can see 
 
what is said there. Whether what is contained in it is accurate or not is another matter but, 
 
for my submission, not one that you have to consider. 
 

It is right that you ought to consider, sir, that the Church of Scientology, at least in 
 
respect of some of its practices, has what you may think are perfectly respectable 
 
defenders as well as critics.   You heard from Mrs D herself in that regard saying in that 
 
in one area – that is to say psychiatric treatment – she shared views with the Church.  One 
 
of your members had some sympathetic views towards one aspect of an organisation 
 
associated with the church. That may simply suggest, sir, that there is a range of opinion. 
 How can  you begin to judge that?   

 
 
How can you begin to say – and this is at the core, as I see it, of my learned friend’s 
 
submissions – how can you begin to say that this prosecution must be tainted because the 
 
kind of thing that the Church of Scientology would do would be to put up a false 
 
complainant, to encourage false complaints, to orchestrate campaigns against 
 
psychiatrists?  Even if they do orchestrate complaints against psychiatrists, where is the 
evidence of any orchestration by them in this case?   

 
 
Indeed, one of the points that may have struck you very forcefully from all of the 
 
documentation that has been disclosed to you, is that the Citizens Commission on Human 
 
Rights is only alleged to have been involved in one of a series of complaints.  If this was 
 
truly an orchestrated campaign, then how come, you may think, there is no evidence of 
any involvement by the Church, by the commission, by Mr Daniels, on any of those other 
 
complaints?   That, in my submission, goes strongly to suggest that there is no 

orchestration by the Church of Scientology. 
 
 
 
Sir, on Monday of last week it was being suggested that the lack of progress in the 
 
complaints against Dr Cosgrove until mid to late 2002, followed by a sudden flurry of 
 
activity, was quite possibly if not probably the consequence of communication from the 
Church of Scientology that had the effect of stirring the GMC into action.  You are aware 

– and my learned friend has made reference to it on at least two occasions now – that he 
 
has seen a bundle of correspondence and some of it is now before you because it has 
 
other relevance in the case – and a bundle of documentation that leads him to make the 
 
concession, as I understand it, that there is no evidence of a letter from the Church of 
 
Scientology that in fact stirred our side of the process into action in 2002. 
 
 
I will if I may, sir, refer to another of the documents that came into existence at or around 

that time.  It is not one that is currently before you.  It is a memorandum of 5 September 
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2002. 
 
 
 
THE CHAIRMAN:  This will now be C6.  
 
 
 
MR PEARCE:  I am obliged, sir.  Sir, if I may read this for the purpose of the record.  It 
 
is a memorandum from a Mr Peter Lynn to Dr Malcolm Lewis.  Paragraph1: 
 

“I should say at the outset that the office needs to apologise for the delays 
 
that have occurred in the handling of this series of cases.  You last 
 
screened cases relating to Dr Cosgrove in February of this year (please 
 
see your note flagged C) and the oldest case in these files dates from 
 
1997.  I have placed the latest memos about all the cases on top of the 
 
first file.  I have picked this up following Ann O’Sullivan going on sick 
leave and, unfortunately, Ann is the person who knows about the history. 

 
 
1a 
One of the difficulties here has been that information has 
 
continued to come in about Dr Cosgrove and additionally the case has 
 
been passed around a number of caseworkers, went to performance and 
 
then came back to screening.  In any event, these cases form part of the 
 
backlog that we are committed to clearing by the end of this month.  
Following my arrival in screening, this was a doctor I discussed 

prioritising with Ann but as you will see from my memo of 16 August 
 
2002, below, Ann went on sick leave that week and will not be back until 
 
October.  I have therefore taken over the case and moved it on by 
 
consulting our in-house solicitor, Peter Steel.  The short summary of his 
 
advice is in the e-mail immediately below this memo but Peter has, very 
 
helpfully, reviewed the files and drafted rule 6 allegations.  They are at 
the end of this tag.” 

 
 
You will recall that that e-mail is a document we have seen already, I should say, sir. 
 
 
 
“The allegations were drafted on the basis of the following ten files” 
 
 
and then numbers are there listed.  Turning on to the next page: 
 
 

“We additionally have yet another case, 2002/1616.  Peter Steel did not 
 
receive this file and it was recently passed to me by Seaton Giles, in light 
 
of the previous cases.  I agreed with Seaton that we would link this with 
 
the other files.  I have drafted an allegation in relation to the referral from 
 
Dr M about seeing JR without a proper referral from a GP – which Dr M 
specifically raises as an issue.  I would be grateful for your views on this 

complaint and whether you feel this in itself raises an issue of SPM.  
 
There is no specific provision in GMP.  I would be grateful for your 
 
comments also on the practice of making out specimen prescriptions to 
 
be then prescribed on the NHS.  Can this be regarded as acceptable 
 
practice?  It sounds very questionable to me and I have drafted an 
 
allegation for consideration.  In relation to JE, I think there is insufficient 
information as we have no medical records, specific dates and, 

importantly, the events occurred six years ago.  I therefore do not suggest 
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considering PPC on those matters, although if you want to pursue them 
 
separately we could do so.  I should say that at that stage the PPC could 
 
initiate further investigation if they thought it appropriate. 
 
 
 
4. 
Again, I am sorry to be presenting these cases in this way at this 
 
stage.  However, Peter Steel has done a lot of work to focus on the 
allegations and I think we are ready to move to the PPC on the cases you 

previously screened and for you to consider everything else. 
 
 
 
5.  
After initially reviewing these files, please give me a call if you 
 
wish to discuss before reaching a decision. 
 
 
 
6. 
I hope you will excuse my audacity in requesting that you look at 
these files and return them to us as soon as you can, given that we are 

committed to getting a screening decision regarding PPC before the end 
 
of September. 
 
 
 
7. 
Again, if you wish to discuss any aspect of these cases at any 
 
stage, please ring me.” 
 
 
Signed, you may think, “Peter Lynn” and below that you may think there is a handwritten 

note that starts off “Medical Screener” and I think is rather difficult to read but you may 
 
think is signed  “Malcolm Lewis”.  I leave that to you to consider. 
 
 
 
What is clear from that memo - which I have read in full because it does give us 
 
information that has not previously been available – is explanations being proffered for 
 
delay in this case and apologies in that regard, as well as explaining the on-going process 
at that stage. 

 
 
Amongst other things that memo, in my submission, clearly gives the lie to any 
 
suggesting that it was activity by the Church of Scientology or the Citizens Commission 
 
or Mr Daniels that led to a sudden flurry of activity in later 2002. 
 
 
Sir, those submissions deal in principle with the respects in which the veracity or 
 
genuineness of Charge 6 is attacked, but my learned friend then seeks to raise the indices 

of suspicion, as he puts it, by raising certain other specific points and it is to those I turn 
 
now. 
 
 
 
The first is that it is said that there was a delay of 21 months in the GMC responding to an 
 
enquiry from the MPS about Mrs D and her signature.  The relevant documents you have 
already been referred to are D18 and D19 and I accept the time scale as put there.  

However, what that submission does not take account of is some other correspondence on 
 
this issue and that I will refer to you because it is some time, I think, since you have 
 
looked at it.  It is in D4.   
 
 
 
D4 comprises three documents that were produced for handwriting purposes but as it 
 
happens the second one relates to this issue.  The second document there is a letter dated 
21 June 22001 from Mrs D, addressed to a person at the Fitness to Practise Directorate of 

the GMC. 
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“Mr Brian Daniels of the Citizens Commission on Human rights has 
 
contacted me after speaking with you on Tuesday morning.  He has 
 
informed me that the procurement of my son’s medical records have been 
 
delayed due to a possible confusion over names. In reviewing my 
 
previous letters to the GMC, I have spelt my surname” 
 

and she gives one spelling with a “p” and then she says 
 
 
 
“as opposed to” 
 
 
 
and she gives another spelling without a “p”. 
 
 
“This may have caused some confusion for Dr Cosgrove so I felt I should 

write to provide you with evidence to confirm the correct spelling.  I have 
 
enclosed a copy of my driving licence as proof of my surname.  I hope 
 
that this will resolve any misunderstandings.” 
 
 
 
Now that letter dated 21 June 2001 falls what – some four, five months after the letter 
 
from the Medical Protection Society at D18 raising this issue and significantly more than 
a year before the response of the GMC.  So, any delay that there may have been – and I 

am not seeking to defend a 21 month delay in replying to a letter – whatever the 
 
explanation is, it is not that this is a matter that went to sleep.  On the contrary, the GMC 
 
raised an enquiry about the very point that is being raised on the part of Dr Cosgrove.  
 
 
 
In what sense does that delay in responding to the letter suggest that in some way there 
 
should be a higher suspicion about the genuineness of Charge 6?  In my submission, not 
at all.  On the contrary, the point was raised with Mrs D and she responded to it. 

 
 
You might note the reference to Mr Daniels in that letter. Conspiracy theorists might say 
 
that this is yet another example of Mr Daniels or the Commission orchestrating 
 
complaints.  Others might say that Mr Daniels clearly had an interest in these proceedings 
 
and a concern about the complaint in relation to Dr Cosgrove and that he was sufficiently 
concerned to be involved in it, to be assisting Mrs D, to be communicating with her as 
 
well as the GMC. What it does not suggest in any way, shape or form is any orchestration 

on his behalf. 
 
  
 
The second area in which we are said or you are invited to have a higher degree of 
 
suspicion relates to an article in the Bath Chronicle on 20 September 2002 and a Press 
 
Release leading to it, those being D20 and I have not written on it but I think it must be 
D21, I take it, the article.  Yes, D21 is the article respectively.  And the point is made 

perfectly accurately that the article, and therefore presumably the Press Release precede 
 
the Rule 6 letter. 
 
  
 
That is perfectly consistent with Mr Daniels, or the Citizens Commission on Human 
 
Rights, enquiring about the state of matters relating to Dr Cosgrove and putting out a 
 
Press Release that they understand that that represents the position.  It does not, in my 
submission, in any way suggest that there is orchestration going on, that the Commission 

is attempting to apply undue, unfair or wrong impression on the GMC.  I do not dispute 
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that the Commission has a position - has a stance - on this.  I do dispute that there is any 
 
evidence to suggest that its stance or position has unduly influenced the GMC in the 
 
prosecution of this case. 
 
  
 
The third area in which it is said we should have a higher level of suspicion is the breach 
 
of promise or the denial of a reasonable expectation in respect of how certain charges 
were to be dealt with. 

  
 
Now, sir, a little like my learned friend in his submissions, I will deal with this point now. 
 
 In many ways what I have to say simply needs to be repeated in due course when we get 
 
to the freestanding abuse arguments relating to this, but I deal with it now because it fits 
 
in neatly to this stage of the submissions. 
 
  
Sir, the remarkable point - and, in my submission, it is remarkable - about this area of my 

learned friend's submissions is that it was raised for the first time today.  It was not even, 
 
in my submission, raised last Friday.  If you have any doubt about that then I invite you to 
 
look at the transcript for last Friday, and in particular Page 3 and the paragraph at letter 
 
capital E, for the indication that this was not how the case was being put then. 
 
  
 
I would read the relevant paragraph if I had not misplaced that day's transcript.  Yes, Page 
3, paragraph E: 

  
 
"There is a suggestion in the various memoranda that went 
 
to and fro within the GMC about this decision ..." (That is 
 
the decision to go down the Conduct route) "... that that 
 
decision could be justified on the basis that further 
 
information had come to light about Dr Cosgrove.  
However, on the face of the documentation that I have all 

the complaints date from 1999, 2000 or earlier and it does 
 
not appear to me that there was any further fresh 
 
information that would justify the Council in  deciding to 
 
take a wholly different approach to the treatment of this 
 
information and complaints. 
  
 
If that is right, it would, in my submission, amount to an 

unfair use of the investigate ..." (and I think it may be 
 
investigative)  "... powers of the General Medical Council 
 
and would amount to an abuse, which I would seek to lay 
 
before you". 
 
  
Now, if my learned friend's submissions are correct, then what has happened here is that 

Dr Cosgrove has been led to a belief either in respect of some charges that no action 
 
would be taken at all, or in respect of other charges that the action that would be taken 
 
was in respect of Performance.  And that therefore when he received a Rule 6 letter 
 
raising various allegations of misconduct he would, you may think, if he had been in any 
 
way whatsoever misled, deceived, led up the garden path -- he would, you may think, 
 
have been frankly up in arms.  You may think that if there was any legitimate complaint 
about the change between professional disciplinary proceedings along the Performance 

route to those along the Conduct route, you may think that he would then and there have 
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been shouting from the rooftops in complaint about what was going on.  But, no, no such 
 
complaint was raised. No such complaint was raised then, at the beginning of these 
 
proceedings last Monday or, indeed, in my submission on Friday of last week. 
 
  
 
The point is quite simply this.  Matters come to light in the course of documents that, in 
 
my submission, appear to give the Doctor a technical argument against us that we cannot 
explain a change in decision-making and that it is sought to use those matters in order to 

persuade you to stay these proceedings as an abuse of process.  But the very fact that 
 
never before until this stage were these points raised is the best indication you might want 
 
that there has never been any misleading of Dr Cosgrove. There has never been a 
 
suggestion in which he has felt unfairly treated in the fact that proceedings were 
 
originally, it is being suggested, not going to be proceeded with and then there was a 
 
change of mind, or were going to be proceeded with down the Performance route and 
then it became the Conduct route. Dr Cosgrove has never felt at a disadvantage, 

prejudiced or unfairly treated because of that.  If he had, the point would have been raised 
 
in my submission.  This is a last minute point that arises out of seeing certain 
 
documentation. 
 
  
 
And even then, sir, the documentation does not give Dr Cosgrove the argument.  The 
 
argument arises out of the fact that he was originally told, "Either nothing or 
Performance" and then in 2002 he was told "Conduct".  Nothing in any of that 

documentation that you have now got makes him any the more misled as to what the true 
 
position was.  Nothing in that documentation that you have now seen gives rise to some 
 
greater expectation than he can possibly have had in the past.  What matters is what was 
 
his expectation, let us say, on the evening before he receives his Rule 6 letter?  Did he 
 
then feel he had had the promise or the expectation?  How had he been treated?  Yet, this 
 
complaint is not raised. 
  

Now in that memorandum of 5 September 2002, C6, you will have noted, sir, when I read 
 
through it, that at the top of the second page there is a reference to a case 2002/1616; a 
 
case passed on by Seaton Giles.  It is clear to say from that, sir, that at the time of that 
 
letter there was indeed new information available in Allegation 2002. 
 
  
Look at D22, the substantial bundle of documents relating to the process at this time, and 
 
in particular that table of open cases  - the open cases list it is called that appears there.  

On the second page of the table, the last complaint:  "2002/1505 01 Home Office 02 West 
 
Yorks Police".  So, again there is new information available at that stage. 
 
  
 
And, indeed, you will have noted that throughout the memoranda that are to-ing and fro-
 
ing at this stage there is reference to information coming in and it being considered.  So, 
it is not right to suggest on the face of this documentation that there was no new 

information in 2002, or at least later on in 2002. 
 
  
 
But let us actually turn to the merits of this abuse point.  I have said already that if this 
 
was a good point it would have been raised a long time ago, but what actually is being 
 
said? Well, in the legitimate expectation cases it is being said that such time had passed 
 
that Dr Cosgrove could and presumably did legitimately think that those cases were not 
going to be pursued. 

  
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I have raised already the suggestion that if he genuinely thought that he might have said it 
 
a long time before today, but more to the point what is it in the passage of time at this 
 
stage that would have led him to that conclusion?  It is quite apparent that there was a 
 
period with relative inactivity, and I do not defend that as I have said already, but equally 
 
from time to time there were periods with flurries of activity with letters being sent 
 
including, you will have seen, contact with Dr Cosgrove. 
  

So, where does this suggestion of legitimate expectation arise? Where does it come from? 
 
 Simply that passage of time?  In my submission there is nothing in that to give rise to 
 
such an expectation, nor as far as I am aware nothing in any of the authorities to suggest 
 
that the mere passage of time - even very lengthy passage of time - will be held to give 
 
rise to such expectation. 
 
  
That is the legitimate expectation point, sir, and then the other group - the promise group. 

 Now if I follow my learned friend's submissions correctly on this group of cases, what he 
 
is saying is not so much that the Doctor was promised the case would go down the 
 
Performance route, but that implicit in that promise is that it would not go down the 
 
Conduct route because that is the real complaint, is it not?  That it has gone down the 
 
Conduct  route when presumably it is being said it should not have done so and that, 
 
therefore, presumably that promise is implicit in the promise that it goes down the 
Performance route. 

  
 
Well, where is the promise?  There is no such promise.  There is a referral to Performance 
 
Procedures.  There is nothing, in my submission, in the Act or the Rules that prevents a 
 
case being sent down Performance Procedures and then a further decision being taken to 
 
refer that case to a Conduct case. 
 
  
It may well be that it would be oppressive on an individual doctor to do that.  It may be 

that it would be very rare for a case to start going down one route and to change to 
 
another route.  I am instructed that it does happen in some cases, but more to the point 
 
and more significantly for your considerations there is in my submission nothing in the 
 
Rules to prevent that happening.  There is nothing in the correspondence with Dr 
 
Cosgrove to indicate that he was given any guarantee, promise, or call it what you will 
that this case would not be dealt with by Conduct Procedures. 
 
  

Sir, I will return to the significance of the alleged legitimate expectations or promises 
 
when I deal with those as freestanding allegations of an abuse of process, but the question 
 
for the moment - because we are still dealing with Charge 6 and the level of suspicion on 
 
Charge 6 - is where does this take us?  Where does this change of decision as to how the 
 
professional disciplinary matters are to be taken to, how does that lead to a greater degree 
of suspicion about the motivation of the prosecution? 

  
 
You have laid bare before you a series of memoranda and screening decisions and such 
 
like.  Where is the suggestion from any of those documents that there has been some 
 
impropriety, some manipulation, some bad faith? 
 
  
 
And it is significant to note the way my learned friend puts his case on this point because, 
when he has spoken of bad faith and manipulation and such like, he has been clear in his 

submissions in saying that he is not making that allegation against the GMC. He makes 
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that allegation against the Citizens Commission, possibly the Church, possibly Mrs D, but 
 
he does not make that allegation against the GMC other than to suggest that the GMC is 
 
the unwitting victim of manipulation by others. 
 
  
 
Well, where does this change from Performance to Conduct fit into that suggestion?  How 
 
does that make in any sense the GMC an unwitting victim?  An unwitting victim of what? 
 There is no evidence whatsoever to suggest any undue pressure that has led to that 

change. 
 
  
 
Sir, you must bear in mind throughout these submissions a point raised quite rightly, if I 
 
may say so, by your learned Legal Assessor last Monday that the burden of proof lies 
 
upon the Doctor and, of course, he only has to satisfy you on the balance of probabilities. 
 
 However, where there is simply no evidence on the point - and there is, in my 
submission, no evidence to suggest any manipulation of the GMC, any bad faith or bad 

behaviour on the part of the GMC - then he cannot in my submission come close to 
 
satisfying the burden, even on the balance of probabilities, that there has been some 
 
misconduct that has affected the prosecution process in this case. 
 
  
 
Sir, the next area in which my learned friend asks you to have a higher level of suspicion 
 
is in relation to the non-disclosure of documentation.  Well I suppose if the 
non-disclosure of documentation were to be considered to be relevant to your level of 

suspicion about bad faith, it would have to be implicit in that that whoever has made the 
 
decision not to disclose any further documentation is themselves acting in bad faith, or is 
 
being manipulated by the parties whom I keep mentioning and is a victim - an innocent 
 
perhaps victim - of some other person's manipulation.  Well in my submission there is 
 
simply no evidence of that, sir, any more than there is of bad faith or bad conduct in 
 
respect of the decisions as to prosecution. 
  

My learned friend seeks, as I understand it -- and I am sure I will be corrected if I am 
 
wrong.  He seeks documentation essentially relating to the original screening decisions in 
 
certain cases.  He says that this documentation is highly relevant.  Well, I ask to what is it 
 
highly relevant?  It is not that original screening decision that is being attacked here.  It 
 
was the later screening decision of Dr Lewis. 
  
 
It is said that disclosure of these documentations might assist, as I understand it, in the 

submissions relating to abuse.  Is it said they will assist in any way in the substantive 
 
issues in the case?  In my submission, they could not possibly do so.  But even in respect 
 
of the abuse proceedings, sir, when one focuses one's mind on what actually is being 
 
alleged here then screening matters back in 2000/early 2001 are going to have no bearing 
 
whatsoever. 
  

Sir, those who instruct me and my lay client take their obligations of disclosure seriously, 
 
and I invite you to say that their willingness to co-operate and be reasonable is amply 
 
demonstrated by events last week when first of all we disclosed a quantity of 
 
documentation sought by my learned friend in order to deal with issues of delay, secondly 
 
we willingly produced Mrs D to give evidence before you on the issue of abuse and, 
 
thirdly, when these issues were raised on Friday we did not simply say,  "We will not 
disclose the documents to you".  We considered our position with very great care. 

  
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But, sir, in my submission there must properly be drawn a line somewhere.  There is no 
 
basis, in my submission, for suggesting that any of this documentation will in any way 
 
either undermine our case or assist the Doctor's case.  These are historic matters. You are 
 
going to be concerned with the substantive issues of what the doctor’s conduct was and 
 
matters relating to that.  How someone came to a particular judgment in the past will be 
 
irrelevant to that.  Moreover, when you are being asked to judge the issues of abuse that 
my learned friend raises, then the basis of that decision making back in 2000 or early 

2001 will help you none the more. 
 
 
 
You must bear in mind, in my submission, that the consequence of a finding of abuse of 
 
process and a stay of proceedings is that those who have a legitimate interest in the case, 
 
those who complain and raise allegations and have a legitimate interest in the 
 
proceedings, are denied their opportunity to appear in front of you and to state what they 
have to state and make any allegations they have to make.   

 
 
Abuse of process arguments, sir, must be considered with very great care, because 
 
precisely what they do is to stop you hearing the case on its merits.  They say you should 
 
not even get to that stage and it is with very great care that you should look at any 
 
argument that suggests that you should not in fact hear a case on its merits.  Of course 
 
there are circumstances where proceedings properly can be stayed, but this comes 
nowhere near that level, in my submission.   

 
 
Finally, dealing with the issue of disclosure at this stage, when my learned friend in his 
 
submissions was putting forward his argument as to the relevance of documentation, he 
 
indicated that the documents he was seeking – and my note of his words, I hope, 
 
approximately accurately  is – “The disclosure of documents may give an avenue for the 
 
doctor to explore which he currently does not know.”  Sir, that, in my submission, is 
fishing for documentation.  That is precisely what parties to litigation may not do.  Of 

course we have an obligation to disclose that which is relevant.  As I have said already, 
 
we treat that obligation seriously.  This is, I regret to say, the mere fishing for 
 
documentation in the hope that something might be there.  When you think about what 
 
that hope might be, is the reality here that what is being sought is some suggestion that 
 
the Church of Scientology or the Citizens Commission or Mr Daniels is somewhere 
mentioned on some other case and that this proves the conspiracy?  Is that what they are 
 
fishing for?   

 
 
In my submission, these abuse of process arguments would, if allowed to continue and 
 
continue and continue, on the basis that sooner or later they would seek to find some such 
 
evidence, there is no basis to suggest that some such evidence exists. 
 
 
Sir, may I at this point turn to the question of the significance of what has been argued in 

respect of charge 6?  Insofar as it is suggested that Mrs D is a fraud, then that, you may 
 
think, would give Dr Cosgrove a cast iron defence to those allegations.  He could not 
 
possibly be convicted of those allegations in charge 6 because the evidence on which they 
 
were based would simply be dishonest and not such as could possibly persuade you to 
 
find in my favour on those issues.  That is what the trial process, the process of you 
 
hearing witnesses on substantive issues is meant to determine.  Dr Cosgrove does not 
need the protection of an abuse of process argument to prevent that happening.  That will 

be dealt with on the evidence at the appropriate time.  No.  Of course, it is put much more 
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broadly on the basis of abuse of process, the tainting, I think it is correct to say, of the 
 
proceedings more generally. 
 
 
 
May I refer you, through your learned Legal Assessor, to Archbold paragraph 4-54 and 
 
following?  This is a section of Archbold that you have had read out to you at some 
 
length already.  There are a large number of cases here cited on abuse of process.  It is 
fair to say that in most cases abuse of process arguments have failed.  In all of those cases 

cited there not a single case of abuse of process has succeeded unless there was evidence 
 
that the defendant’s ability to defend himself was adversely affected by the alleged abuse 
 
of process, or there was conduct by the prosecuting or state authorities that was 
 
manipulative or deprived the defendant of a protection at law.  I think there particularly of 
 
cases where people were illegally brought into this country – Mullen is an example of that 
 
cited at 4-56 – and then subject to trial where, but for them illegally being brought here, 
the trial would not and could not have happened. 

 
 
There were no cases in that section dealing with the alleged manipulation of authorities 
 
by third parties.  That matter is touched upon at another paragraph in Archbold which is 
 
4-63A, again a section to which my learned friend has referred you in the past.  There it is 
 
said as follows, 
 
 
“An abuse of process exists where the plaintiff in civil proceedings is in effective 

control of criminal proceedings against the same defendant to the extent that the 
 
prosecution are unable to exercise independently their prosecutorial duties.” 
 
 
 
The case of Regina v Leominster Magistrates Court, ex parte Aston Manor Brewery is 
 
cited.  Effectively it is the same barrister there appearing both to prosecute a case and in 
 
civil cases who thereby had in his possession information, the disclosure of which was 
disputed and where the Divisional Court strongly disapproved of the manner in which the 

criminal prosecution was being conducted. 
 
 
 
Sir, there is, as I seek to emphasize again and again, no evidence here that the prosecution 
 
process is in any way shape or form tainted by manipulation.  It is the most extreme 
 
cases, such as Regina v Leominster Magistrates Court where the court will stay on those 
grounds.  May I contrast with that the very strong public interest in these proceedings 
 
going ahead, in respect of which I seek to cite another case to you which does not appear 

in Archbold and which is not in the criminal jurisdiction.  There are three authorities I am 
 
going to refer to.  I have referred to Leominster already and I have another two 
 
authorities.  I have bundled them together and have copies for everyone.  It might be 
 
useful to distribute that now as C7. 
 
 
THE CHAIRMAN:  Yes.  (Same handed

 
 
MR PEARCE:  On the front page of C7 you will see the best report we have of the 
 
decision in Regina v Leominster Magistrates Court, which is there simply to demonstrate, 
 
we say, the exceptional nature of that particular case.  I invite you to look at the second 
 
case here, a Court of Appeal decision, A Health Authority v X and others [2001] EWCA 
 
Civ 2014.  It is also reported, from where this copy comes, in [2001] Lloyd’s Reps Med 
139.  If I may read the head note, 

 
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“On the conclusion of public law proceedings under the Children Act the local 
 
authority reported to its area health authority that facts had emerged which it 
 
considered relevant to the discharge of its duties.  The health authority applied to 
 
the Court for permission for the local authority to disclose specified case papers, 
 
including two general practitioner records, of two named individuals to it.  Munby 
 
J [2001] Lloyd’s Rep Med 349 held that the authority was entitled to disclosure of 
the papers, including the judgment in the proceedings, and an order requiring the 

Respondent to produce within seven days the medical records of the two named 
 
patients whose consent to production had been refused or not obtained.  In each 
 
case Munby J had held that such disclosure should be subject to express 
 
conditions, including a requirement that the authority would not without the prior 
 
consent of the Court disclose any disclosed document to any person other than a 
 
specified disciplinary body on the ground that the doctor’s duty of confidentiality 
included a duty to assert the confidentiality in any answer to a claim by a third 

party to disclosure and to put before the Court every proper argument against 
 
disclosure.  The health authority appealed. 
 
 
 
Held, dismissing the appeal…” 
 
 
 
It is paragraph 1 of the head note I am concerned with at the moment, although I will 
return more generally to this case in due course, 

 
 
“1. 
There is a high public interest analogous to the public interest in the due 
 
administration of criminal justice, in the proper administration of professional 
 
disciplinary proceedings, particularly in the field of medicine…” 
 
 
 
Reference is made to paragraph 19.  If I take you to paragraph 19 in the judgment, you 
will see that that paragraph there appears.  What is apparent from this case and from that 

analysis is that the high public interest in professional disciplinary proceedings taking 
 
place means that, in that case, the Court must, whilst balancing its duties in making a 
 
decision, consider very important the fact that the disciplinary proceedings ought, if 
 
appropriate, to take place.  If you look at paragraph 20, the part of paragraph 20 which is 
 
marked with a heavy line,  
 
 
“In those circumstances in my opinion the objection to production fell to be 

decided in accordance with the principle that determined the application for the 
 
release of the list A documents, namely whether the public interest in effective 
 
disciplinary procedures for the investigation and eradication of medical 
 
malpractice outweighed the confidentiality of the records.  I do not regard the 
 
application for production much enhanced by the Regulation 36(6) duty.  A 
balance still had to be struck between competing interests.  The balance came 

down in favour of production, as it invariably does, save in exceptional cases.” 
 
 
 
   You will see this case may have relevance to another part of my learned friend’s 
 
submissions, but at this stage I seek to emphasize to you the importance of professional 
 
disciplinary proceedings taking place and not, as it were, being stymied by arguments that 
 
lack merit.  There is no evidence of impropriety on the part of the prosecuting authorities. 
 There is no evidence of inappropriate control by any body.  There is no evidence of any 

abuse in the decision to proceed with charge 6 or, in consequence of that, with the rest of 
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the charges.   
 
 
 
Sir, that deals at some length with the first part of my learned friend’s submissions, but 
 
makes a lot of the points that I need to make in respect of the remaining charges.  May I 
 
deal with the second area and that is the legitimate expectation or breach of promise 
 
argument?  I have put my submissions on the circumstances at length and they will be no 
better than they are already by me repeating them again.  What I do see to refer to is 

certain passages in Archbold on this issue.  If I could take your learned Legal Assessor to 
 
paragraph 4-62, and in particular on page 340 halfway down. It is a case called R v 
 
Horseferry Road Magistrates Court is cited.  I apologise that I do not have a copy of the 
 
judgment.  We will obtain it if necessary.   
 
“In R v Horseferry Road Magistrates Court ex parte DPP a prosecution had been 
 
instigated despite an assurance of no prosecution given by the police to the 
defendant’s solicitor and after some delay.  The Stipendiary Magistrate concluded 

that it would ipso facto be unfair to try the defendant in such circumstances and 
 
stayed the proceedings.  The Divisional Court quashed the stay and remitted the 
 
matter for reconsideration.” 
 
 
 
Here we get to the important part of the judgment, in my submission. 
 
 
“Breach of an assurance not to prosecute cannot per se justify a stay.  The 

situation straddled the two categories of abuse.  In such a situation it is incumbent 
 
upon the Court to investigate what, if any, prejudice to the defendant would result 
 
from pursuit of the proceedings, bearing in mind the exceptional circumstances 
 
that must exist before delay can be seen to result in prejudice such as to justify a 
 
stay and the Court must consider whether there are special circumstances 
 
present.” 
 

As in R v Croydon Justices ex parte Dean referred to by my learned friend, where special 
 
factors were the defendant’s youthfulness and the assistance he had given subsequent to 
 
the assurance and R v Bloomfield, the other case referred to by my learned friend, where a 
 
special factor was that the assurance had been given to the Court and would already have 
 
been acted upon for an adjournment to suit the convenience of the prosecution.   
 
 
If I may take you down a little further on that same page to the next paragraph,  

 
 
“Further, there is no rule to the effect that an early decision in the Magistrates 
 
Court not to proceed on one of several charges cannot in the absence of fresh 
 
evidence be revisited by Counsel prosecuting in the Crown Court (R v Murphy).  
 
The prosecution withdrew at the Magistrates Court a charge of indecent assault.  
Another such charge in respect of a different child being transferred to the Crown 

Court where the withdrawn charge was reinstated despite the absence of any new 
 
evidence.   
 
 
 
Held that where the decision to reinstate was taken in a different court at a 
 
significantly different stage in the process and no objection had been taken by the 
 
defence at the time, the course taken did not bring the administration of justice 
into disrepute.” 

 
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That is what this is about.  Does the decision to proceed in this case bring the 
 
administration of justice in this context, professional disciplinary proceedings before the 
 
General Medical Council, into disrepute?  In my submission there is no basis for so 
 
finding, even if Dr Cosgrove was given a promise or an assurance or was led into any 
 
expectation. 
 
 
It is the exceptional case that will be stayed and it will be stayed either where there is 

evidence of prejudice to the doctor.  By prejudice here, that does no simply mean that the 
 
proceedings go ahead.  Prejudice is some unfairness to him because of the decision and 
 
the manner in which it has been taken that makes him the less able properly to defend 
 
himself than he would have been had the decision been reached in a different way.  That 
 
is the prejudice situation or the particularly special circumstances called exceptional in ex 
 
parte Dean
 

No attempt to define all circumstances which are exceptional is ever going to be wholly 
 
comprehensive, but when one looks at those cases of Dean and Bloomfield that my 
 
learned friend refers to, those are very striking cases, in my submission, with very 
 
particular features as highlighted in Archbold, which is far from the situation here.  If this 
 
case has similarity with any of the cases cited in Archbold it is, you may think, with 
 
either R v Murphy or ex parte DPP, the two cases I have referred you to in paragraph 4-
62. 

 
 
Sir, if I can turn to the third freestanding basis of an application to stay, that relates to the 
 
disclosure of documentation, again I have set out my arguments at considerable length.  I 
 
do not think I can do better on them than I have already in terms of seeking to explain 
 
them.  May I pick up one point that amply demonstrates a point that I sought to make this 
 
morning.  This is the wrong procedural route for this kind of challenge.  It is not 
appropriate for this Committee to be expected to decide on abuse of process arguments of 

this nature without us having the proper types of procedure that would arise in 
 
proceedings in an administrative court.  If it is being alleged that some impropriety in the 
 
process somehow taints the proceedings, then it is that decision, the decision to refer to 
 
screening, which ought to be challenged and ought to be challenged through the route of 
 
Judicial Review where there would be a number of protections and very well established 
principles as to the proper way to deal with the challenge.   
 
 

What we have here, as I have indicated already, is fishing on the part of the doctor 
 
desperately trying to find documents that may in some help him, and then a complaint of 
 
a general nature that we do not disclose everything because it might help him. 
 
 
 
Yet no basis in my submission for how it is said that these documents might assist his 
case or undermine our case is put forward.  We are then subject to criticism if we do not 

simply disclose everything that is asked for. 
 
 
 
I have indicated already that we seek to deal with our obligations of disclosure properly 
 
and, if I may say so, in accordance with those duties of a prosecuting authority.  Your 
 
learned Legal Assessor did refer to a case this morning.  I have not had an opportunity to 
 
investigate that point further, not least because I have been dealing with other matters, as 
you might anticipate, but I am quite willing to accept at least for these purposes that we 

should be so dealing with issues of disclosure.  I do not seek to make an argument out of 
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that but we ought properly to disclose documents if they undermine our case or assist the 
 
defendant’s case.  In my submission there is simply no basis for saying that there are any 
 
undisclosed documents that are relevant to that point.  
 
 
 
So, may I then finally, subject to any issues that arise out of any of those, turn to the one 
 
specific area of abuse raised by my learned friend in respect of the second of the charges 
before you, that is to say the non-disclosure of documentation. 

 
 
I have referred you already to the case of A Health Authority v X and the strong public 
 
interest in the proper administration of professional disciplinary proceedings.  This 
 
Committee is empowered by Regulation 50 to receive evidence over a very broad remit.  
 
There is nothing in the regulations that restricts the  receiving of evidence on the grounds 
 
of confidentiality.  Of course the Committee would bear in mind any lack of consent for 
disclosure of medical records but, if documents are available, there is nothing, in my 

submission, to prevent the Committee receiving them and, having regard to the Judgment 
 
of the Court of Appeal in A Health Authority v X, everything to suggest that, when you 
 
consider the balancing exercise of whether documents ought to be received, you would 
 
lean very much in favour of receiving documents before you that might assist the doctor, 
 
even if the patient to whom the document referred did not give consent.   
 
 
In my submission, insofar as documents are available, there is nothing to prevent you 

receiving them.  My understanding is that Dr Cosgrove has a quantity of documents 
 
himself relating to this patient, there being his private notes.  His concern is that he 
 
should not use those documents  without the written consent of the patient.  It is not clear 
 
to me what attempts are being made on behalf of Dr Cosgrove to obtain the consent, but I 
 
accept my learned friend’s statement that those attempts have been made but in my 
 
submission there is nothing in any event to stop you receiving those documents in 
evidence. 

 
 
Insofar as other documents are concerned, my understanding is that records relating to Dr 
 
Holmes’ practice would be with the relevant Trust.  We had sought – and of course 
 
timetables have changes somewhat – to have Dr Holmes bring those documents to the 
 
Committee so that they would have been available, but we discovered last week that he 
has since left that Trust.   
 
 

Sir, there is going to be the opportunity in this case because of time considerations that 
 
have already been canvassed, to have somebody from the Trust produce those  documents 
 
and, in my submission, in that case, just as much as in Dr Cosgrove’s notes, you will be 
 
able to receive and properly receive those documents if they are relevant to the issues. 
 
 
In fact, sir, you will have noted that passage that my learned friend read from the letter in 

response to the Rule 6 letter and it appears from that passage, if I may say so, that the 
 
issue that arises in this case is as to whether Dr Holmes was asked to do monitoring by Dr 
 
Cosgrove and, if so, whether he did that monitoring.  There are clearly factual issues 
 
between the parties, as my learned friend correctly identifies.   
 
 
 
You may think that in reality that is not an issue that medical records are going to assist 
on in any event.  It is a very straight conflict of fact between Dr Holmes on the one hand 

and Dr Cosgrove on the other hand as to what the arrangement between them was for 
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monitoring.  So, in my submission, any medical records will be of limited assistance in 
 
any event. 
 
 
 
Sir, finally on this point I refer you to the third case in that bundle of cases before you, a 
 
case called R v Feltham Magistrates’ Court.  Sir, this is a case that deals with video 
 
evidence that was not available at trial and with the arguments that arose as to the 
unfairness to the Defendant in that case as to the non-availability of the  

evidence. 
 
 
 
I will read the headnote, if I may: 
 
 
 
“Where courts are dealing with an application to stay proceedings against 
 
a defendant for abuse of process on the grounds that videotape evidence 
has been obliterated, the court should structure its inquiries by 

considering whether in the circumstances of the particular case, the 
 
nature and extent of the investigating authorities’ and the prosecutor’s 
 
duty if any, to obtain and/or retain the videotape evidence in question.  In 
 
doing so the court should have recourse, first, to the 1997 Code of 
 
Practice published pursuant to sections 23 and 25 of the Criminal 
 
Procedure and Investigations Act 1996, relating to the nature and extent 
of the duty of the police and other investigating authorities to obtain and 

retain material which may be relevant to an investigation and, second, to 
 
the guidelines issued by the Attorney-General on November 29 2000 
 
concerning the disclosure of information in criminal proceedings.  If, in 
 
all the circumstances, there is no duty to obtain and/or retain that 
 
videotape evidence before the defence first sought its retention, then 
 
there can be no question of the subsequent trial being unfair on this 
ground.   If, however, such evidence is not obtained and/or retained in 

breach of the obligations set out in the 1997 code and/or the Attorney 
 
General’s guidelines, then the court has to go on to consider whether it 
 
should take the exceptional course of staying the proceedings for an 
 
abuse of process.  There will be an abuse of process if there is either an 
 
element of bad faith or, at the very least, some serious fault on the part of 
the police or the prosecuting authorities and it is clear that the defendant 
 
cannot be fairly tried.  The court, however, has to bear in mind the fact 

that a fair trial involves fairness to both the defendant and the prosecution 
 
and that the trial process itself is equipped to deal with the bulk of 
 
complaints on which applications for a stay are founded.” 
 
 
 
I pause there, sir.  It is factually a different situation but there are very few cases on abuse 
of process and the absence of evidence and, in my submission, what the Feltham 

Magistrates’ Court makes clear is that the non-availability of evidence will not lead to a 
 
stay of proceedings as an abuse of process without there being evidence of, in broad 
 
terms, misconduct on the part of the prosecution.  That misconduct might be bad faith, it 
 
might be serious fault as well as prejudice to the defendant or, in this case, the doctor.  It 
 
is argued that there is prejudice.  I suggest there is no evidence of that but, more to the 
 
point, I submit that there is no evidence of any bad faith or misconduct of any nature 
whatsoever in respect of the non-availability of these medical records. 

 
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If you treat the lack of consent from parents as preventing the documents being disclosed, 
 
sir, then that is through no fault, we say, on the part of the prosecution. 
 
 
 
Sir, unless I can assist further – and your Legal Assessor may have questions, I do not 
 
know – those are my submissions. 
 
 
THE LEGAL ASSESSOR:  Mr Pearce, thank you.  I have a number of questions.  Just 

going to your submissions on part 2 first, I just want to make sure I have understood this 
 
correctly.  It is your submission that Rule 50 empowers this Committee to receive Dr 
 
Cosgrove’s notes in relation to patient A.  Is that correct? 
 
 
 
MR PEARCE:  Yes, sir, that is may submission. 
 
 
THE LEGAL ASSESSOR:  In deciding whether to receive those notes, the Committee 

would take into account, would they not, the interests of patient A – I believe he is a 
 
child? 
 
 
 
MR PEARCE:  Yes.  
 
 
 
THE LEGAL ASSESSOR:   Now, as regards the records of Dr Holmes, if I have 
understood you correctly, the Council are making efforts to have those notes brought to 

the resumed hearing, if, indeed, there is to be a resumed hearing in the matter.  
 
 
 
MR PEARCE:   I have to say we have not done that yet, sir, there having been so many 
 
things going on over the last week.  What I am saying is that we will do so if there is a 
 
resumed hearing.  I cannot, of course, guarantee they will be here.  I can only guarantee 
 
that we will make the efforts to get them here, which is slightly different. 
 

THE LEGAL ASSESSOR:  I just wanted to make sure I had understood that.  There is an 
 
intention? 
 
 
 
MR PEARCE:  Yes. 
 
 
THE LEGAL ASSESSOR:  The other matters that I wanted to raise with you is 
 
concerning legitimate expectation. 

 
 
MR PEARCE:  Yes.  
 
 
 
THE LEGAL ASSESSOR:  Now, during the course of your submissions you said to the 
 
effect that the simple passage of time could not give rise to a legitimate expectation. 
 

MR PEARCE:  Yes.  
 
 
 
THE LEGAL ASSESSOR:   Can I just question that in this way.  My understanding is 
 
that Article 6 of the European Convention of Human Rights as incorporated by the 
 
Human Rights Act, now requires proceedings like this effectively to be held within a 
 
reasonable space of time.   
 

MR PEARCE:  Yes.  
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THE LEGAL ASSESSOR:  Is it not the case that if a complaint is made and just left, 
 
there will inevitably come a point in time when the person who is complained about will 
 
say, “So much time has elapsed I have a legitimate expectation that it has all been 
 
forgotten about”? 
 
 
MR PEARCE:  Yes, as an aspect of their right to a fair trial, yes.  

 
 
THE LEGAL ASSESSOR:  As an aspect of, if I can call it the English law, doctrine of 
 
legitimate expectation?  I am just questioning whether or not the mere passage of time 
 
can never amount to in due course a legitimate expectation arising that there will be no 
 
further action taken on the complaint. 
 
 
MR PEARCE:  It can certainly give rise to an remedy if action is taken but that, if I may 

say so, is not precisely the same matter. 
 
 
 
THE LEGAL ASSESSOR:  I am just a little concerned about what I understood you to 
 
say, that it does not matter how long it goes on for, we never told Dr Cosgrove  he is not 
 
going to prosecuted.  You say that no legitimate expectation can arise in his mind that he 
 
will not be prosecuted by the mere passage of time?  Is that your submission? 
 

MR PEARCE:  Yes.  Nor did it arise here but I appreciate you are asking whether it could 
 
arise, not whether it did arise. 
 
 
 
THE LEGAL ASSESSOR:  Just as a matter of law, really.  The other point was in 
 
relation to the promise.  You said nothing in the rules or procedure can prevent a change 
 
from the performance procedure to the conduct procedure. 
 

MR PEARCE:  Nothing does, yes. 
 
 
 
THE LEGAL ASSESSOR:  I was going to ask you the question the other way round.  
 
Once the performance procedure has been instigated, if I can put it that way, and in Dr 
 
Cosgrove’s case in relation to certain charges it clearly was, I was really asking you the 
other side of the coin – how do you justify by relation to the rules or in law the change to 
 
conduct proceedings? 

 
 
MR PEARCE:  If the matter is referred to a screener, the screener has to decide whether 
 
the circumstances referred to him or her may give rise to an issue of professional conduct 
 
and is obliged to refer to the Committee if it does. 
 
 
THE LEGAL ASSESSOR:  Forgive me.  What I understood had happened in this case 

was that Dr Cosgrove had been told you were going down the performance route.  Is that 
 
right? 
 
 
 
MR PEARCE:  On those cases. 
 
 
 
THE LEGAL ASSESSOR:  On those charges.  Later he is told, “No, it is conduct on the 
basis of further information.” 

 
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MR PEARCE:  Yes. 
 
 
 
THE LEGAL ASSESSOR:  What I am just seeking is, can you point to a rule or some 
 
implication that can be derived from a rule as to which permits that or are the rules just 
 
silent? 
 
 
MR PEARCE:  The rules are silent on that point, in my submission.  How it comes to be 

before a screener, of course, is a matter of internal practice within the GMC.  This is 
 
precisely the kind of reason I say that this is an inappropriate forum but be that as it may, 
 
I appreciate the argument is launched and I have to meet it on abuse of process. 
 
 
 
What may be being suggested – and let us be open about it – it may be being suggested 
 
that the decision was in some way perverse which is precisely what this Committee is ill 
placed to judge.  Not that it is not empowered to do it, in my submission.  It is not that 

there is anything in the rules that could prevent that decision being made, only that if the 
 
decision were made it might be said to be the case that is was perverse to change one’s 
 
mind. 
 
 
 
THE LEGAL ASSESSOR:  Let me just explore this because I am still not quite clear, I 
 
am a little worried about this.  If Dr Cosgrove is told that his conduct on a particular 
occasion is to be dealt with under the performance procedure, can it not be said that he 

has got a legitimate expectation that it will be dealt with under that procedure? 
 
 
 
MR PEARCE:  As it happens it has been put forward as a promise but more to the point, 
 
why should that give rise to an expectation that it will be dealt with in that procedure 
 
rather than any other procedure?  He knows there are going to be proceedings.  That is, if 
 
I may say so, that puts my learned friend’s case another way, to suggest that it gives rise 
to an expectation rather than it is a promise that it will be dealt with like that.  Since I 

might well say what is so very different about going down the conduct route than going 
 
down the performance route?  There are different consequences of it.  Why is one, as it 
 
were, favourable, less favourable then the other? 
 
 
 
THE LEGAL ASSESSOR:  I think this all arises out of the fact that there is no express 
provision for a change in the rules.  Is that a fair comment? 
 
 

MR PEARCE:  If I may say so I am not sure that I follow that.   
 
 
 
THE LEGAL ASSESSOR:  I am not making myself clear.  All I am saying is there was 
 
mention made of the rules and in this case  there has clearly been a change in relation to 
 
certain counts from performance to conduct? 
 

MR PEARCE:  Yes.  
 
 
 
THE LEGAL ASSESSOR:  There does not appear to be any rules which bear directly on 
 
that. 
 
 
 
MR PEARCE:  I agree with that.  
 

THE LEGAL ASSESSOR:  Right, so it is a sort of vacuum? 
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MR PEARCE:  Yes.  
 
 
 
THE LEGAL ASSESSOR:  That is helpful.  The other point – I am sorry to jump around 
 
but I was making a list and a note of them as I went along.  I obviously listened to what 
 
you had to say about the categories of conduct which may constitute an abuse of process.  
 

MR PEARCE:  Yes.  
 
 
 
THE LEGAL ASSESSOR:  At Archbold paragraph 456, there is a reference, perhaps 
 
rather confusingly called R Horsferry Road Magistrates’ Court ex parte Bennett
 
 
 
MR PEARCE:  Yes.  
 

THE LEGAL ASSESSOR:  I will not read the paragraph there but if I can just refer you 
 
to it.  It seems to me from my reading of that authority that there is a category of conduct 
 
which may be classed as an abuse of the process which does not depend upon the 
 
defendant’s right to a fair trial being prejudiced or there being, shall I say, culpable 
 
conduct on the part of the prosecution or, if you like, someone who provides evidence to 
 
the prosecution, namely a complainant.  Would you agree with that? 
 

MR PEARCE:  I agree that there is a category of abuse of process that arises out of State 
 
actions, where the State actions are independent of the prosecution process and do not 
 
affect the ability of a defendant to defend themselves. 
 
 
 
THE LEGAL ASSESSOR:  As I understood it Mr Morris relies on the case of Bennett 
 
primarily as there is this category of abuse and it does not matter whether – I am really 
just repeating myself.  Do you accept that there is that sort of, I would not say residual 

category but… 
 
 
 
MR PEARCE:  Limited to state actions as is expressed in the case by the House of Lords 
 
in Bennett.  The sentence – you may have noticed I picked up a file, I do have a copy of 
 
Bennett here but my recollection is that the sentence that begins with: 
 
 
“Lord Griffiths said that the court had the power to interfere with the 

prosecution because the judiciary accepted a responsibility for the 
 
maintenance of the rule of law invoked a willingness to oversee executive 
 
action and to refuse to countenance behaviour that threatened either basic 
 
human rights or the rule of law.” 
 
 
Bennett in my submission is a narrow factual situation. It is an important residual right 

but it is not a general line as to abuse of process.  It is very specifically to the misuse of 
 
executive action.  In that case that is another deportation or extradition case of somebody 
 
being brought into the country by --- 
 
  
 
THE LEGAL ASSESSOR:   I think Bennett was tricked into the country in South Africa 
 
and he was then promptly taken off the aircraft at Heathrow and he complained, 
summarising it probably very simplistically. 

  
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Well, just to put it this way.  If - if - it was a case that there was a change from Conduct to 
 
Performance in the case of certain charges and if that is against the law (if that is against 
 
the law to put it simply) is it possible for that to fall within the category which I have just 
 
outlined?  There has been a procedure -- just assuming for the sake of argument that the 
 
change from Performance to Conduct constitutes a breach of some procedural 
 
requirement for a fair trial, can that or could that ever possibly - and I am just talking 
about questions of law - fall within the category of abuse as we have just been 

discussing? 
 
  
 
MR PEARCE:   I would say it would not come close to that area of such conduct. 
 
  
 
THE LEGAL ASSESSOR:   But would it be a question of fact, or would it be a question 
 
of law then? 
  

MR PEARCE:   Well, I suppose it would be ... 
 
   
 
THE LEGAL ASSESSOR:   I am sorry to be asking you difficult questions, but this is a 
 
difficult area. 
 
  
 
MR PEARCE:   No, no.  One could postulate facts where the change from Performance to 
Conduct involved such misconduct on the part of the executive that it did fall within 

Bennett, but it would be miles, or kilometres I think I am supposed to say, away from 
 
where we are here, in the sense that it would have to involve executive misdeeds, rather 
 
than some decision at this level in the GMC in my submission. 
 
  
 
THE LEGAL ASSESSOR:   Well, you will appreciate that I cannot comment on 
 
questions of fact to the Committee. 
  

MR PEARCE:   Yes. 
 
  
 
THE LEGAL ASSESSOR:   What they are entitled to expect from me is guidance on 
 
what test is to be applied and what findings are open to them on the evidence. 
 
  
MR PEARCE:   Yes. 
 
  

THE LEGAL ASSESSOR:   So, if I state the parameters it is because I want to know or I 
 
want to see --- 
 
  
 
MR PEARCE:   No, I understand that. 
 
   
THE LEGAL ASSESSOR:   So, you accept my understanding of the law in Bennett

  
 
MR PEARCE:   Yes. 
 
  
 
THE LEGAL ASSESSOR:   And on the premise that the change between Performance 
 
and Conduct may, looking at the law in detail, amount to conduct which might fall within 
 
that category? 
  

MR PEARCE:   I do not accept that what is being factually alleged here could ever fall 
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anywhere close to the Bennett category. 
 
  
 
THE LEGAL ASSESSOR:   I see. 
 
  
 
MR PEARCE:   All I am saying is that one could postulate facts involving misconduct by 
 
a Cabinet Minister involving GMC procedures which did amount to such an abuse of 
process, but it is an extreme area of case and what is being alleged here could not come 

close to it in my submission. 
 
  
 
So, I think to try and put that accurately for what you have to direct the Committee, my 
 
submission is what is being alleged here could not amount in law to that kind of abuse of 
 
process. 
 
  
THE LEGAL ASSESSOR:   Right.  Can I just pick you up on one thing there.  I do not 

direct the Committee.  I have to advise them. 
 
   
 
MR PEARCE:   No, you advise them. 
 
  
 
THE LEGAL ASSESSOR:   So, that apart, thank you very much indeed. I am much 
 
obliged. 
  

MR MORRIS:   Sir, I would ask for a short indulgence to enable me to look at the 
 
additional documentation that was put before you and I have not had a chance to look at 
 
from D's medical notes. 
 
  
 
THE CHAIRMAN:   Yes.  Clearly there are quite complex legal issues here and the Legal 
 
Assessor is not going to give his advice this evening.  He will think about it overnight and 
he will give his advice first thing in the morning.  We could have a short break just now 

and come back to see if there are any issues you want to raise in relation to the clinical 
 
notes which have been made available and get that out of the way today and leave the 
 
field free to the Legal Assessor to start first thing in the morning.  Would that be 
 
acceptable to you? 
 
  
MR MORRIS:   I would like to do that, sir, and if I may just reply as I think I am entitled 
 
to to my learned friend's submissions briefly? 

  
 
THE CHAIRMAN:   Yes.  I also wondered if you might have had observations on the 
 
conversation that took place between the Legal Assessor and Mr Pearce? 
 
   
 
MR MORRIS:   Yes, I do. 
  

THE CHAIRMAN:   So, we will have a break just now and we will come back just 
 
before 4 o'clock. 
 
  
 
(The Committee adjourned for a short time
 
  
 
THE CHAIRMAN:   Mr Pearce? 
  

MR PEARCE:   I wonder whether I might return to a point on which I was responding to 
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some questions raised by your learned Legal Assessor a moment ago, sir, and that is the 
 
decision of the House of Lords in ex parte Bennett
 
  
 
THE CHAIRMAN:   Yes. 
 
  
 
MR PEARCE:   It occurs to me -- I have a copy in front of me which I have annotated, 
but it then occurred to me that your learned Legal Assessor may not have one.  So, I can 

only refer to certain page references and either we will arrange to serve a copy to come to 
 
you, or as the case may be. 
 
  
 
But, sir, in my submission each of their Lordships in the case of ex parte Bennett in the 
 
majority made clear that they were dealing with executive action and not any other forms 
 
of misconduct.  And I should say that of the five Lordships in the  House Lord Oliver 
dissented in any event and felt they had no jurisdiction. 

  
 
So, if we put his Judgment aside, for the other four Lordships I shall simply give you 
 
relevant page references if I may, sir.  In the case of Lord Griffiths it is -- and this is, I 
 
should say, the Weekly Law Reports for 1993, Volume 3, Page 90.  Lord Griffiths deals 
 
with this issue on Page 104 at Paragraphs E to F and Lord Bridge deals with the position 
 
at Paragraph 110 Letter A.  In Lord Bridge's case, but not in the case of the rest of the 
majority in the House of Lords, it appears to be the case that he was limiting the abuse 

even more narrowly to executive action outside of the United Kingdom within the 
 
territorial jurisdiction of another country, but he is in the minority of one I think on so 
 
limiting it. 
 
  
 
Lord Lowry, at Page 119 F, again indicates that the Court "... must jealously protect its 
 
process from misuse by the executive", which words he highlights, and then finally Lord 
Slynn in one of those one-paragraph Judgments where he agrees with everybody else 

clearly agrees with what the majority have to say and in particular adopts the speeches of 
 
Lord Griffiths.  So, in my submission that principle is limited to the misuse of power by 
 
the executive. 
 
  
 
THE LEGAL ASSESSOR:   Thank you. 
  
 
 MR MORRIS:   Now, sir, may I respond to the submissions of my learned friend and 

start off with Head of Charge 6 and the two options which he quite accurately spelled out 
 
as to:  (1) whether the first case that I made was that there were two different people, or 
 
two different authors, for the letters at 1996 and the letters of 2000 onwards; or, if that 
 
was not right, there was the alternative proposition that I put forward that the author was 
 
one and the same person. 
  

And I think it was in the context of that latter proposition that Mr Pearce said that, if that 
 
is right, you have this scenario that you have the mother who is at first not complaining 
 
and being manipulated by Mr Daniels on behalf of the Commission inasmuch as he is 
 
putting in documents on her behalf without her authority, but now in 2004 you have the 
 
good lady coming here to say, "But I do support the complaint.  I do adopt the 
 
complaint", and he says to you, "That is madness to make such a proposition". 
  

Well in an ideal world it would be madness, but I am afraid that in relation to the Head of 
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Charge we are not in an ideal world. We are in a world that is coloured by the attitude and 
 
approaches and procedures of the Church of Scientology and I say on behalf of Dr 
 
Cosgrove that, if you look at the evidence here, it is not a mad proposition to make. 
 
  
 
Look at the difference in the tone of the letters that were written, if we are assuming that 
 
this is the same person, in  1996, and the manner and tone in which that person - that 
author - gave evidence before you in 2004.  There could not be a starker difference.  In 

1996 she was writing gratefully to Dr Cosgrove saying that, "Were it not for you, Doctor 
 
..." -- I am not quoting her accurately, but the substance is correct.  "Were it not for you, 
 
Doctor, I am sure that my child now would be in care”, whereas now we have put forward 
 
in strident tones all the criticisms that, in my submission, have all the hallmarks of the 
 
concerns of the Commission of Scientologists.  
 
 
I suggest she has been suborned, corrupted by the Commission.  That is not a mad 

proposition.  That is what Scientologists do.  Do not take my word for it.  In the Foster 
 
Report Mr Foster made reference to the Anderson Inquiry.  You will recall that that was 
 
the Inquiry that took place in the State of Victoria a few years before the Foster Inquiry 
 
was set up.  It is detailed at paragraph 17 of the report.  Mr Anderson is described by Mr 
 
Foster, 
 
 
“Mr Kevin Victor Anderson, Q.C., a distinguished leader of the Melbourne Bar, 

who has since been elevated to the Victorian Supreme Court Bench.” 
 
 
 
He chaired the Inquiry.  You may think, unlike any other Inquiry into Scientology and its 
 
practices, this was an Inquiry where all parties took an active part, those against, those in 
 
favour and the Church itself took an active part in the proceedings.  They were all 
 
represented by Solicitors and Counsel. They were all available to give evidence on oath 
with cross-examination of witnesses.  The evidence was given in public.  I am looking at 

paragraph 18.  I will be corrected if it I am wrong, but also significantly it was the only 
 
Inquiry in which Scientologists, and they later felt this was a big mistake, agreed to take 
 
part in this full and frank way.   
 
 
 
The thoroughness of the Inquiry is set out at paragraph 19 and the conclusions drawn by 
Mr Anderson in his report at the conclusion of this very thorough Inquiry of 160 days, 
 
151 witnesses, many millions of words given in evidence, proved to be wholly 

unfavourable to Scientology.   
 
 
 
“Scientology is evil; its techniques evil;  its practice a serious threat to the 
 
community, medically, morally and socially, and its adherents sadly deluded and 
 
often mentally ill.   
 

(10)  Scientology is a fabric of falsehood, fraud and fantasy.” 
 
 
 
That is not someone shooting from the hip.  That is the considered conclusion of Mr 
 
Anderson at the end of that Inquiry.  I am afraid this is the nature of the beast you are 
 
dealing with.  That is why I suggest that it is not madness to make that proposition.   
 
 
If I am right and the name of your panel member who stood down has been put on to the 

names of the letterhead of the Commission as someone who is clearly senior, active and 
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centrally involved in that Commission when that is not the truth, that speaks volumes for 
 
the nature of the organisation with whom Mrs D got involved.   
 
 
 
My learned friend sought to defend Mrs D from any allegations of dishonesty.  Of course, 
 
it is a matter for you and you have to make up your own minds.  He tells you that the 
 
manner she gave evidence and the way she dealt with cross-examination showed only that 
she was an honest witness.  I regretfully have to dispute that submission.  The evidence of 

her dishonesty is perhaps most obvious just from two documents.  They are D6 and D2.  
 
They are the letter of complaint which she said she wrote out in manuscript and had typed 
 
by Mr Daniels, and D2, the letter of authority giving consent for the disclosure of her 
 
son’s medical records which she said she wrote out in manuscript and got a near 
 
neighbour to type up.  In my submission, that cannot be correct if you look at the form of 
 
those two letters and the heading, and the fact that in both those letters her name, 
apparently if she is right, copied incorrectly by two different people, one her neighbour 

and one Mr Daniels when typing out her manuscript. 
 
 
 
That is a telling piece of evidence, in my submission, which tells you that she has come 
 
here with every intention, not of telling the truth but of hiding the degree of involvement 
 
by the Commission in the complaint that she now seeks to assert is hers and effectively 
 
hers alone.  That is my answer to the rhetorical question my learned friend asked you in 
his submissions:  where is the evidence in this case of orchestration of complaint?     

 
 
Can I turn to the breach of promise issues and can I deal with them globally, inasmuch as 
 
they both concern the effect of head of charge 6 and as they stand as a freestanding head 
 
of abuse.  Mr Pearce says this is just a technical point that has occurred to those advising 
 
Dr Cosgrove in the last few days, indeed over the weekend.  It has no merit for that 
 
reason, because if it had any merit you would expect Dr Cosgrove when he received his 
rule 6 letter to screaming from the roof tops.  It is a novel proposition, in my submission, 

that an abuse of process only becomes an abuse of process if the victim of it complains.  
 
If he remains silent there is no abuse.  I do not accept that for one moment on the part of 
 
Dr Cosgrove, who you have not heard from and we have here a doctor who has been 
 
notified of complaints sometimes up to three years before that letter was written.  When 
 
the letter is duly written on 1 October 2002 who is to say what his reaction should be?  
Who is to say what his knowledge of the law of abuse of process might be and whether or 
 
not he felt entitled to make any complaint of the fact that after three years he was being 

sent down the conduct route? 
 
 
 
Can I deal with the factual matters in relation to additional matters of complaint or 
 
information that may have come in to the Council subsequent to the decisions made by 
 
the first screener or screeners in which cases were sent down the performance route?  My 
learned friend relied on a new document, C6.  Can I put in a further memorandum which 

was in the bundle disclosed last week and the Committee have not seen?  Of course, I 
 
appreciate I should not be putting in new documentation at this time.  If my learned friend 
 
wishes to make further submissions on it I shall not stand in his way.   
 
 
 
THE CHAIRMAN:  This will be D26. 
 
 
MR MORRIS:  This is a memorandum from Mr Lynn to the screener, Dr Malcolm Lewis, 

dated 12 September 2002, first of all, dealing with the proposed heads in the proposed 
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rule 6 letter.  Can I take you to paragraph 3, which hopefully will begin to fill in some of 
 
the gaps you might be wondering about in the Cosgrove open cases list which I would 
 
invite you to turn up.  It is the table at D22.  Paragraph 3, 
 
 
 
“I would be grateful if you could confirm your approval of the revised allegations 
 
and also to sign off the SDFs which I have attached to the front of the appropriate 
files.  There are only seven files as I have removed the latest file which you 

declared an interest in and suggested that we need to make further inquiries, and 
 
the three closed cases which were complaints from Dr Cosgrove…” 
 
 
 
not about Dr Cosgrove, 
 
 
 
“…have similarly been removed because no allegations arise from those cases and 
they are in any event already closed.  These seven files are therefore the ones 

where screening decisions had to be taken.  You might find the following of some 
 
help, but of course your decision and the reasons for it is entirely a matter for 
 
you.” 
 
 
 
Then we have 1997/1376 SDF 04.  If you look at the table you will see that reference and 
 
that is the very first reference.  It is the Home Office drugs reference.  It goes on to say, 
 

“Referral by Home Office.  Field Fisher Waterhouse.  This is not going forward to 
 
PPC.  I think this would have to be on the grounds that there is no probative 
 
evidence to suggest that Dr Cosgrove has prescribed irresponsible for the reasons 
 
we have talked about and which Peter Steele outlined in his advice.” 
 
 
 
So there is nothing there by way of further information justifying any change in the 
previous stance of the Council.  Then we have SDF 06, which I think again refers to the 

Dr Holme complaint.   
 
 
 
“Complaint from Dr Holme.  This is going forward to PPC.” 
 
 
 
In manuscript then 2000/0871.  That we see is the next box down.  That is the 
Pembrokeshire and Derwen NHS Trust going forward to PPC.  2003/017.  That is the 
 
Oxfordshire Mental Health Care NHS Trust going forward to PPC.  2001/1711.  That is 

the Commission’s case.  SDF 01.   
 
 
 
“This case I believe from the FPD system is about…” 
 
 
 
A name of a patient is given.  Indeed, it seems that the patient’s mother’s name appears in 
the box over the page on the table.   

 
 
“This case is not going forward.  Again, I think it would have to be on the basis 
 
that there is no probative evidence that Dr Cosgrove’s prescribing in itself was 
 
serious professional misconduct.” 
 
 
 
So, again, there is no fresh information there justifying a change by the Council.  SDF 02 
is the case of, and I think this clearly is a reference to patient D, which is going forward 

to PPC.  2000/1390 is Dr Karen Moses, Gwent Health Care NHS Trust.  You can see the 
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reference on the table. 
 
 
 
“This is going forward to PPC.” 
 
 
 
2000/3359 is Helen Chubb of Cardiff and Vale, 
 
 
“This is going forward to PPC.” 

 
 
2002/1505, which is one of the cases raised by my learned friend as possibly being new 
 
material, SDF 01 and SDF 02.  We have that.  That is the final box on the table.   
 
 
 
“Referrals from Home Office and West Yorkshire Police.  Neither of these are 
 
going forward to PPC.  Again, I think this would have to be on the basis of no 
probative evidence of Dr Cosgrove’s prescribing in itself being serious 

professional misconduct.” 
 
 
 
That, I hope, fills in some of the lacunae in that table and does not disclose anywhere 
 
further information or complaints that could possibly be said to amount to or raise a 
 
question of serious professional misconduct. 
 
 
Then we have the other matter that was raised out of C6, which is the other memorandum 

from Mr Lynn to Dr Lewis of 5 September 2002, where there was one other matter and 
 
that is at paragraph 3, 2003/1616, which has not made it on to the table of the open cases 
 
list.  Again, we see here that concerns are raised about that and that is put forward to the 
 
screener.  That is a case that came in.  I am not sure when it came in.  I am not sure a date 
 
is put there, but it appears to be a fairly recent case.  It certainly did no get on to that 
 
table.  We know that it did not feature in the rule 6 letter and it does not feature in the 
matters before you.  In my submission, one can infer from that that when it went before 

the screener, presumably Dr Malcolm Lewis, it was not put forward by him to be added 
 
to the list.   
 
 
 
There is nothing in the documentation, in my submission, that amounts to any additional 
 
matters being available to the Council over and above those matters that were already 
there and available to the first screener or screeners when they saw these complaints.  
 
That is an important point and premise when one comes to consider the significance of 

what happened here. 
 
 
 
What you have got here, in my submission, is the Council through one screener looking at 
 
these cases and saying some of them should go down the performance route, and in 
 
relation to others no positive recommendation that they go down the conduct route.   
 

Mr Pearce says on behalf of the Council that there is no evidence of bad faith here on the 
 
part of the General Medical Council.  Well, I make a number of points on that and the 
 
first one is a legal point which, in my submission, is that you do not need to have bad 
 
faith before finding such a breach of promise an abuse of process. 
 
 
 
If you look at the Dean case, D23, I will just refer you to a passage which clearly bears 
repeating because, although I have cited it once, I am not sure it has sunk home in certain 

quarters.  If we look at page 82 – and this I said was one of the leading cases in relation to 
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breach of promise – under the heading “Abuse of Process” Lord Justice Staughton about 
 
half-way down there, referred to the submission made by the prosecuting counsel in that 
 
case that you needed to have either delay or manipulation or misuse of the rules of 
 
procedure but Lord Justice Staughton took the view and the judgement stated such, that 
 
there was authority that the concept was wider than that and he cited a House of Lords 
 
case in which Lord Diplock said: 
 

“The inherent power which any court of justice must possess to prevent 
 
misuse of its procedure in a way which, although not inconsistent with 
 
the literal application of its procedural rules, would nevertheless be 
 
manifestly unfair to a party to litigation before it would otherwise bring 
 
the administration of justice into disrepute among right-thinking people.  
 
The circumstances in which abuse of process can arise are very varied.” 
 

So it is not necessary to establish a manipulation or misuse of the rules of procedure.   To 
 
that extent and in that context it is not necessary to establish bad faith.  At the end of his 
 
judgment over the page: 
 
 
 
“In my judgment the prosecution of a person who has received a promise, 
 
undertaking or representation from the police that he will not be 
prosecuted is capable of being an abuse of process.  Mr Collins was 

eventually disposed to concede as much providing (i) that the promisor 
 
had power to decide and (ii) that the case was one of bad faith or 
 
something akin to that.  I do not accept either of those requirements is 
 
essential.” 
 
 
 
What we have here, then, is a case where these cases were put before a screener and that 
screener decided they should go down the performance route.  Without any further 

information or relevant information or complaint, Dr Lewis in February 2002 has the 
 
complaints back before him.  He looks at them and decides no, this is going to conduct.   
 
 
 
Now my learned friend in discussion with the learned Legal Assessor said that this cannot 
 
possibly approach within kilometres the threshold for amounting to abuse.   There is no 
breach of any rule either within the conduct Committee rules or the performance 
 
Committee rules here.  Again, I take you to the passage from Lord Diplock which says, 

“There can be abuse even though what has happened is not  
 
inconsistent with the literal application of its procedural rules.” 
 
 
 
The logic of what my learned friend is saying is this.  He is saying that it is quite in order 
 
for the General Medical Council through it screeners to say, “Right, we have got a set of 
complaints.  One medical screener says it is performance.  We will put it back before 

another medical screener and see what he says and if we get conduct then so be it, we will 
 
send it down the conduct route.”  The logic of that is this; there would be nothing wrong 
 
if Dr Lewis had said, “No, I agree with the first screener, these matters ought to go down 
 
the performance route.” There would be nothing wrong for the council to say, “We will 
 
put it in front of a third, different, medical screener and see what he or she says” and so 
 
on and so on until somebody says, “We suggest this should go down the conduct route.”  
That is the logic of what he is saying. 

 
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In my submission when you look at it in that rather extreme form you can see quite 
 
clearly why this process can amount to an abuse.  My submission is that in the absence of 
 
any explanation before you as to why those matters came back to a screener, one can only 
 
infer that something very wrong with the process has occurred. 
 
 
 
This is not a situation, as in the case of Murphy where, in a different court at a different 
time – at a very different time – a different view was taken in relation to an indecent 

assault charge.  We are at the very same stage.  Nothing has moved on.  We are at the 
 
screening stage.  Why did it have to come back to the screener when there was nothing 
 
new, no change of circumstance? 
 
 
 
It is quite clear in my submission from what has been disclosed that the powers that be 
 
within the General Medical Council felt thoroughly uncomfortable with what had 
happened and you will recall I took you through the memoranda where numerous 

personnel sought to think why it might be or how it might be that they could justify the 
 
appearance of these matters before another screener and a different view being obtained.  
 
 Throughout it is the suggestion, “There is further information coming in.”  No indication 
 
in Dr Lewis’ memo at the end of February of any such information.  He says at paragraph 
 
7: 
 
 
“In this case the doctor has been previously informed that this case would 

not progress under the conduct procedures.  However, cases that have 
 
come to light since would enable this case to be resurrected under the 
 
appropriate clause.” 
 
 
 
There are no such cases, if you look at the table, nor has my learned friend sought to 
 
identify any such cases.  It goes on with other personnel there talking about the need to 
seek legal advice.  Most extraordinary of all, in my submission, the legal advice that was 

eventually given by Mr Steel on 30 August.  He was quite open, frankly, about the 
 
position.  Under paragraph 1, performance conduct: 
 
 
 
“It appears that all the files were reviewed by Malcolm Lewis on 27 
 
February who screened them all down the conduct route despite the fact 
that some had already been screened down the performance route.  Dr 
 
Cosgrove had been informed that this was the case.  I have discussed this 

with Paul who is of the view that on policy grounds alone we cannot go 
 
behind this decision regardless of whether it was correct in law to do so.  
 
It may in fact have been legitimate for the screener to say that in the light 
 
of the further complaints this case was better dealt with down the conduct 
 
route but that is perhaps an academic debate.” 
 

There were no further complaints and it is not an academic complaint.  If there are no 
 
further complaints we are left with a huge vacuum which the Council cannot fill as to 
 
what possible legitimate reason was there for putting that matter back before Dr Lewis? 
 
 
 
My learned friend went on to deal with the question of non-disclosure of information.  He 
 
said to what issues did the matters or the material that was sought go.  It has been clear 
since the beginning of last week that an abuse argument was being run and disclosure has 

been made.  It is the duty of the prosecuting authorities to review all the material that they 
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have in their possession and to see whether any of it may assist in the defence case as it is 
 
made known to them.   
 
 
 
There has been no indication – and of course I will be corrected if I am wrong and I will 
 
accept that, of course, from my learned friend but there has been no indication – that the 
 
Council has reviewed the original screener’s memoranda to see whether or not there is 
material in there that may or may not assist the defence in the case they seek to put and it 

is not right, in my submission, to describe the request for those memoranda as a “fishing 
 
expedition.” 
 
 
 
The Council have an obligation to review that.  The Council have disclosed the 
 
subsequent screener’s letter.  The original screener’s letter or memoranda must give 
 
reasons why it is that in the view of a medical person it is right that these matters do not 
go down conduct but do go down performance. 

 
 
It followed, I would have thought, as a matter of pure logic that that material must be 
 
relevant to the defence of this case, which is that this doctor is not guilty of serious 
 
professional misconduct. 
 
 
 
My learned friend says that in relation to Head of Charge 6 if Mrs D is guilty of fraud, 
then there is a cast iron defence to that and that can be properly dealt with by the trial 

process where the truth will out.  That is indubitably right but the whole point about an 
 
abuse of process argument and the jurisdiction that allows abuse of process to be argued, 
 
that there are certain sets of circumstances where it would be wholly wrong to put a 
 
defendant at risk in any way of being found guilty of a substantive charge if the process 
 
by which that charge came to be brought has wholly been subverted by the prosecuting 
 
parties or the people who complain to the prosecuting party. 
 

My learned friend cited the case of A Health Authority v X and I wholly agree with the 
 
point made there that it is of overriding importance that the disciplinary process should 
 
take place if appropriate – the words my learned friend cited.  Of course, that is right.  So 
 
it should be that murder trials take place if appropriate and, again, that caveat, “if 
 
appropriate”, is the important quotation here.  Even the most serious of allegations can be 
stopped from being heard if the process by which they came to be put in train has been so 
 
corrupted as to amount to an abuse of the process of the trial procedure. 

 
 
Can I deal finally with the Head of Charge 2 submission.   My learned friend said that he 
 
of course accepted that the parents had not given their consent.  It is my fault if he has not 
 
been shown the basis upon which we say that.  Could I circulate the relevant document? 
 
 
THE CHAIRMAN:  This will be D27.  (Produced

 
 
MR MORRIS:  I have the original letter that was sent by Radcliffes le Brasseur to the 
 
parents dated 5 November here and the original endorsement at the bottom, which his 
 
signed by the patient’s father and says: 
 
 
 
“We regard our son’s medical files as strictly confidential and do not 
agree to the release of such information to your firm or to other people 

connected with the GMC hearing.” 
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it is signed on 18 November 2003 and if the Committee wish to see the original it is here 
 
available for them. 
 
 
 
My learned friend asks really whether or not the notes are going to help here in relation to 
 
the issue that appears to be between the parties here as to whether or not Dr Holmes was 
asked to monitor.  The answer to such an issue, in my submission, clearly the Committee 

would be helped in deciding such a factual dispute, in my submission, by the 
 
contemporaneous notes of both parties where one might, you would think, get some very 
 
cogent assistance as to who made the request for monitoring, what form of monitoring 
 
was done by either Dr Cosgrove or Dr Holmes and whether or not there was any 
 
communication between the two noted in either sets of notes. 
 
 
I of course accept that, if this Committee feels that it would be right to admit those notes, 

it has the power given to it by the Rules to admit into evidence such notes.  
 
Notwithstanding the refusal of consent by the parents I accept that they have that power, 
 
and all I would say is that at present that power has not been exercised and at present the 
 
Doctor could not receive a fair trial on the issues raised in Head of Charge 2 without 
 
being able to look at and consult the relevant notes. 
 
  
And I would invite, if this is what the Committee has in mind and feels it would be right 

to override the consent of the parents, the Committee to make that clear now in its 
 
determination in relation to these various issues so that steps could be put in train for the 
 
notes to be made available in advance of any substantive hearing if there is going to be a 
 
substantive hearing. 
 
  
 
Those are the submissions I make. 
  

THE LEGAL ASSESSOR:   Just very briefly, Mr Morris, I fear one of the places where it 
 
did not quite sink in as regards Bennett and the case of Hunter was with me.  I apologise 
 
if that is the case, but could I just very briefly refer you to the case of R -v- Croydon 
 
Justices, ex parte Dean.  You took us to the passage on D23, Page 82, and I just want to 
 
make sure that I have understood this correctly. 
  
 
You referred us to the passage which Lord Diplock said in the case of Hunter -v- Chief 

Constable of the West Midlands Police [1982].  Have I understood you correctly that is 
 
your submission to this Committee that, applying if you like a definition of abuse of 
 
process as being reflected in that passage, that if I substitute the word "Committee" for 
 
"Court": 
 
  
"the inherent power which any ..." (Committee) "... must 

possess to prevent misuse of its procedure in a way which, 
 
although not inconsistent with the literal application of its 
 
procedural rules, would nevertheless be manifestly unfair to 
 
a party to litigation before it, or would otherwise bring the 
 
administration of justice into disrepute among 
 
right-thinking people", 
  

is it your submission that what happened procedurally in Dr Cosgrove's case amounts to 
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an abuse within that definition or description of the abuse of process? 
 
  
 
MR MORRIS:   Yes, it is. 
 
  
 
THE LEGAL ASSESSOR:   Yes.  I just wondered because, as I understood Mr Pearce, he 
 
was saying as I understand him that his submission was that it could not possibly -- what 
happened procedurally in this case could not possibly meet that test but, as I understand 

you, you are saying, "No, that is wrong.  It does fall within that test". 
 
   
 
MR MORRIS:   Yes. 
 
  
 
THE LEGAL ASSESSOR:   Thank you.  Okay, I am grateful. 
 
  
MR MORRIS:   Yes.  And I gave the rather extreme example where if this matter had 

gone back not just to the second screener, but to a third, fourth and fifth screener.  I hope 
 
that makes it clear. 
 
  
 
THE LEGAL ASSESSOR:   And just so I have clearly understood, if the Committee is 
 
minded to say that they use their power under Rule 50 in relation to the medical records, 
 
which are relevant to Count 2 I think it was, then that would solve any difficulty provided 
they exercised their power now? 

  
 
MR MORRIS:   Yes, because I could not submit that the Doctor was unable to have a fair 
 
trial on that Head.  That is assuming that the earlier submissions have failed. 
 
  
 
THE LEGAL ASSESSOR:   Absolutely, yes. 
 
  
MR MORRIS:   Yes. 

  
 
THE LEGAL ASSESSOR:   And then just lastly, if they were not minded to consider to 
 
exercise their power under Rule 50 then a different set of circumstances would apply? 
 
  
 
MR MORRIS:   Then my submission would remain. 
  
 
THE LEGAL ASSESSOR:   Yes, thank you very much indeed.  Thank you. 

  
 
THE CHAIRMAN:   Well, I think that has brought us to the end of the submissions and it 
 
has brought us to the end of the proceedings for today.  We shall reconvene hopefully at 
 
9:30 tomorrow and, with a bit of luck, the Legal Assessor will be able to give his advice 
 
before we go into camera. 
  

Thank you very much. 
 
  
 
(The Committee adjourned until Tuesday, 27 January 2004 
 
at 9:30 a.m.
 
  
 
  
  

  
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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
Tuesday, 27 January 2004 
 
Held at: 
Barnett House 
53 Fountain Street 
Manchester M2 2AN 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Five) 
 
 
Committee Members: 
Professor Norman Mackay (Chairman) 
Dr Alison Hamilton 
Mr John Matharu 
Dr Belinda Stanley 
Mr Richard Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of TranscribeUK 
Tel No:  0208 614 5799) 
 
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INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
 
PRELIMINARY MATTER RELATING TO COMMITTEE MEMBER         1 
 
 
 
LEGAL ASSESSOR’S ADVICE                                                                       2 
 
DETERMINATION 
        
 
 
 

 
 
 
 
 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:  Good morning.  Before I ask the Legal Assessor to tender his advice 
 
I would wish to report that following on from a letter which was submitted to the Panel 
 
yesterday, D17, the question was raised as to whether the Christopher Brightmore whose 
 
name featured in the left hand side of that page was the same person who originally 
 
started on this Panel on Monday of last week.  As you recall, Mr Brightmore stood down. 
 
 
Last night I had a telephone call from Mr Brightmore and he confirms that he is one and 

the same person who features on this letter.  He was a Commissioner of the Citizens 
 
Commission on Human Rights, but he informs me that he resigned that position on 1 
 
January 2001.  This letter is dated 28 March 2001 and the explanation that was given to 
 
me was that his name featured on that document, because the Commission was using up 
 
old notepaper, but that his name has been removed from it subsequently.  It does not alter 
 
the fact that he was a Commissioner on the Citizens Commission on Human Rights.  That 
piece of information was not known to us last week when he stood down. 

 
 
I thought in the circumstances that, as Mr Morris was raising questions as to whether the 
 
name Brightmore was the same Mr Brightmore as sat on our Panel and whether his name 
 
appeared on that letterhead with his knowledge and permission, I should certainly share it 
 
with you all today.  Mr Morris. 
 
 
MR MORRIS:  Sir, I am very grateful for that information.  I was given it by the learned 

Legal Assessor a little in advance of our sitting, so I have had an opportunity to discuss it 
 
with Dr Cosgrove.  There are three small points I wish to make.  The Chairman is quite 
 
right in saying that at D17 there is a letter dated 28 March which still carries Mr 
 
Brightmore’s name on the letterhead.  There is also a later letter of 9 May in D17, which 
 
also has his name on it, so it does appear that five months after his resignation the 
 
Commission was still using outdated letterhead paper.   
 

The second point is that it is a matter of regret, as far as the defence of Dr Cosgrove are 
 
concerned, that this information was not made known at the outset of this hearing when 
 
the possibility of the involvement of members of the Committee with Scientology or in 
 
any connection with Scientology was raised, because obviously, had I known that, I 
 
would not have made the submission in relation to Mr Brightmore that I did yesterday.  I 
obviously must withdraw the suggestion that I made yesterday that if Mr Brightmore was 
 
correct in what he disclosed to us at the outset, then this was a serious misrepresentation 

on the part of the Commission to include his name as one of their Commissioners.  
 
Clearly, the Commission cannot be criticised for that and I withdraw that.   
 
 
 
Nevertheless, my overall submissions about the Commission remain and I made the 
 
submission I did about Mr Brightmore very much as a footnote to those submissions.  I 
remind the Committee that I also submitted that the Commission had been guilty of 

misrepresenting Professor Roth leading to defamation action, and that generally they 
 
were imbued with the Scientology approach to psychiatry as set out in the Foster Report, 
 
and indeed confirmed by way of up to date approach by exhibit D16, the front of the 
 
current website, where psychiatry is equated with misappropriation, pretended authority, 
 
betrayal, raft, abuse and greed.  I am very grateful to the Committee for raising that.   
 
 
THE CHAIRMAN:  Mr Pearce. 

 
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MR PEARCE:  Sir, we are grateful for you raising the point.  We have nothing to add to 
 
what is being said. 
 
 
 
THE CHAIRMAN:  Thank you very much.  At this point I will turn to the Legal Assessor 
 
for his advice. 
 
 
THE LEGAL ASSESSOR:  I have written my advice down.  I propose to read it to you as 

it is in draft.  The reason for this is that the draft can then be taken with the Committee 
 
into its deliberations and can be referred to, should they need reminding of the advice.  Of 
 
course, if any new advice is given in the course of deliberations the parties will be 
 
informed of that. 
 
 
 
My advice is as follows:  Mr Morris wishes to make an application to stay these 
proceedings on the ground that their prosecution amounts to an abuse of the process.  He 

does so in relation to the entirety of the charges and in relation to specific charges.  What 
 
is an abuse of the process?  One looks in vain for a comprehensive definition in the 
 
authorities and in the case law.  In order to hopefully provide guidance to the Committee 
 
I propose to adopt and then attempt to adapt the circumstances of a GMC disciplinary 
 
hearing the words of Lord Diplock in the case of Hunter v Chief Constable of the West 
 
Midlands Police.  I pause there to say that that is a House of Lords authority, as quoted in 
R v Croydon Justices, ex parte Dean, which the Committee has at page 82 of D23.   

 
 
The result of this attempt and adaptation is as follows.  An abuse of the process occurs 
 
when there is a misuse of the GMC disciplinary procedures in a way which, although not 
 
necessarily inconsistent with the literal application of its procedural rules, results in 
 
manifest unfairness to the practitioner or otherwise brings the administration of justice 
 
through the disciplinary process into disrepute in the view of right thinking persons.  The 
circumstances in which such an abuse can arise are very varied.  I stress that last sentence 

and repeat:  the circumstances in which such an abuse can arise are very varied.   
 
 
 
This is the nearest, in my opinion, that I can get to a working definition and I think it 
 
important to add a number of points of general application.  Firstly, if the effect of the 
 
continued prosecution of the charges is one of manifest unfairness to the practitioner or 
that the administration of professional justice is brought into disrepute, then it matters not 
 
that there has been a failure to demonstrate bad faith, or conscious manipulation of the 

procedures by the prosecution.  This I take from the case of ex parte Dean, which is at 
 
D23.   
 
 
 
Secondly, in determining whether an abuse is established, the Committee may have 
 
regard to how far any unfairness to the practitioner or bringing into disrepute of the 
system may be cured by the actual trial process and/or the exercise of the other powers 

available to it.  The Committee will have regard to the pressing public interest in having 
 
disciplinary hearings determined on their merits and should proceed to do so, save in 
 
cases in which an abuse is duly proved to them.   
 
 
 
Thirdly, it is for the practitioner to prove such an abuse.  The standard of proof required 
 
of him is that he proves his case on the balance of probabilities, i.e. is it more likely than 
not that the continued prosecution of the charges under attack amounts to an abuse of the 

process?  The standard of proof is a simple tipping of the balance of probabilities and is 
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not a heavy or enhanced balance of probabilities, i.e. one just falling short of the criminal 
 
standard which is sometimes utilised in civil cases involving fraud. 
 
 
 
Fourthly, the Committee should take into account all the evidence before it and consider 
 
all the submissions made by counsel.  The weight you attach to any piece of evidence is a 
 
matter for you, the Committee.  What reasonable inferences you draw from the evidence 
is also a matter for you. What you cannot do, however, is ignore any of the evidence 

before you.  Once you have considered it, however, the weight that you attach to it is 
 
exclusively a matter for you.   
 
 
 
That is the general advice on law that I want to give.  I am not going to go through all the 
 
evidence and counsel’s submissions.  However, there are a number of specific points I 
 
feel call for advice.  In relation to count 6 you are asked to find that in reality the 
complainant is an agent of the Church of Scientology Commission who have suborned 

and corrupted the witness (who I shall refer to as Mrs D) into supporting the complaint 
 
and thereby taking part in the orchestrated campaign that the Church of Scientology is 
 
said to conduct against practitioners such as Dr Cosgrove. Whether you find this proved 
 
and that it results in what amounts to an abuse of the process is a matter for you.  As 
 
indicated, you must take into account all the evidence and Mrs D’s evidence is clearly 
 
material to this particular charge.  It is important that you consider the inconsistencies 
that Mr Morris has pointed out about her evidence; for example, the venue of her 

consultation with Dr Cosgrove (was it Bristol or was it Bath?)  If you consider these 
 
significant (and that is a matter for you) this may affect the weight you attach to her 
 
evidence.  On the other hand, where her evidence is consistent with other evidence it may 
 
enhance her credibility. Again, I stress it is ultimately a matter for you what weight you 
 
place on her evidence, but you must consider the submissions of counsel as to the 
 
inconsistency or otherwise of her evidence. 
 

The attack on count 6 broadens into an attack on all the charges on the basis (and I will 
 
try and put this shortly) that the abuse on count 6 taken with the overall manner in which 
 
the procedures were followed in Dr Cosgrove’s case  have the knock on effect of making 
 
the prosecution of all charges against him an abuse.  Again, it is a question of fact for you 
 
to decide whether this has been proved to the required standard, taking into account all 
the evidence before you and the submissions made on them by learned counsel.  
 
However, there are three matters on which I want to give specific advice.  Firstly, insofar 

as it is submitted by Mr Pearce for the GMC that Dr Cosgrove’s failure to complain until 
 
this hearing  about the change in how some of the complaints against him were dealt with 
 
(i.e. they were removed from the procedures relating to an assessment of his professional 
 
performance and considered under ones which focused on his professional conduct) that 
 
these prevent such a charge from ever being considered abusive I respectfully disagree.  
Insofar as it is submitted that such a failure to complain necessarily points to an absence 

of there being an abuse, again I have to respectfully disagree. 
 
 
 
The time when any complaint about such a change is made is indeed in evidence before 
 
you and may assist the Committee in its deliberations, as may any evidence, but whether 
 
an abuse is proved is not determined by the subjective reaction of a practitioner to the 
 
facts which are said to constitute the abuse, but by an objective assessment as to the 
evidence relating to the effect of those facts.   

 
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Secondly, it has been submitted by Mr Pearce for the GMC that the delay in dealing with 
 
some of the complaints against Dr Cosgrove, taken with the communication to him of the 
 
decision which was subsequently reversed, that some of the complaints would be dealt 
 
with under the performance procedures cannot amount in law to an abuse.  Again, I have 
 
to say I respectfully disagree with that view.  My advice is that it is a question of fact for 
 
you, the Committee, to decide whether or not the procedural career of Dr Cosgrove’s case 
meets the threshold requirements of what constitutes an abuse and that it would be open 

to you to decide that such a threshold has been met.   
 
 
 
Let me be abundantly clear here.  I am not for one moment suggesting that you make that 
 
finding.  I am not attempting by implication, express or subliminal, to point you in that 
 
direction.  What I am simply saying is that it is a decision which is open to you on the 
 
evidence. 
 

Thirdly, there has been considerable discussion about the significance of whether or not 
 
what has happened procedurally (and I use the word widely to describe the whole 
 
procedural career of this case) amounts to a breach of Dr Cosgrove’s legitimate 
 
expectations.  I have thought long and hard about this and my opinion is that this is only 
 
relevant to the question of whether or not had the General Medical Council been 
 
challenged earlier in the administrative court any of its decisions would have been 
quashed by that court.  Breach of a legitimate expectation is a fact sensitive test which the 

High Court applies when judicially reviewing the actions of public bodies.  The same 
 
facts which may have persuaded the administrative court to grant judicial review may or 
 
may not amount to conduct which this Committee finds amounts to an abuse of the 
 
process.  The test to be applied to the facts of this case by this Committee is not the test 
 
used by the administrative court, but, I advise, that which is found in the dictum of Lord 
 
Diplock in Hunter v. Chief Constable which I have quoted earlier and which appears at 
D23, even though the two tests may ultimately lead to the same result. 

 
 
The question, in my opinion, ultimately is:  Has what has happened here been proved to 
 
be an abuse?  I stress that that is a factual question for you to decide. 
 
 
 
Lastly, I turn to Mr Morris’s submission on Count 2 in relation to Patient A who is a 
minor, that the refusal of Patient A’s parents to consent to the release of his medical 
 
records to the Committee prejudices his case.  My advice is that as the records are 

contemporaneous records of facts, at least in issue, if not in dispute, they are, I suggest, 
 
clearly relevant and although it is a question of fact for yourselves you may find that their 
 
non disclosure would prejudice Dr Cosgrove such that the continuation of Count 2 would 
 
result in manifest unfairness to him and it would, therefore, be abusive to continue with 
 
that count, although I do stress ultimately it is a matter for you to decide. 
 

Both counsel appear to be in agreement that one solution is by the application of Rule 50 
 
to override the consent of Patient’s A’s parents.  I agree subject to this. Before you can 
 
take that route you would have to be satisfied that the pressing public interest in Dr 
 
Cosgrove having a fair resolution of the complaints against him outweighs the right of 
 
Patient A to have his confidentiality respected, particularly as he is a minor.  Once again, 
 
this is a factual question for yourselves.  You may, of course, take into account any 
procedural powers you have, such as the ability of the Committee to sit in camera which 

may allow the Committee to receive the medical records whilst at least in part preserving 
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Patient A’s confidentiality.  That is my advice. 
 
 
 
THE CHAIRMAN:   I turn to Mr Pearce and Mr Morris.  Mr Morris, do you want to pass 
 
any comment? 
 
 
 
MR MORRIS:  Sir, may I just raise one slight query and it may be that I have misheard 
what the learned Legal Assessor has said.  It is in relation to his general remarks at the 

outset as to abuse of process where he made the remark that the Committee may have 
 
regard to how far any unfairness can be remedied by the trial process itself.  I hope that 
 
was not said (and I do not think it was, and I just want to clarify) to suggest that in 
 
relation to any sort of unfairness which is found the Committee can then consider whether 
 
or not that can be cured during the trial process before coming to a decision on abuse, 
 
because, in my submission, Archbold makes clear that there are two types of abuse, abuse 
which makes the trial process unfair or abuse such that it would be unfair to have a trial 

even though the trial process itself might be fair. 
 
 
 
LEGAL ASSESSOR:  I am grateful for that. Can I just not answer you directly, but say it 
 
this way.  I have tried to structure my advice by looking in the cases for what comes 
 
closest to a general definition of what constitutes an abuse of process. I have tried to 
 
avoid going into the distinctions, as you say, between those which make a trial unfair and 
those which for any other reasons mean it should not go ahead.  The definition I have 

tried to put before the Committee which, in my opinion, is the most workable one, is what 
 
is the effect of what has happened, does it result in manifest unfairness to the practitioner 
 
or does it otherwise bring the procedures into disrepute?    I have tried to go down that 
 
route. 
 
 
 
What I am saying is that in considering whether or not manifest unfairness is made out 
against the practitioner, they can have regard to, not determination, but regard to the fact 

that the trial processes have certain procedures, the existence of which prevent  manifest 
 
unfairness arising in the first place.  I am sorry I cannot answer your question directly, 
 
because you posit a definition of abuse which I have avoided. 
 
 
 
MR MORRIS:  I think I can use the definition that you have used, which is an adoption of 
the words of Lord Diplock, just to make the point I wish to make about the advice you 
 
have tendered, where he says: 

 
 
“The inherent power which any Court of Justice must possess to prevent 
 
misuse of its procedure in a way which, although not inconsistent with the 
 
literal application of its procedural rules, would nevertheless be manifestly 
 
unfair to a party to litigation before it or would otherwise bring the 
administration of justice into disrepute among right-thinking people.” 

 
 
All I am trying to clarify as to the advice that you are giving, is to make the 
 
suggestion that there can be circumstances – for example breach of promise that 
 
I have submitted in this case – whereby if there were such a breach of promise 
 
and a trial proceeded, the trial process itself could be perfectly fair but that 
 
because the breach of promise is such that to allow the proceedings to continue 
would amount to bringing the administration of justice into disrepute, then abuse 

is established.  
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THE LEGAL ASSESSOR:  Can I say it this way.  The way I would try and 
 
square that particular legal circle is that in those circumstances – breach of 
 
promise – the Committee can take that into account.  They may find that that 
 
persuades them there is manifest unfairness. 
 
 
MR MORRIS:  Very well.  

 
 
THE LEGAL ASSESSOR:  Perhaps I can do it this way.  I understand your 
 
concerns and I am most anxious that Dr Cosgrove has a fair hearing on this.  I 
 
will just read again the actual adaptation that I am trying to use: 
 
 
 
“An abuse of the process occurs when there is a misuse of the GMC 
disciplinary procedures in a way which, although not necessarily 

inconsistent with the literal application of its procedural rules, results in 
 
manifest unfairness to the practitioner.” 
 
 
 
There that stands alone. 
 
 
 
MR MORRIS:  The only gloss I wish to add is that there are circumstances when 
nothing within the trial process would be able to cure such manifest unfairness.   

 
 
THE LEGAL ASSESSOR:  Then that would amount, in the context of my 
 
advice, to manifest unfairness.  I have attempted – can I say this – to trek 
 
through the authorities to try and identify a short workable definition.  I am 
 
grateful for the gloss.  I think the gloss is included there in the advice, in the 
 
words “manifest unfairness.” 
 

MR MORRIS:  I am grateful for that clarification.  Thank you. 
 
 
 
THE CHAIRMAN:  At this point the Panel will go into camera and strangers 
 
will withdraw. 
 
 
STRANGERS THEN, BY DIRECTION FROM THE CHAIR WITHDREW 
 
AND THE PANEL DELIBERATED IN CAMERA 

 
 
STRANGERS HAVING BEEN READMITTED 
 
 
 
THE CHAIRMAN:  Mr Morris, the Committee have considered your request under rule 24 
 
(2) to stay proceedings against Dr Cosgrove on the grounds of an abuse of process. They 

have carefully considered the submissions made by you and Mr Pearce, Counsel for the 
 
GMC and the comprehensive advice tendered by the Legal Assessor, which the 
 
Committee have followed. 
 
The application has been made on the grounds that to allow the hearing of these charges 
 
to proceed would be an abuse of process.  There are three separate submissions on which 
 
the applications to stay these proceedings are based, namely  

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•  a fraudulent or manipulative complaint being made to the GMC with regard to Head 6 
 
and the effect that complaint had on bringing the other complaints before the 
 
Professional Conduct Committee; 
 
 

•  Legitimate expectation, breach of promise and bad faith on Heads of Charge 2, 3, 4, 
 
5, 6, 7, 8, and 9 and the effect of those Heads of Charge being redirected into conduct 
on Heads 10 and 11 being referred to the Professional Conduct Committee.  In 

addition the Committee have considered the concerns raised about the non-disclosure 
 
 of internal GMC documents surrounding the initial screening process; 
 
 

•  The third issue is the disclosure of documentation in relation to Head of Charge 2. 
 
The first submission is that Head of Charge 6 concerning Master D was based on 
 
information submitted to the GMC in a letter dated 18 August 2000, purporting to come 

from Mrs D.  It is your contention that this letter came from an organisation named “The 
 
Citizens’ Commission on Human Rights” (CCHR) which was established in 1969 by the 
 
Church of Scientology to investigate and expose psychiatrists’ breaches of human rights 
 
and that information forwarded to the GMC by the CCHR is fraudulent. 
 
The Committee have heard evidence from Mrs D on oath that whilst the letter of 18 
 
August 2000 outlining the complaint was unsigned and was typed by the CCHR, it had 

been drafted by her and she accepted ownership of it. 
 
The Committee have also heard evidence from Mrs D that it is her signature which is 
 
present on other documents being considered by the Committee and have heard and 
 
accepted her explanation for the inconsistencies in the spelling of her name.  They have 
 
also heard evidence from a handwriting expert who gave the opinion that the signatures 
 
given in the name of Mrs D on a variety of documents are probably all written by the 

same person. 
 
Mrs D in her evidence was adamant that the signatures were hers.  Despite 
 
inconsistencies in Mrs D’s witness statement as to where she consulted Dr Cosgrove, the 
 
Committee accept that her evidence is credible and reliable and, although the letter of 18 
 
August 2000 is not signed by her, they consider that she has ownership of the complaint 
 
and that the complaint is not fraudulent. 

Mrs D acknowledges that she obtained advice and assistance from “Overload” and Mr 
 
Daniels from CCHR, but the Committee do not consider this to be inappropriate.  The 
 
Committee have determined that there has not been an abuse of process in relation to 
 
Head of Charge 6. 
 
You have further submitted that Heads of Charge 2, 3, 4, 5, 7, 8 and 9 which relate to 

patients A to F all concern complaints about Dr Cosgrove where information was 
 
submitted to the GMC in the years 1997 to 2000.  There is no evidence before the 
 
Committee that these complaints were orchestrated by CCHR.  The Committee 
 
acknowledge that there were enquiries from CCHR as to the progress of Head 6 but not in 
 
relation to the other cases being considered at that time.  In the light of not having found 
 
an abuse of process in relation to Head 6, the Committee consider that the GMC has not 
been influenced by CCHR in their decision in relation to Head 6.  As a consequence the 

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Committee find that there has been no abuse of process on this submission in relation to 
 
Heads 2, 3, 4, 5, 7, 8 and 9. 
 
 

The Committee next considered the second submission made in relation to a stay of these 
 
proceedings due to an abuse of process.  The basis of this submission is that the internal 
procedures which were followed were an abuse of process and in addition there was 
 
legitimate expectation that the complaints would be taken through the performance 

procedures.  You also submitted that the actions of the GMC towards Dr Cosgrove were 
 
in bad faith, a breach of promise and a breach of his legitimate expectation. 
 
 

The Committee have carefully reviewed and considered all the evidence on this point.  
The GMC wrote to Dr Cosgrove in May 2001 in relation to some of the complaints made 
 
against him and it was indicated that these complaints would be put forward for 
 
consideration under the GMC’s performance procedures.  The Committee have carefully 

considered your further submission that Dr Cosgrove had not had any correspondence 
 
from the GMC that other complaints were going to be investigated and as such had a 
 
legitimate expectation that those complaints had been closed and that no further action 
 
would be taken. 
 
The Committee have limited evidence which suggests that further information was 
 
submitted to the GMC which triggered a review of the earlier decision to submit the 

complaints to the performance procedures.  Whilst the new information which led to the 
 
review of the earlier cases did not lead to additional charges being formulated against Dr 
 
Cosgrove, a decision was taken that the matters in question were conduct matters rather 
than performance matters and this was communicated to Dr Cosgrove in the Rule 6 letter 
 
dated 1 October 2002.  The Committee note that the Medical Act and the GMC Procedure 
 
Rules are silent on the legitimacy of such a change.  They have determined that 
 
insufficient evidence has been adduced whereby the Committee could come to a decision 

that changing the way in which the complaints were to be pursued amounts to an abuse of 
 
process. 
 
The Committee note that the GMC has not disclosed internal documentation concerning 
 
the initial screening process and after due consideration were of the view that this did not 
 
produce manifest unfairness to Dr Cosgrove.  Therefore, the Committee do not find that 
 
there has been an abuse of process. 

In relation to your submission with regard to Dr Cosgrove’s legitimate expectation that 
 
due to the passage of time complaints were closed or that no action was to be taken, the 
 
Committee have carefully considered the advice tendered by the Legal Assessor and 
 
concur with that advice.  The Committee considered that whether or not Dr Cosgrove’s 
 
legitimate expectations had been breached was only relevant to whether the 

Administrative Court would have quashed any of the GMC’s procedures had they been 
 
challenged prior to this hearing.  The test they applied was whether the conduct which is 
said to have breached Dr Cosgrove’s legitimate expectation amounted to abuse of the 
 
process as defined in the Legal Assessor’s advice.  The Committee have considered the 
 
facts placed before them and whilst it is regrettable that Dr Cosgrove was not kept fully 
 
informed of progress with regard to the complaints made against him, this does not 
 
amount to an abuse of process.  The Committee therefore reject your application that 

there has been an abuse of process in relation to charges 2, 3, 4, 5, 6, 7, 8 and 9.   It 
follows that there is no abuse of process in relation to Heads of Charge 10 and 11. 
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The Committee next considered your submission that Head of Charge 2 should be stayed 
 
on the grounds that the parents of Patient A have not given consent for the medical 
 
records to be disclosed for the purposes of this hearing.  It is your submission that without 
 
the contemporaneous notes relating to Patient A’s treatment and care Dr Cosgrove would 
 
not have a fair hearing.  The Committee note that Counsel agree that the Committee could 
 
exercise their powers under rule 50 of the GMC’s Procedure Rules to have the medical 
records disclosed.  In considering this matter the Committee balanced the public interests 

and Dr Cosgrove’s interest in having a fair resolution of the allegations against Patient 
 
A’s right to confidentiality.  The Committee are mindful of their powers in relation to 
 
hearing evidence in private and consider that this would be the appropriate step to take in 
 
relation to Head of Charge 2.  In so doing the public interest is served in resolving these 
 
matters and Patient A’s confidentiality is respected.  The Committee therefore reject your 
 
application to stay this Head of Charge and wish to exercise their powers under rule 50 to 
have the medical records at the substantive hearing. 

 
That concludes this phase of the enquiry and that is the end of business for today.  The 
 
Committee Secretary will speak to you outside once the Panel has left but my 
 
understanding is that the dates which had been canvassed at some point last week if we 
 
were going to a substantive hearing are 9, 10 and 11 June and the five days in the 
subsequent week beginning 14 June.  The hearing would be in Manchester.  That is eight 
 
days.  If there is any alteration to that, no doubt it will be dealt with by the secretariat.  

Thank you very much. 
 
 

 
 
The hearing was concluded. 
 
 

 

 
 
 
 
 


 
 

 
 

 
 
 
 
 


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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
Wednesday, 9 June 2004 
 
Held at: 
St James’ Building 
79 Oxford Street 
Manchester M1 6FQ 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Six) 
 
 
Committee Members: 
Professor Norman Mackay (Chairman) 
Dr Alison Hamilton 
Mr John Matharu 
Dr Belinda Stanley 
Mr Richard Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
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(Transcript of the shorthand notes of TranscribeUK 
Tel No:  0208 614 5799) 
 
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INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
CHARGES    
 
 
 
 
 
 
 
 1 
 
 
 
MR PEARCE OPENED THE CASE ON BEHALF 
 OF 
THE 
COUNCIL 
 
        

 
 DISCUSSION 
RE 
TIMETABLE 
     23 
 
 
PROFESSOR ERIC TAYLOR sworn 
  Examined 
by 
MR 
PEARCE 
 
     24 
 
 
WENDY ANNE SAMWAYS sworn 
  Examined 
by 
MR 
PEARCE 
     44 
  Cross-examined 
by 
MR 
MORRIS 
    46 
  Re-examined 
by 
MR 
PEARCE 
    47 
 
 
DR CHARLES OLIVER HOLME sworn 
  Examined 
by 
MR 
PEARCE 
     48 
 
 
  Cross-examined 
by 
MR 
MORRIS 
    58 
  Questioned 
by 
THE 
COMMITTEE 
    66 
 
 
DR KAIS MOHAMER KHALID AL SHABNDER sworn 
  Examined 
by 
MR 
PEARCE 
     68 
  Cross-examined 
by 
MR 
MORRIS 
    74 
  Questioned 
by 
THE 
COMMITTEE 
    76 
 
DR SEAN WALLACE HUMPHREYS Sworn 
 
 Examined 
by 
MR 
PEARCE 
 
     77 
 
 
 
 
 
 
 
 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:   Good morning.  This Committee has reconvened from a hearing 
 
which took place in January to consider the case of Dr Cosgrove.  At the session in 
 
January there was before the Committee an application for abuse of process, or a stay of 
 
proceedings as a consequence of an abuse of process, but that application was 
 
subsequently refused and so the Committee will now proceed to consider the case of Dr 
 
Cosgrove. 
  

Dr Cosgrove is not present, but is represented by Mr David Morris, Counsel, instructed 
 
by Radcliffe Le Brasseur solicitors, and Mr Richard Pearce, Counsel, instructed by Field 
 
Fisher Waterhouse solicitors, represents the General Medical Council. 
 
 
 
In January we did read the Heads of Charge at the commencement of the hearing and 
 
normally at the resumption of an adjourned hearing we do not read the charges, but I 
think such is the time interval since then and to give Mr Morris the opportunity to 

respond to the Heads of Charge that I will ask the Committee Secretary to read out the 
 
Heads of Charge.  
 
 
 
THE COMMITTEE SECRETARY:  The Committee will inquire into the following 
 
charge against  Patrick Vernon Finn Cosgrove, MB BS 1968 Lond; MRCS Eng LRCP 
 
Lond 1968 SR: 
 

 
"That, being registered under the Medical Act, 
 
 
 
 
 
‘1. 
At all material times, you were practising as a Consultant Child and 
 
Adolescent Psychiatrist working in private practice at the  
 
 
Bristol Priority Clinic; 
 
 
‘2. 
a. 
On 3 May 1996, you saw Patient A, a child who had been 

diagnosed as suffering from Attention Deficit Hyperactivity Disorder 
 
(ADHD), 
 
 
 
 
b. 
You prescribed drugs to Patient A as follows: 
 
 
 
i. 
between May 1996 and May 1999, you prescribed 
 
methylphenidate (Ritalin), 

 
 
 
ii.by July 1996, you had increased the prescribed dose of 
 
Ritalin to 62.5 mg per day, 
 
 
 
 
iii. 
in May 1998, you increased the daily dosage of Ritalin to 
100 mg per day, 

 
 
 
iv. 
by May 1999, you had increased the dose of Ritalin to 130 
 
mg per day, 
 
 
 
 
v. 
from July 1996, you prescribed an additional daily dosage 
 
of risperidone at 1 mg per day, 
 

 
vi.by November 1998, you had in addition prescribed clonidine as 
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a night time sedative, 
 
 
 
 
c. 
Having so prescribed, your monitoring of Patient A was 
 
irresponsible in that 
 
 
 
 
i. 
you did not see Patient A in person between May 1996 and 
May 1999, 

 
 
 
ii. 
you did not make an adequate assessment of Patient A’s 
 
weight, 
 
 
 
 
iii. 
you did not monitor Patient A’s growth, 
 
 
 
iv. 
you did not warn Patient A’s mother that sudden 

withdrawal of clonidine could have a deleterious effect on Patient 
 
A’s blood pressure, 
 
 
 
 
v. 
you did not advise Patient A’s General Practitioner (GP) to 
 
monitor Patient A as above; 
 
 
 
‘3. 
a. 
On 1 December 1999, you saw Mr B as a private patient and 

diagnosed that he was suffering from ADHD, 
 
 
 
 
b. 
On 3 December 1999, you wrote a letter about that consultation to 
 
Dr Humphreys, Mr B’s GP, which letter you copied to Dr K Al-Shabner 
 
and to Mr and Mrs B, 
 
 
 
c. 
In that letter, you stated as follows: 

 
 
 
i.that Mr B had seen a doctor who might have been Dr Al-Shabner, 
 
 
 
 
ii. 
that the doctor whom Mr B had seen had been rude and 
 
unhelpful, 
 
 
 
iii. 
that the doctor whom Mr B had seen had been scruffily 

dressed, 
 
 
 
 
iv. 
that the doctor whom Mr B had seen knew nothing about 
 
ADHD, 
 
 
 
v. 
that the doctor whom Mr B had seen was guilty of medical 

negligence, 
 
 
 
 
vi. 
that the doctor whom Mr B had seen had demonstrated 
 
professional incompetence, 
 
 
 
 
d. 
The comments that you made in the said letter were 
 

 i. unprofessional, 
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 ii. 
unsustainable, 
 
 
 
 
iii. 
likely to cause the reader to doubt Dr Al-Shabner’s 
 
knowledge and/or skills; 
 
 
‘4. 
a. 
On 27 May 1999, you saw Master C, a nine year old boy, as a 

private patient, 
 
 
 
 
b. 
On 29 May 1999, you wrote a letter to Master C’s GP about the 
 
consultation, sending a copy of the letter to Dr Karin Moses, Consultant 
 
Child Psychiatrist responsible for the treatment of Master C under the 
 
NHS, 
 

 
c. 
The said letter requested that Master C’s GP prescribe him 
 
risperidone and Ritalin, 
 
 
 
 
d. 
The letter did not contain any advice for Master C’s GP about 
 
appropriate monitoring of Master C whilst he was taking those drugs, 
 
 
 
e. 
Your failure to provide such advice to Master C’s GP was 

 
 
 i. irresponsible, 
 
 
 
 
 
ii. 
not in the best interests of Master C; 
 
 
 
‘5. 
a. 
On 7 July 1999, you wrote a letter to Dr Karin Moses, which letter 
you copied to Master C’s parents and his GP, 

 
 
 
b. 
In that letter, you stated 
 
 
 
 
 
i. 
that Dr Moses was likely to deny some or all of what 
 
Master C’s parents had told you about her treatment of Master C, 
 
 
 
ii. 
that Dr Moses had seen Master C only once whilst he was a 

day patient on the children’s psychiatric unit at St Cadoc’s 
 
Hospital, Caerleon, Newport, during which period Master C was 
 
getting worse and worse when he should have been getting better 
 
and better, 
 
 
 
iii. 
that Dr Moses owed Master C’s parents an explanation as 

to why she had not prescribed Ritalin during the time that Master C 
 
was a patient at the children’s psychiatric unit, 
 
 
 
 
iv. 
that when Dr Moses first saw Master C he was aged 5 years 
 
old, and that she made no diagnosis and that she had done nothing 
 
that resulted in alleviating Master C’s malfunctioning, 
 

 
v. 
that nothing that Dr Moses had done when she saw Master 
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C aged 5, 6 and 7 years had prevented his behaviour causing him to 
 
be asked to leave two schools and to be admitted to St Cadoc’s 
 
Hospital, 
 
 
 
 
c. 
The comments that you made in the said letter were 
 
 
  i. 
unprofessional, 

 
 
  ii. 
unsustainable, 
 
 
 
 
iii. 
likely to cause the reader to doubt Dr Moses’ knowledge and skills; 
 
 
 
 
‘6. 
a. 
In or about May 1996 you saw Master D, a ten year old boy, as a 
private patient, 

 
 
 
b. 
You diagnosed Master D as suffering from ADHD, 
 
 
 
 
c. 
You prescribed Ritalin for Master D, 
 
 
 
 d. 
Your examination of Master D on that occasion was inadequate in that 
 

 
 
i. 
you did not weigh him, 
 
 
 
 
 
ii. 
you did not take his blood pressure, 
 
 
 
 
e. 
You subsequently spoke to Master D’s mother by telephone, 
 
following which you prescribed risperidone, 
 

 
 
 
f. 
You failed to make proper arrangements for monitoring the effects 
 
of the treatment which you provided for Master D; 
 
 
 
 
‘7. 
a. 
In or around August 2000, Oxfordshire Mental Healthcare NHS 
 
Trust carried out an investigation into a number of features of the 
treatment of a patient of the Trust, Patient E, 
 
 

 b. 
On 29 September 2000, Miss Wendy Samways, Complaints Manager at 
 
the Oxfordshire Mental Healthcare NHS Trust, wrote to you requesting 
 
copies of your medical records concerning Patient E and enclosing signed 
 
authorisation for the release of the records, 
 
 
 c. 
By a letter dated 3 October 2000, you replied to  

 Miss Samways that you would not supply the medical records, 
 
 
 
 
d. 
Your failure to supply the notes as requested was 
 
 
 
 i. 
inappropriate, 
 
 
   
 
ii.  unprofessional; 

 
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‘8. 
a. 
In the letter referred to in paragraph 8c above, you also stated as 
 
follows: 
 
 
 
 
i. 
that Patient E had been given inadequate care by an employee of 
 
the Oxfordshire Mental Healthcare NHS Trust, 
 
 
 
ii. 
that the investigation being carried out might end in a whitewash of 

such inadequate care, 
 
 
 
 
iii. 
that you believed the investigation to be a cover up of grossly 
 
inadequate care received by Patient E from the Trust, 
 
 
 
 
iv. 
that the investigation was programmed to ensure that the Trust was 
not criticised at all or only criticised in a minor way, 

 
 
b. 
The comments set out in the letter were 
 
 
 
  i. 
unprofessional, 
 
 
 
 
 
  ii. 
unsustainable, 
 

 
iii. 
likely to cause the reader to doubt the knowledge or skills of the 
 
employees of the Oxfordshire Mental Healthcare NHS Trust who 
 
treated Patient E; 
 
 
 
 
‘9. 
a. 
By a letter dated 17 November 2000, concerning a patient Mr F, 
 
which you sent to his GP, and copies of which you sent to Dr Helen 
Chubb, Consultant Psychiatrist at the Cardiff and Vale NHS Trust and 

Dr Miranda Thomas, SHO in psychiatry at the same Trust, you stated that 
 
you had diagnosed Mr F as suffering ADHD and that you had prescribed 
 
him Ritalin, 
 
 
 
 b. 
That letter did not contain any advice to the prescribing GP about the 
monitoring of Mr F, 
 
 

 
c. 
In the letter, you stated as follows: 
 
 
 
 
i. 
that Mr F had not felt that Dr Thomas had listened to him when he 
 
talked about his personal understanding of ADHD, 
 
 
 
ii. 
that Dr Thomas had stated that a “concentration problem is for 

messy kids”, 
 
 
 
 
iii. 
that the comment alleged to be made by Dr Thomas was an 
 
ignorant comment, 
 
 
 
 
iv. 
that both Dr Thomas and Dr Chubb were arguably guilty of 
medical negligence in knowing less about ADHD in adults than Mr 

F, 
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v. 
that Dr Thomas had made an assertion of “therapeutic nihilism” in 
 
saying “the consultant thinks that you have got a personality 
 
disorder which is not treatable”, 
 
 
 
 
vi. 
that if Mr F responded to treatment for adult-type ADHD, it would 
indicate that Dr Thomas and Dr Chubb were negligent in not 

listening to Mr F and in not knowing about ADHD as a real 
 
condition in adults, leaving room for formal complaint to the 
 
Fitness to Practice Directorate of the General Medical Council, 
 
 
 
 
d. 
The comments that you made in the said letter were 
 
 
 i. 
unprofessional, 

 
 
 ii. 
unsustainable, 
 
 
 
 
iii. 
likely to cause the reader to doubt the knowledge or skills 
 
of Dr Chubb and Dr Thomas; 
 
 
 
‘10. 
a. 
In or around January 2003, you saw a 4 year old child, 

 
 
Patient G, as a private patient, 
 
 
 
 
b. 
Thereafter, you prescribed Ritalin and risperidone to Patient G, 
 
 
 
 
c. 
By May 2003, you were prescribing 
 
 
 
i. 
Ritalin at 25 mg per day, 

 
 
 
ii. 
risperidone at 0.625 mg per day, 
 
 
 
 
d.Having so prescribed, your monitoring of Patient G was irresponsible in 
 
that 
 
 
 
i. 
you did not make an adequate assessment of  

 
Patient G’s weight, 
 
 
 
 
ii. 
you did not monitor Patient G’s growth, 
 
 
 
 
iii 
you did not adequately monitor any possible side effects; 
 

 
 
‘11. 
a. 
On or around 16 July 2003, you saw Patient H as a private patient, 
 
 
 
 
b. 
On 19 July 2003, you wrote to Patient H’s GP, which letter you 
 
copied to Patient H’s parents and to Dr Dover, a Consultant Psychiatrist 
 
who had treated Patient H, 
 
 
 
c. 
In that letter you stated amongst other things 

 
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i. 
that, if Dr Dover did not believe in ADHD, he might have 
 
difficulty in being revalidated by the General Medical Council, 
 
 
 
 
ii. 
that Dr Dover should have studied Patient H’s school 
 
reports, 
 
 
 
iii. 
that Dr Dover had behaved in a professionally unacceptable 

manner by not arranging a second opinion when asked to do so, 
 
 
 
 
b. 
The comments that you made in the said letter were 
 
 
 
 i. 
unprofessional, 
 
 
 ii. 
unsustainable, 

 
 
 
iii. 
likely to cause the reader to doubt the knowledge or skills 
 
of Dr Dover;’ 
 
 
 
“And that in relation to the facts alleged you have been guilty of serious 
 
professional misconduct.”  
 

THE CHAIRMAN:   Thank you very much. 
 
  
 
Mr Morris? 
 
  
 
MR MORRIS:   Sir, may I first of all confirm the obvious that Dr Cosgrove is at present 
 
not attending the inquiry, but that in his current absence I am instructed to proceed to 
represent his interests. 

  
 
Turning to the Notice of Inquiry, I can tell the Committee that the following matters are 
 
admitted:  Head of Charge 1; Head of Charge 2(a); Head of Charge 3(a), Head of Charge 
 
3(b), under Head of Charge 3(c) (i), (iv), (v) and (vi) and Head of Charge 3(d), (iii). 
 
  
Under Head of Charge 4:  (a), (b), (c) and (d). 
 
  

Under Head of Charge 5:  (a), under Paragraph (b) (i), (iii), (iv) and (v) and under Head 
 
of Charge 5 (c), (iii). 
 
  
 
Under Head of Charge 6:  (a), (b), (c) and (e). 
 
  
Under Head of Charge 7:  (a), (b) and (c). 

  
 
Under Head of Charge 8:  (i), (ii), (iii), (iv) - I am sorry, 8(a) I beg your pardon.  8(a) (i), 
 
(ii), (iii) and (iv) - and 
 
Head of Charge 8(b) (iii). 
 
  
 
Under Head of Charge 9:   (a), (b), under Paragraph (c) (i), (iii), (iv), (v) and (vi) and 
under (d), (iii). 

  
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Under Head of Charge 10:  (a), (b) and (c) in its entirety.  (c) in its entirety. 
 
  
 
Under Head of Charge 11:                                    
 
 
 
Head of charge 11(a), (b) and (c) in its entirety.  Head of charge 11 (b)  (iii). 
 
 
THE CHAIRMAN:  Do you mean 11 (d) (iii)? 

 
 
MR MORRIS:  I mean 11 (d) (iii).  I do apologise. 
 
 
 
Sir, something has just been pointed out to me.  I think for safety’s sake can I go back to 
 
Head of Charge 10c, which is, “By May 2003 you were prescribing one Ritalin and two 
 
risperidone.”  That paragraph c should not be admitted. 
 

THE CHAIRMAN:  Perhaps I could just go over these again, the charges which have 
 
been admitted and consequently found proved are 1; 2;  
 
 
 
3a, 3b, 3c i, iv, v and vi, 3e ii; 
 
 
 
4a, b, c, and d; 
 

5a, 5b i, iii, iv, v, 5c iii; 
 
 
 
6a, b, c and e;  
 
 
 
7a, b, c; 
 
 
8a i, ii, iii and iv, 8b iii;  

 
 
9a, b, 9c i, iii, iv, v and vi, 9d iii;  
 
 
 
10a and b;  
 
 
11a, b, c in its entirety and 11d iii. 
 
 

MR MORRIS:  I believe, sir, you said that Head of Charge 2 was admitted without 
 
qualification. 
 
 
 
THE CHAIRMAN:  2a. 
 
 
MR MORRIS:  2a is admitted but the rest is not admitted. 

 
 
THE CHAIRMAN:  2a and the rest of 2 is not admitted.  So, I think we have now got 
 
agreement on what has been admitted and proved and what has not.  Mr Pearce. 
 
 
 
MR PEARCE:  I am obliged, sir.  Dr Patrick Vernon Finn Cosgrove qualified with 
 
MBBS from London University in 1968.  He holds the qualifications of membership of 
the Royal College of Surgeons in England, he is a Licentiate of the Royal College of 

Physicians of London.  He is a specialist in child and adolescent psychiatry. 
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At the time relevant to the matters with which the Committee is concerned, he practised 
 
from the Bristol Priority Clinic, a private clinic.  That was in practice as a consultant child 
 
and adolescent psychiatrist. 
 
 
 
These Heads of Charge all arise out of cases in which Dr Cosgrove has been involved in 
treating patients for attention deficit hyperactivity disorder - ADHD.   

 
 
ADHD is a common and well-recognised psychiatric disorder for children and 
 
adolescents.  Recent evidence suggests that symptoms might continue into adulthood, 
 
thought this is a field where far less is known about the condition.  Diagnostically the 
 
condition is characterised, as the name suggests, by a combination of a deficit in attention 
 
and an element of excessive activity, hyperactivity.  In addition the syndrome is typically 
associated with symptoms of impulsiveness.  It tends to be associated with significant 

school-based problems, particularly poor achievement and behavioural difficulties.  
 
 
 
Treatment of ADHD has been by a variety of techniques, including most significantly, for 
 
the purposes of the matters you are concerned with, behavioural management and through 
 
medication.  Of the medication that has been used in this country at least, Ritalin, which 
 
is the proprietary name for methylphenidate hydrochloride is the most commonly used 
medication.  Ritalin essentially is a stimulant which has been proved effective in the 

treatment of ADHD in many cases. 
 
 
 
Dr Cosgrove has worked extensively in this area.  He has written on, amongst other 
 
things, the use of risperidone, an anti-psychotic drug, to augment the use of stimulants 
 
such as Ritalin. 
 
 
Sir, I anticipate that this Committee will hear evidence certainly from Professor Taylor, 

whom I intend to call and possibly from other sources, that will indicate to the Committee 
 
that there is a range of view about the use of drugs in dealing with both children and 
 
adults who present with ADHD.   
 
 
 
It is, I hope, fair to say that Dr Cosgrove’s views lie towards one end of that spectrum, in 
the sense that he is a psychiatrist who has been more ready then many to prescribe drugs. 
 
 

Many of the Heads of Charge here relate to the manner in which he has spoken of and to 
 
other psychiatrists who do not share his views and who lie, perhaps, at a different point in 
 
the range of opinions. 
 
 
 
The charges against Dr Cosgrove, then, relate to the circumstances surrounding 
prescriptions to a number of individual patients and to correspondence arising out of 

those prescriptions.  You will have noted, sir, from the charges that consecutive letters of 
 
the alphabet have been used to preserve anonymity and you will recall that on the last 
 
occasion concern was expressed about anonymity for patients, a course which we will 
 
seek to preserve by using those consecutive letters. 
 
 
 
If I may, then, take you through the charges and the individual patients with whom we are 
concerned and give you something of the background to each of those patients. 

 
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Charge 2 relates to Patient A.  This was a child who was referred to Dr Charles Holme, a 
 
consultant community paediatrician based at that time at Salisbury District Hospital.  The 
 
referral was made by a doctor who felt that Patient A was showing symptoms of ADHD  
 
 
 
Patient A was prescribed methylphenidate but subsequently was referred by the general 
 
practitioner to Dr Cosgrove.   
 

Dr Cosgrove saw Patient A and his mother on 3 May of 1996.  Thereafter he prescribed a 
 
rapidly increasing dose of Ritalin for Patient A.  This caused concern to Dr Holme, the 
 
paediatrician to whom I have referred and to a local psychiatrist.  They reviewed the case 
 
and agreed that the management of the Ritalin prescription should be left to Dr Cosgrove 
 
alone. 
 
 
Dr Cosgrove then reviewed the progress of Patient A with his mother and progressively 

raised the dose of Ritalin to 62.5 mg daily adding the risperidone and latterly clonidine, a 
 
night-time sedative.  
 
 
 
By May 1999 it appears that the dose of Ritalin had increased to 130 mg a day with 
 
risperidone and clonidine being taken on a daily basis.  This dosage increase had taken 
 
place without Dr Cosgrove reviewing Patient A in person and without, we say, proper 
monitoring having taken place. 

 
 
130 mg of Ritalin per day is a very high dosage indeed.  That is not to say that it was 
 
necessarily inappropriate and you will have noted from the charges that in no case do we 
 
criticise the dosage per se.  If such a high dosage of Ritalin is to be prescribed, then the 
 
importance of the kind of monitoring to which I will return in due course is all the 
 
greater.  We say there was a failure properly to monitor here. 
 

The level of dosage was such as to cause concern to Dr Holme, who communicated that 
 
concern to Dr Cosgrove.  It seems that Dr Cosgrove then reviewed Patient A and 
 
recommended a reduction in dosage.  Subsequently Patient A’s care was taken over by a 
 
different psychiatrist. 
 
 
I turn if I may, now, sir, to Charge 3, Patient B.  It would be appropriate at this point, if I 
 
may, to produce to the Committee a bundle of documents that I will refer to in respect of 

this charge and some of the other charges.  (Produced
 
 
 
THE CHAIRMAN:  We will refer to this as C8, the reason being that we got up to C7 on 
 
the previous occasion and we do not want to confuse documents. 
 
 
MR MORRIS:  It is immediately convenient to flag up in terms of this bundle, as 

described on the front of it, it has been tabbed in such a say that the tab numbers cross-
 
relate to the charge numbers, which is why numbers 1, 2 and 8 are missing because there 
 
are no documents relevant to those charges. 
 
 
 
If I might just give a little of the background in relation to Patient B before we turn to the 
 
relevant documentation.  Patient B was an adult patient of Dr Sean Humphreys, a general 
practitioner in Aberystwyth.  Patient B was referred to Dr Al-Shabner, a psychiatrist 

employed by the Pembrokeshire and Derwen NHS Trust.  Dr Al-Shabner saw Patient B in 
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late 1999. 
 
 
 
Patient B was also referred to Dr Cosgrove and Dr Cosgrove wrote a letter to the patient’s 
 
general practitioner, Dr Humphreys, on 3 December 1999.  In that letter Dr Cosgrove sets 
 
out evidence of Patient B’s inattentiveness, poor motivation and his impulsive behaviour. 
 
 Dr Cosgrove goes on to indicate that he considers that Patient B has attention deficit 
hyperactivity disorder - ADHD.  The letter the goes on to deal with the recent 

appointment that Patient B has had with Dr Al-Shabner. 
 
 
 
If I may turn you to tab 3 - at the risk of confusing, I should say that when these 
 
documents were anonymised, they were done by simply leaving initials of the first name 
 
and surname, so one sees other letters but it this fact relates to Patient B. 
 
 
I will not take you, if I may, to the first part of the letter.  May I take you to page 2.  A 

little over half way down - and if you will excuse me for reading through this and other 
 
parts of relevant correspondence so that the Committee is aware of what matters we are 
 
concerned with. 
 
 
 
Dr Cosgrove is here dealing with Patient B’s recent appointment and says as follows: 
 
 
“I was perplexed as to which local adult psychiatrist 

Patient B actually saw.  Your referral letter is written to 
 
Dr Thorpe-Belton but Patient B said that he saw a Dr 
 
Guyse although the person he met never introduced 
 
himself.  However, the letter you received from the 
 
Gorwelion Day Hospital was from Dr K Al-Shabner, who 
 
describes himself as an Associate Psychiatrist. 
 

There is some importance in this, since whoever Patient B 
 
actually saw, he found him to be rude and quite unhelpful. 
 
 Patient B describes his as being a scruffily dressed man in 
 
his fifties or possibly his forties.  The appointment got off 
 
to a bad start when the doctor sped on ahead so that 
Patient B found himself at the top of some stairs with no-
 
one in sight and not having a clue as to where to go.  This 

doctor then appeared to rebuke Patient B by saying that he 
 
had been waiting for him. 
 
 
 
During the interview, Dr Al Shabnder or Dr Thorpe-Belton or Dr Guyse 
 
then asked D what the date was, which floor of the building he was on, and 
to subtract 7 from 100 and then 7 from 93. By this time, D was thoroughly 

irritated by the offensive manner in which he was experiencing he was 
 
being treated that he told this person that he was rude.   
 
 
 
Anyhow, this specialist declares (I was told) that “there’s nothing I can do 
 
for you”.  Indeed, this fits with Dr Al Shabner telling you that he had left 
 
the diagnosis open to Patient D.  I find this a truly amazing statement.  
Sure it is the doctor specialist who makes the diagnosis so that it is not 

something to be left up to the patient.  This doctor says that he did inform 
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Patient D that he may or may not be have Deficit Syndrome, “as he calls 
 
it” and “I somehow at least let him start thinking of why it is that 
 
important to him at this moment in time.   
 
 
 
It is clear from Dr AlShabnder’s total misuse of the word “Deficit 
 
Syndrome” that he knows nothing about ADHD.  ADHD is well described 
in both international classifications of mental and behavioural disorders 

where is (ICD-10 and DSM 4) where it is clearly stated that ADHD can 
 
continue into adulthood.   
 
 
 
In view of his appalling failure of knowledge about ADHD, in view of Dr 
 
AlShabdner’s failure to elicit the simply dreadful level of Patient D’s 
 
motivation (“he seems to be well motivated”), in view of his rudeness as 
reported by Patient D, in view of his statement about “there’s nothing I can 

do for you” (when ADHD responds so well to dopaminergics like Ritalin 
 
or Dexamphetamine), I must formally register my strong disapproval of 
 
the medical negligence of this doctor. 
 
 
 
Of course, Dr AlShabdner is a non-consultant member of the tam, then this 
 
professional incompetence must surely reflect on the teaching of the 
consultant in charge, whom I presume is Dr Thorpe-Belton, to whom you 

originally referred your patient. 
 
 
 
Then Dr Cosgrove goes on to making out a prescription.   
 
 
 
We contend that comments of this nature, and you will find that there is a thread of 
 
similar comment in a number of documents, are unprofessional, unsustainable and likely 
to cause the reader to doubt the knowledge and skills of the doctor, here we say Dr 

AlShabdner. 
 
 
 
May I turn, sir, to Patient C.  The relevant charges are numbers four and five.  Patient C 
 
started to the attend the Pollard Well Children's Unit at St Cadoc’s Hospital in Newport in 
 
November 1998. He had daily contact with specialist teaching and nursery staff, he was 
reviewed weekly at multi-disciplinary staff meetings, at which a consultant in child 
 
adolescence, Dr Karen Moses, was present.  Subsequently Patient C was seen by Dr 

Cosgrove.  Dr Cosgrove then wrote to C’s General Practitioner by letter dated 29 May 
 
1999.  This letter appears, sir, at division four in the bundle.  In that letter, to summarise 
 
for a moment, Dr Cosgrove indicates that C has the Attention Deficit Hyperactivity 
 
Disorder, he indicated he started the patient on a low dose of Risperidone to be followed 
 
two days later by a dose of Ritalin, the dosage is then to be increased.   
 

This letter to the General Practitioner indicates that Dr Cosgrove has written private 
 
prescriptions but invites the General Practitioner to copy those sent on to an NHS script.  
 
On subsequent occasions it is said that Dr Cosgrove was sending to the parents a 
 
specimen script to bring to the GP so that the prescriptions could be altered.  The 
 
prescription of these drugs without proper monitoring is not appropriate.  The letter 
 
contains no advice to the General Practitioner about monitoring and the submission that 
we make: this is irresponsible and not in the best interests of the patient. 

 
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So it is also significant to note the contents of the letter and what Dr Cosgrove has to say 
 
about Dr Moses.  If you look at page two you will note that, first of all, at the very bottom 
 
this is a letter copied to Dr Moses, in fact, page one is clearly a letter to the General 
 
Practitioner, but copied to Dr Moses.  I have not referred to, but might in passing mention 
 
that in division three relating to patient B on page three of that letter, it was copied by Dr 
 
Cosgrove to both Dr AlShabdner and to patient B’s parents.   
 

Dealing with Patient C and Dr Moses a third of the way down page two of division four: 
 
 
 
“Mrs C”,  
 
 
 
I understand to be Patient C’s mother, 
 
 
“told me that Patient C was seen by Dr Moses, Consultant Child 

Psychiatrist, when he was five years old but she was given no diagnosis.  
 
At this time she was being called into school every week and she considers 
 
that her son was hyperactive at that stage.  Dr Moses saw Patient C again 
 
when he was six, had half an hour talk with his mother and told her that 
 
she should see Patient C again in one year’s time. His mother said that Dr 
 
Moses has seen Patient C three times in four years. In view of the serious 
state that Patient C is now in, I am surprised that more has not been done 

for this poor child by the local specialist. Fortunately Mrs C has the 
 
financial wherewithal to bring her son to see me but one dreads to imagine 
 
how other mothers, who cannot pay to go privately, are fairing.”   
 
 
 
Dr Moses, having received what a copy of what you may think is clearly a letter critical 
 
of her or her team, responds in a letter that appears in division five, page one: 
 

“Dear Dr Cosgrove,  
 
 
 
Thank you for sending me a copy of your letter on this boy. At the time 
 
you saw him he was a day patient on our Children's Psychiatric Unit.  It 
 
would seem that you did not elicit this piece of information.   
 
 
I am most unhappy about your intervention with this boy and with your 

false assumption that not more has been done for this poor child by the 
 
local specialist.” 
 
 
 
So Dr Cosgrove replied to that by letter dated 7 July 1999 that appears at pages two to 
 
four of division five in the bundle.  If you will forgive me, I will read this in its entirety, 
sir, because, in our submission, this letter amounts to a an unwarranted diatribe against Dr 

Moses, which you will note from page four of division five was copied to parents of 
 
Patient C and to the General Practitioner:   
 
 
 
“Dear Dr Moses, 
 
 
 
Thank for your letter of 1 July in which you say that: 
 

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1) I did not elicit the fact that Patient C was a day patient on your 
 
Children's Psychiatric Unit.   
 
 
 
2) I am most unhappy about your intervention with this boy, 
 
 
 
3) I am most unhappy with the false assumption that not more has 
been done for this poor child by the local specialist.   

 
 
In relation to 1), I was told by the General Practitioner, Dr Rackham, that 
 
Patient C “has been under the care of Dr Karen Moses at St Cadoc’s 
 
Hospital.”  Put like that it could mean that he has been under in your care 
 
but is no longer.  But anyhow, even if Patient C was still under your care, 
 
the GP is entitled to ask for a second opinion and hence he states at the end 
of his referral letter to me? “I would be grateful for your opinion.”  

 
 
When I met Mr and Mrs C I was told that Patient C had been attending St 
 
Cadoc’s Hospital five days per week since November 1998.  I was also 
 
told that in that time of some six months you have seen Patient C only 
 
ONCE and that, furthermore, you had told his parents that you were going 
 
to prescribe a sleeping tablet at night for C.  This never happened!  You 
neither prescribed this medication you had promised nor did you explain to 

his parents why you hat changed your mind and were no longer going to 
 
prescribe it. 
 
 
 
I appreciate that you are likely to deny some of or all of this, which is what 
 
the parents have told me. Whether or not the parents have reported to me 
 
everything totally accurately is of less relevance than what they consider 
to have happened (or not happened) as the case may be.  Anyhow, the 

number of times you actually did see him, as he was under your consultant 
 
care, would be recorded in his notes and would be beyond dispute.   
 
 
 
So you see, I did elicit the piece of information that C was a day patient on 
 
your Children's Psychiatric Unit at the time I saw him.  He had been there 
for six months; you had seen him only once and he was getting worse and 
 
worse when he should have been getting better and better.   

 
 
…2) you are unhappy about my intervention with the this boy. Why are 
 
you unhappy? After all you told the parents that you agreed with C being 
 
prescribed Ritalin.  If you agreed with the prescription of Ritalin why did 
 
you not prescribed it for him during the six months he was in your 
Children's Psychiatric Unit? I am sure you owe C’s parents an explanation 

on this particular point! 
 
 
 
Why are you unhappy? I feel sure that your unhappiness will turn to sheer 
 
joy and happiness when I tell you that within ten days C was very much 
 
better. He has ceased being aggressive and abusive and his maternal 
 
grandmother has had him visit her three times over one weekend since 
starting the medication compared with the no visits during the last eight 

months – six of which he was in your Children’s Psychiatric Unit 
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attending for five days per week! So why should you be unhappy about my 
 
intervention? 
 
 
 
As a result of my intervention, Durands School have now changed their 
 
mind and are going to have him back - following a visit from a member of 
 
their staff. His mother says that her son is “a lot better” and that there has 
been “a great improvement”. So why be unhappy about my intervention?  

Perhaps you will be good enough to write to me to tell me why you are 
 
most unhappy about my intervention when the child concerned is 
 
transformed. I cannot believe that you as a caring doctor would do 
 
anything else but rejoice with me and with C and with both his parents that 
 
C is back to good health. 
 
 
As regards 3) you are most unhappy with my false assumption that “not 

more has been done for this poor child by the local specialist.” You first 
 
saw C when he was five years old when he was not eating, was thin, was 
 
having frequent tempers, when the parents were being called into school 
 
on a weekly basis.  You made no diagnosis and did nothing that actually 
 
resulted in and alleviation of this child’s malfunctioning.  You saw him 
 
again when he was six years old and had one half hour’s talk with C’s 
mother.  There was a similar meeting when he was seven years of age.  So 

that you have seen C and his mother three times in four years.  What did 
 
you actually achieve by these three meetings.  I will would appreciate it if 
 
you would write to me and tell me what you achieved by these three 
 
appointments. 
 
 
 
In 1998 he was not allowed to return to Caldicot St Marys school because 
of his behaviour there during the previous academic year.  In September 

1998 he was expelled from school after one month there because of his 
 
violence to other children and because he complete refused to any of the 
 
work that the teachers set.  In November 1998, he was admitted under you. 
 
 Please tell me, please, what benefit your three 
 
interventions/sessions/appointments were when he was 5 and 6 and 7 years 
of age. Nothing you said or did on those occasions prevented his behaviour 
 
causing him to be asked to leave from two schools last year and from 

being admitted to St Cadoc’s. 
 
 
 
If you can tell me what you achieved for C from 5 years to now, then I will 
 
withdraw my comment that makes you most unhappy and apologise to 
 
you. I look forward to hearing your justification of what you did when you 
saw the boy and his mother three times in four years. 

 
 
    I note that you letter is headed in bold, black capital letter         
 
   Restricted and Confidential Information. You are a public          
 
   servant, being paid by public monies and employed in a  public 
 
   service.  You are, therefore, publicly accountable I will not        
 
   have correspondence going between you and me that disallows  
   the parent from knowing what is being said about them and       

   about their son, C. I have ignored this restriction by quoting       
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   verbatim from your letter and by sending a copy of this letter to 
 
   you, Mr and Mrs C and to Dr Rackham.  I look forward to         
 
   hearing from you". 
 
  
 
I described it as a diatribe, sir, and that in our submission it is.  Robust criticism of a 
 
fellow professional is one matter. This goes in our submission far beyond that and far 
into, we say, the territory of criticisms which are likely to undermine confidence in fellow 

medical practitioners and which are likely and liable to cause harm to medical treatment 
 
and I will return to that point. 
 
  
 
Sir, Patient D is referred to in Charge 6 and Charge 6, just so that you are aware, is the 
 
charge or at least the patient and his mother to whom a great deal of reference was made 
 
last time and from whose mother we contend at least you heard on the last occasion. 
  

Patient D was born on 12 February 1986 and so that makes him now eight years of age.  
 
As a result of poor behaviour at school, his mother became -- I am sorry, that is a bad 
 
miscalculation.  That makes him 18 years of age, not eight, does it not? 
 
  
 
As a result of poor behaviour at school, his mother became considerably concerned.  She 
 
happened upon a television programme where the issue of ADHD was being discussed 
and, realising that the characteristics described were similar to those of her son, she 

investigated further and through a Family Support Group she was put in touch with Dr 
 
Cosgrove. 
 
  
 
In May 1996 she took her son to see him and the consultation took she estimates 15 to 20 
 
minutes, during which time Dr Cosgrove asked various questions about her son's 
 
behaviour and she completed a questionnaire about her son.  However we contend that Dr 
Cosgrove did not speak directly to Patient D, notwithstanding the fact that he was then 

ten, nor did he carry out a physical examination.  Dr Cosgrove diagnosed ADHD and told 
 
the patient's mother that he could assist by prescribing Ritalin on a private prescription, 
 
which he did. 
 
  
 
The failure of Dr Cosgrove to weigh Patient D or to take his blood pressure was, we say, 
inappropriate and inadequate. 
 
  

D's mother paid Dr Cosgrove £160 in cash, and Dr Cosgrove indicated that he would 
 
check on D's progress by telephoning in a fortnight and that would cost £25.  Dr 
 
Cosgrove duly telephoned two weeks later and D's mother explained that she was still 
 
having problems with her son's behaviour.  Dr Cosgrove indicated that he would increase 
 
the dose of Ritalin. 
  

Two weeks later, again Patient D's mother spoke to Dr Cosgrove by telephone.  She 
 
indicated that she was concerned about her son not eating or sleeping and him losing 
 
weight.  She explained this to Dr Cosgrove, who said that he would prescribe another 
 
drug  which would help her son's sleep and would, as he put it, counterbalance the 
 
Ritalin.  This drug was risperidone.  D's mother also asked whether she should seek help 
 
from Psychiatric Services, to which Dr Cosgrove replied that this was not necessary and 
that he could prescribe all that was necessary to deal with D's condition.  Dr Cosgrove 

then sent a private prescription for risperidone and D's mother obtained the drug. 
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D remained on Ritalin and risperidone for a number of years. However, after the first visit 
 
Dr Cosgrove did not see him.  It was, we submit, inappropriate for this treatment to 
 
continue without monitoring taking place by Dr Cosgrove. 
 
  
 
Sir, Charges 7 and 8 relate to a Patient E and an investigation of features of the treatment 
of his care at the Oxfordshire or via the Oxfordshire Mental Healthcare NHS Trust. 

  
 
Patient E, as I say, was treated in that Trust and he was also a patient of Dr Cosgrove.  
 
Following a complaint from his parents about the treatment at the Trust, the Trust 
 
launched a review. Miss Wendy Samways, a Complaints and Patient Advice Liaison 
 
Service Manager at the Trust, wrote to Dr Cosgrove requesting a copy of his notes.  In 
 
Division 8 of the bundle -- I am sorry, it is Division 7.  I will get the numbering right, I 
apologise.  At Page 1 of Division 7 you will see a letter from Miss Samways to Dr 

Cosgrove requesting copies of any medical records that he might hold. 
 
  
 
Sir, the response of Dr Cosgrove to that letter appears in a letter at Pages 2 and 3 of 
 
Division 7.  Again that is copied to this patient's parents, as you will see at the bottom of 
 
Page 3, and again if you will excuse me I will read it out at length now: 
 
  
"Dear Miss Samways, 

  
 
Thank you for your letter of 29 September and your request for 
 
copies of any medical records that I hold regarding Patient E.  I 
 
note that you have enclosed signed authorisation and request that 
 
I send you copies of any medical records. 
 
  
I am unwilling to accede to your request in the matter.  I do not 

believe that the independent expert will be truly independent nor 
 
sufficiently knowledgeable concerning the treatment that I have 
 
given to E subsequent to my taking over his care from Dr 
 
McDonald.  I am concerned that I am being drawn into a process 
 
which, in the end, will whitewash the circumstances of E's 
inadequate care given by an employee of your Trust.  It seems to 
 
me inevitable that the Trust will come to a final decision which 

first and foremost will ensure that the Trust cannot be sued by Mr 
 
and Mrs E in regard to the care of their son. 
 
  
 
I assert that the expert you have called upon will not be 
 
sufficiently independent to do justice in this case for E and his  
parents.  The independent expert will never, ever say anything 

that would cause Dr McDonald any distress or difficulty with 
 
employment for the simple reason that this so-called independent 
 
witness will always face the unpleasant prospect of coming face 
 
to face with Dr McDonald in the future at conferences and 
 
meetings.  The expert witness will have this in the forefront of 
 
his/her mind in coming to a conclusion on this matter. 
  

I assert that the expert will also not be knowledgeable or 
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experienced enough with the use of risperidone which is not only 
 
the medication that has dramatically changed E's treatment but is 
 
precisely the medication that Mrs E was calling upon Dr 
 
McDonald again and again to prescribe, but which he persistently 
 
refused to do so.  His constant refusal to do this was partly 
 
because of your Trust's policy not to prescribe this medication to 
children. 

  
 
I am probably the most experienced specialist in the UK in the 
 
use of risperidone with children, having treated more than 500 
 
young patients with it since 1993.  You will not find an expert 
 
who will be able to do justice to E's case. 
 
  
I am not prepared to become involved with what I believe will be 

a cover-up of the grossly inadequate care that this child, who is 
 
now my patient, has received in your Trust.  You have set up a 
 
semi-secret system of investigation which will be programmed to 
 
ensure that the Trust comes out of it with a clean bill of health or 
 
with a few minor cosmetic points.  Your independent expert will 
 
come under very considerable pressure to be kind and generous to 
a fellow medic and not to be troublesome to the Trust who has 

appointed him in the first place and probably paying him 
 
considerable expenses and fees for his trouble. 
 
  
 
The only fair and just way to deal with Mr and Mrs E's 
 
complaints against your Trust and against Dr McDonald is to 
 
formally complain to the Fitness to Practise Directorate of the 
GMC.  Here a medical screener, who will be unknown 

completely to your Trust, will decide if the complaint should go 
 
forward to the next stage which is Preliminary Proceedings 
 
Committee.  This Committee consists of laypeople who will 
 
represent Mr and Mrs E's interests for justice better than any 
 
'independent' medical expert that your Trust appoints.  
Furthermore, the medical members of the committee, not being 
 
psychiatrists and not having to meet Dr McDonald at any 

conferences, will be able to give a fair and impartial decision on 
 
that matter as to whether it should go forward to the next stage of 
 
investigation. 
 
  
 
And finally, with the GMC involved, I will be able to put my 
views in on behalf of Mr and Mrs E and E.  I find it 

incomprehensible that you should ask the specialist, who has 
 
transformed E in a way that your Trust was quite incapable of 
 
doing, to just simply send you copies of the medical notes.  You 
 
should be asking me for my expert opinions on the matter and not 
 
just for the notes.  However, please be assured that any  requests 
 
from now on for my opinion from yourselves will not be 
forthcoming.  For E and his parent's sake, the GMC is by far the 

best way to pursue their complaints". 
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Sir, a number of points arise from that letter in our submission. First of all, Dr Cosgrove 
 
was not attempting in any way to assist with the review procedure.  Secondly he was 
 
criticising that procedure, and more particularly one named doctor and in a more general 
 
sense other medics at the Trust, in a manner which -- and you will have noted this 
 
admission under this charge, an admission which we say is quite an appropriate and 
inevitable admission, "... in a manner which is likely to cause the reader to doubt the 

knowledge and skills of employees of the Oxfordshire Mental Healthcare NHS Trust who 
 
treated Patient E".  That is 8(b) (iii), sir, an admission which is similarly made under 
 
some of the other charges. 
 
  
 
I have indicated already that there is a proper role for robust criticism but, sir, this kind of 
 
criticism shows first of all an arrogance on the part of Dr Cosgrove that he is the only 
person properly able to understand the patients' needs and properly able to treat them, 

whereas in fact we say that on any proper reading of the situation there is a range of 
 
opinion and that the criticism that he makes of others whilst no doubt genuinely and 
 
firmly held are not criticisms that can properly be made so as to put the conduct of others 
 
outside of the reasonable conduct of medical practitioners, but also that it is likely to 
 
interfere with the relationship between this Trust, Patient E, Patient E's parents and others 
 
to whom they speak.  It is not, in our submission, good medical practice.  It is not 
conducive to good and proper medical treatment. 

  
 
Charge 9 relates to Patient F.  Patient F is an adult patient, again, registered with the 
 
practice of a Dr Dolby.  Dr Cosgrove saw Patient F in the Year 2000.  At that time, Dr 
 
Helen Chubb was a Consultant Psychiatrist at the Cardiff and Vale NHS Trust and Dr 
 
Miranda Thomas was her SHO.  Dr Thomas saw Patient F, during this period, and later 
 
Dr Cosgrove wrote a letter to F's General Practitioner, Dr Dolby, a copy of which appears 
at Division 9. 

  
 
Again, if you will excuse me so doing, I will read at some length from the letter.  Not 
 
from the first half of the letter, but picking up halfway down the second page.  I think the 
 
typed numbers that appear in some of the divisions of the bundle do not appear on this 
 
particular document, but it is numbered I think handwritten number 232 in the bottom 
right-hand corner.  It is the passage beginning, "He has been seen twice by Dr Melinda 
 
Thomas, who works for Dr Helen Chubb, Consultant Psychiatrist": 

  
 
"Between them, these two psychiatrists came to the conclusion 
 
that Patient F has a Personality Disorder, and told him that there 
 
was no medication for it.  He was told that referral would be 
 
made to a local psychiatrist who specialises in personality 
disorder. 

   
 
Patient F did not feel that Dr Thomas listened to him when he 
 
talked about his personal understanding of ADHD.  She said that  
 
'a concentration problem is for messy kids', which is such an 
 
ignorant comment to make in this new century.  He told me that 
 
he felt so bad after attending this psychiatric outpatients.  It is 
ironic and, arguably, even medically negligent that F knows more 

about ADHD in adults than both these two psychiatrists 
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combined. 
 
  
 
Dr Thomas came back from telling Dr Chubb about F (for the 
 
latter has never seen him) with a sentence of therapeutic nihilism 
 
to say, 'The consultant thinks that you have got a Personality 
 
Disorder, which is not treatable'. 
  

If F responds to treatment for adult-type ADHD, it will show that 
 
he has got a treatable disorder.  Since personality disorder is 
 
untreatable, according to Drs Thomas and Chubb, it will that F 
 
does not have a personality disorder and that these two 
 
psychiatrists were wrong.  It will also mean that F was right in his 
 
tentative diagnosis of ADHD in himself, and that they were 
negligent in not listening to him and in not knowing about ADHD 

as a real condition in adults.  All this leaves room for a formal 
 
complaint to the Fitness to Practise Directorate of the GMC", 
 
  
 
and Dr Cosgrove then goes on to deal with a specimen prescription. 
 
  
 
Again, these comments are in our submission highly critical and disparaging comments 
made in this case to the GP and copied to the psychiatrists but not, it appears in this case, 

copied to the patient or any relative of the patient himself.  Again the comments show an 
 
arrogance that Dr Cosgrove's understanding of ADHD is the only proper understanding, 
 
and that others attempting to deal with patients in this field do not properly understand 
 
and do not properly have a knowledge base of the condition. Again, we say this is 
 
unsustainable and unprofessional. 
 
  
Charge 10 now, sir, and I hasten to add I am coming to a conclusion fairly shortly now of 

this opening.  Charge 10 relates to Patient G, born on 14 March of 1998 and so now six 
 
years old, who was seen by Dr Cosgrove in about February 2003 when he was prescribed 
 
Ritalin and then risperidone.  Details of this attendance can be seen from a letter from Dr 
 
Cosgrove to the patient's General Practitioner dated 25 February 2003, a copy of which 
 
appears at Pages 3 to 5 of Division 10.  In this case I do not need to read from the letter, 
sir, but if we need to refer to any relevant parts of it in due course we will do. 
 
  

Subsequently, though, this patient was seen by Dr Judge, a Consultant Child and 
 
Adolescent Psychiatrist.  She discovered that Dr Cosgrove had seen G only once, had not 
 
adequately assessed his weight and had not subsequently monitored growth or any side 
 
effects of the medication. 
 
  
 It might perhaps conveniently be noted from the letter of 25 February 2003 that there is 

no reference to any system of monitoring save that on Page 4, just to flag-up this, about 
 
perhaps a fifth of the way down the page in the first full paragraph, there is reference to a 
 
series of telephone appointments with his parents in order to monitor his progress and to 
 
find the optimum dosage and frequency through the day. Such monitoring, in our 
 
submission, is not sufficient when dealing with medication of this nature. 
 
  
Charge 11 relates to Patient H, sir, who was seen by Dr Cosgrove in July 2003.  This was 

a patient who had previously been treated by a Consultant in Child and Adolescent 
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Psychiatry, Dr Stephen Dover, and in Division 11, Pages 1 and 2, we see a letter from Dr 
 
Cosgrove to Dr Patel, Patient H's General Practitioner, and the form of the letter is we say 
 
all too familiar. 
 
  
 
It deals first of all with ADHD, the diagnosis and the nature of the condition and the 
 
prescription, and then four lines up from the bottom of Page 1 of Division 11 continues as 
follows: 

  
 
"I understand that H was seen by Dr Dover, Consultant Child 
 
Psychiatrist, about one year ago for one appointment.  I was told 
 
by Mr and Mrs H that Dr Dover told them that he did not believe 
 
in ADHD, and that 'it was too Americanised'.  I was informed that 
 
Dr Dover told H's parents to go away and to sort out their own 
lives.  I was also told that Dr Dover did not read H's school 

reports nor did he ask to see them. 
 
  
 
According to H's parents, his headteacher was concerned at what 
 
Dr Dover had told Mr and Mrs H to do, namely to 'go away and 
 
to sort out your own lives'. 
 
  
And finally, I was informed that Dr Dover refused your own 

request to him for a second opinion. 
 
  
 
I would like to say that, firstly, ADHD most definitely does exist 
 
and is clearly described and written about in the ICD10, which is 
 
not 'Americanised'. 
 
  
Secondly, if Dr Dover really does not believe in ADHD, then he 

may have difficulty in getting revalidated by the GMC when his 
 
turn comes around. 
 
  
 
Thirdly, Dr Dover should have studied H's school reports before 
 
blaming the parents' relationship for H's behaviour at school and 
at home. 
 
  

Fourthly, it seems professionally unacceptable to me not to 
 
provide a second opinion when it is requested, especially when 
 
you yourself, as the child's GP, took the trouble to ask for it", 
 
  
 
and then finally there is a reference again to specimen prescriptions. 
   

Sir, I have said before and I repeat that the comments made by Dr Cosgrove in this letter 
 
and in other similar letters undoubtedly represent genuinely held opinions on his behalf.  
 
He is at times in the course of correspondence clearly referring to what he has been told 
 
about the conduct of other doctors, but you may think that in this letter and in other letters 
 
he readily adopts his understanding from typically parents of patients from what other 
 
doctors have said and then gives that validity by making criticism of the other doctors on 
the basis of it.  You may think, for example in the case of Dr Dover, that he appears to 

have far too little information available to him to publicly make comments of this nature. 
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Sir, you will I have no doubt be aware that "Good Medical Practice" has something to say 
 
about matters of this nature and it is perhaps helpful if I just flag that up now so that we 
 
have it in the forefront of our minds. 
 
                                                                  
 
If I might start from division 2 in the GMC booklet that we have available.  Division 2 is 
Good Medical Practice from October 1995 and on page 8, paragraph 24, under the 

heading “Working with colleagues”, the following appears: 
 
 
 
“You must not make any patient doubt your colleague’s 
 
knowledge or skills by making unnecessary or 
 
unsustainable comments about them.” 
 
 
Sir, turning to the next division, divider 3 of the same bundle, Good Medical Practice, 

July 1998, page 10, paragraph 29 repeats that paragraph in the same form. 
 
 
 
In Good Medical Practice for May 2001, which is division 4 of this binder, page 12 
 
paragraph 35, the words are put in a slightly different way: 
 
 
 
“You must not undermine patients’ trust in the care…” 
 

THE CHAIRMAN:  Page 13, I think it is.  You said page 12.  It is page 13.  It is 
 
paragraph 35 but it is on page 13.  I think you said it was 12. 
 
 
 
MR PEARCE:  It is on page 12 of the copy that I have got in front of me.  
 
 
 
THE CHAIRMAN:  I think we agree it is para 35, it is disagreement about the page 
number.  Approved May 2001, issued September 2001.  It looks like the same. 

 
 
MR PEARCE:  At the next available adjournment may I just check that because I have 
 
got two copies where it appears on page 12.  Let me read what it says here and then we 
 
can tell whether at least the wording is the same.  It may be a point of no significance 
 
whatsoever.  What I am reading is: 
 
 
“You must not undermine patients’ trust in the care or 

treatment they receive or in the judgment of those treating 
 
them by making malicious or unfounded criticism of 
 
colleagues.” 
 
 
 
THE CHAIRMAN:  The wording is the same. 
 

MR PEARCE:  I think it is a point of no significance although mild perplexity as to why 
 
page numbers should be different. 
 
 
 
Sir, we say that in each case that paragraph is important and, as I said twice before and 
 
repeat again, robust criticism is one thing but this went far beyond that. 
 
 
Sir, that concludes my comments by way of opening on the facts.  It might be a 

convenient moment for a break.  There are one or two matters of what is sometimes 
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called housekeeping - timetabling is a more accurate way to describe that, I think.  Unless 
 
you particularly wish me to deal with them now, I will deal with them after the short 
 
break, if this is a convenient moment.  
 
 
 
THE CHAIRMAN:  I think this is a convenient time to have a break but before doing so, 
 
could I just check with Mr Morris that I have got it correct.  9c ii was not admitted? 
 

MR MORRIS:  Sir, it is not admitted.  May I explain the basis of its non-admission.  The 
 
allegations as it currently reads,  
 
 
 
“In the letter you stated as follows: 
 
 
 
ii. 
that Dr Thomas had stated that a ‘concentration 
problem is for messy kids’” 

 
 
The concern is that it does not make it clear that that was a statement that he was 
 
reporting as having been made to him by the patient.  
 
 
 
THE CHAIRMAN:  Thank you very much.  We will have a break now and we will 
 
reconvene at about five-past eleven. 
 

The Committee adjourned for a short time 
 
 
 
MR PEARCE:  Sir, I had indicated that there were just one or two housekeeping matters. 
 
 First of all, the first witness whom I intend to call is Professor Taylor, who I call as an 
 
expert witness.  I have discussed the matter with my learned friend this morning and he 
 
quite rightly says - and quite understandably says - that he will have some difficulty in 
cross-examining Professor Taylor, part of whose evidence will be based upon what other 

witnesses have to say, until he has heard the other witnesses say it. 
 
 
 
It is quite understandable that he should say that and we have therefore made the 
 
following arrangement, that Professor Taylor will start his evidence today - it is 
 
convenient for him to give evidence now by way of background and some little 
information about Ritalin in particular, risperidone and such like, some little information 
 
about monitoring and reference to some literature which has a general application to these 

issues, but without descending to the particularity of any of the charges at this stage.  
 
Then, Professor Taylor will be recalled later on in the case in order to complete 
 
examination in chief so that I can ask him to consider particular charges with which you 
 
are concerned and to allow my learned friend to cross-examine him.   
 
 
Convenient as that is from our point of view, it has one slight problem which is that the 

only time that Professor Taylor can return - or the earliest that he can return - is next 
 
Wednesday.   
 
 
 
I have discussed it with my learned friend.  I think we are agreed that we will make it fit 
 
in that way.  I appreciate that that is some way through the case and that there is quite a 
 
lot of other evidence to hear in the meantime. 
 

THE CHAIRMAN:  Mr Morris, I take it you agree with that? 
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MR MORRIS:  I do.  I am grateful to my learned friend for mentioning it. 
 
 
 
THE CHAIRMAN:  I assume that Professor Taylor, from what you are saying, is not 
 
going to be listening to the witnesses when he comes to be recalled and cross-examined? 
 
 
MR PEARCE:  No doubt any relevant information, however it is adduced, will be put to 

Professor Taylor so that he can consider what the witnesses have had to say. 
 
 
 
THE CHAIRMAN:  We will agree with that. 
 
 
 
MR PEARCE:  I am most obliged, sir.  Otherwise, the witnesses I call are called to suit 
 
their convenience as far as possible.  It means that we are somewhat higgledy-piggledy in 
terms of the order but I think I am right in saying that insofar as there is more than one 

witness on any particular head of charge or any particular patient, that two witnesses are 
 
called consecutively, so we are dealing with it patient by patient, albeit that it will not be 
 
in the same order as in the charges.  I am sure that that will cause the Committee no 
 
trouble, but so that you understand that position now.  It is very much for the convenience 
 
of witnesses who, of course, may either have attended or were available to attend in 
 
January and again I am sure you will understand that. 
 

THE CHAIRMAN:  Do these proposals have any implication for the potential eight day 
 
schedule for the case, or is it too early? 
 
 
 
MR PEARCE:  I think the answer is it is too early to say.  I have touched on that with my 
 
learned friend but I think that it is too early to say.  I would like to think it will have no 
 
effect on it.  If it does, the greater concern will be Professor Taylor not being available 
until Wednesday of next week.  Unfortunately Professor Taylor is one of those witnesses 

who did actually physically attend on the last occasion and was kept waiting, I think on 
 
the Wednesday of the first week - I may be wrong on that - for a good part of the day on 
 
the basis that it was not clear whether he would be able to give evidence or not.  It is 
 
unfortunate, but there we are.  Hopefully it will not delay us. 
 
 
THE CHAIRMAN:  We can now proceed, if there are no other housekeeping matters. 
 
 

MR PEARCE:  I am much obliged.  I will call Professor Taylor, please. 
 
 
 
PROFESSOR ERIC TAYLOR Affirmed 
 
Examined by MR PEARCE: 
 
 

Could you identify yourself to the Committee, please 


I am Eric Taylor.  I am Professor of Child and Adolescent Psychiatry at the 
 
Institute of Psychiatry, Kings College, London and I am an honorary consultant child and 
 
adolescent psychiatrist at the Maudsley Hospital. 
 
 
 

I am obliged.  Could I produce your curriculum vitae, Professor Taylor?  I thought 
 
when I first saw this bundle that it was a bundle of both the curriculum vitae and the 
literature and was alarmed to discover it is the curriculum vitae alone! 

 
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THE CHAIRMAN:  This will be C9.  (Produced
 
 
 
MR PEARCE:  I am much obliged.  Can I ask you to confirm that this is your curriculum 
 
vitae, Professor Taylor? 
 

Yes, it is. 
 
 

I am not going to go through this in any detail at all because, as we will see when 

we refer to some literature in a short while, you have written in this area with which we 
 
are concerned, that of ADHD.  Could I ask you first of all to describe attention deficit 
 
hyperactivity disorder for the benefit of the Committee? 
 

Yes, of course.  It is a condition that is characterised by high, inappropriate and 
 
impairing levels of some types of behaviour the children show enduringly.  The particular 
 
types are being very inattentive, distractable, disorganised, chaotic, being very impulsive, 
not thinking things through, jumping to conclusions, getting things wrong, getting into 

trouble because of thoughtlessness and of being over active as well, as the name implies.  
 
The actual level of activity is seldom the most important problem.  It is a condition in 
 
which there has been a great deal of scientific research and there are a number of different 
 
causes that affect it. 
 
 
 

You mention the condition in children.  What about the condition in adult? 

The condition in adults gives rise to much more scientific uncertainly.  There is 

not the same kind of level of scientific research that has been done, at least until very 
 
recent years.   
 
 
 
It is, of course, a matter of every day observation that people vary a good deal.  Some 
 
adults are much more disorganised than other.  The controversy has been about how to 
 
understand that and for some psychiatrists, including myself, a lot of those cases can be 
seen as the direct continuation of the childhood problem of ADHD.  

 
 
For others - and probably for the majority of general adult psychiatrists in the country, 
 
they are best seen either as the result of another disorder, such as a kind of mild 
 
hypermania, as a sort of bipolar disorder, as part of a wider reaching issue, a personality 
 
disorder or as a way of talking about people’s problems that they have encountered in life 
and have lacked success, therefore overlapping with the issues of mild learning disability 
 
and specific problems such as memory difficulties. 

 
 
So, there is an argument which I think the evidence has not completely resolved about 
 
how far ADHD should be recognised as an adult problem and a proper thing to treat in 
 
adult life. 
 
 
My view is it probably is.  The majority view is that it is not.  As far as I know there are 

only two clinics under the NHS that deal with adult ADHD. 
 
 
 

May I ask you about treatment for ADHD.  Again, for the moment let us limit it to 
 
children where I think the diagnosis may be a little less controversial.  What forms of 
 
treatment are considered by psychiatrists dealing with ADHD? 
 

Well, as the problem is recognised, there is first of all assessment that looks to see 
whether there are underlying problems that may be causing it, such as a learning 

disability or something of that kind.  Secondly, it is a process of educational process, 
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advice and liaison with schools. Thirdly, there is a range of psychological treatment 
 
available of which, especially with younger children, parent training of the principles of 
 
behaviour therapy is of great value.  The most effective therapies are medication - or the 
 
most powerful therapies are medication, of which the front line of drugs are stimulant 
 
medicines, drugs such as methylphenidate, dexamphetamine, drugs whose purpose is 
 
considered to be to raise the levels of available dopamine within the brain. 
 


There is also a range of second line drugs that are used, typically used if the 
 
stimulants are not effective which do not have the evidence base, do not in general have 
 
the evidence base for the stimulants.  One was licensed just last week, I think.   
 
 
 
Other drugs that are used include antidepressants, for which there is limited evidence for 
 
some value.  Drugs such as the motor tranquilisers, the neuroleptic drugs, such as 
Risperidone, for which there is not any trial evidence in favour, but which are used 

especially for the control of aggression, though their prime indication is for psychosis and  
 
a range of other drugs which, especially ones which have an influence upon the 
 
noradrenalin(?) system, rather than the dopamine system in the brain, drugs which would 
 
include clonidine. 
 
 
 

You have identified Methylphenidate, of which Ritalin is a variety? 

That is correct. There are several proprietary names and Ritalin is the best known. 

 
 

Could I return to Methylphenidate for a moment and those stimulants.  Could you 
 
explain in a little further detail how they are thought to assist in treating people with 
 
ADHD? 
 

At the psychological level then it is thought that their main action is to help to 
 
correct the impulsiveness that children often show.  That is to say, they are not sedatives, 
they are not tranquilisers, their purpose is to restore normal function.  Their intention is to 

help performance in psychological tests and, more importantly, in real life, in education 
 
performance. Through giving children more time to plan ahead and think their actions it 
 
makes them less likely to be in impulsive trouble, it affects both the inattentive side and 
 
the restless side of the children's problems. 
 
 

How is it thought to do that? You mentioned dopamine. 
 

Yes, the best evidence is coming from assaying the levels of chemicals in the 

brain when the medication is given by comparison by when a dummy medication is 
 
given.  Then what happens is they inhibit the dopamine transporter, which is the protein 
 
in the brain that combines with the dopamine and removes it from effective working in 
 
the brain.   
 
So because it inhibits that molecule removes dopamine in the brain, they raise the 
effective level of dopamine concentration. 

It is thought that that is related to the actual causes of ADHD because one of the genes 
 
which is weekly associated with ADHD is the one that helps to form that dopamine 
 
transporter molecule. 
 
The other drugs, the second line drugs work in rather differed ways. 
 
 
 

Risperidone is one of those? 

That would work in a quiet different way.  It is more of a damper down than a 

stimulant.  Its purpose essential is to control, well, its license purpose is for the control of 
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psychotic illness, but in this context its key purpose is to be controlling aggressive 
 
behaviour, but that class of drugs of the neurolectics are antagonists of dopamine, they do 
 
not have helpful effects upon the attention side of the problems specifically, they are 
 
more like a general way of reducing the actively levels and especially the aggression 
 
levels of what the child is doing and they carry rather more hazards than the stimulants do 
 
precisely because they have a broader range of actions in the brain. 
 


The matters with which we are concerned in heads of charges before the 
 
Committee cover a period from 1996 to 2003, predominantly in the late 1990s and around 
 
2000.  At that time was it easy to find psychiatrists who would be willing to treat children 
 
with ADHD by the use of drug therapy? 
 

By the late 1990s that was developing, yes.  There was a gradual increase through 
 
the 1990s in the recognition of the problem in children.  So I think it was in 1995 that 
Ritalin was reintroduced to the market having been withdrawn by its manufacturers for 

some years.  The years subsequent to 1995 to 2000 saw a considerable increase and a 
 
good deal of controversy within the profession as well. 
 
 
 

What was the nature of that controversy in general terms? 
 

Firstly as to whether ADHD should be recognised widely or narrowly.  Whether it 
 
should be seen as a relative uncommon problem, affecting perhaps half a per cent of 
children,  which was the definition of Hyperkinetic Disorder, which remains the official 

diagnosis in this country, or whether one should recognise more broadly the ADHD, 
 
Attention Deficit Hyperactivity Disorder, which is the term from the American 
 
classification, affecting more perhaps like four or five per cent of the childhood 
 
population.  First of all there was a controversy of the recognition of the disorder.  
 
Secondly, and linked to that, there was controversy about the balance of psychological 
 
therapy as against medication; which you should give first.  There still is some 
controversy about that.  Most mental health services in the country do now have services 

for ADHD in children, but they still vary as to whether they began with the psychological 
 
treatment or whether they began with the medication treatment, though all would regard it 
 
as essential for children to have the availability of both at some point. 
 
 
 

In terms of those two areas of controversy, you have had an opportunity to read a 
large amount of documentation relating to this case and also, I think, you have read Dr 
 
Cosgrove's published writings.  Where do you understand Dr Cosgrove to lie in that 

controversy, first of all about Hyperkinetic Disorder as against ADHD, the broader or the 
 
narrower classification? 
 

Dr Cosgrove was a pioneer in the recognition and the introduction of stimulant 
 
medication for AD HD in this country.  He was from the start a propounder of it.  My 
 
understanding is that he would be taking the view that really medication is the sole 
answer to the problems of ADHD, which I would see as an extreme view.  But certainly 

his position throughout has been one for the wide recognition of ADHD and the early and 
 
simpler course to medication is therapy. 
 
 
 

Might I ask you to look in the Committee bundle, under division seven, page two,  
 
I am not in any way concerned with detail of the charge, this is a letter from Dr Cosgrove 
 
to Miss Samways,  I am concerned with a point that Dr Cosgrove makes in the course of 
this letter he says, last paragraph: 

 
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“I am probably the most experienced specialist in the United Kingdom in 
 
the use of this Risperidone in children, having treated more than 500 
 
young patients with it since 1993.”   
 
 
 
Do you agree with that comment by Dr Cosgrove? 
 

Yes, I would agree that he has probably treated more children with Risperidone 
than anybody else.  I would not necessarily agree that was a definition of expertise 

because, of course, it would be quite possible if that practice were wrong that it would be 
 
a wide experience of error, rather than a wide experience of correct practice, but I would 
 
agree that it is very likely that he treated more children than anyone else in the country. 
 
 
 

May I now turn to dealing with some literature on the subject.  Another two 
 
exhibits that I have here, (handed) the first one begins with an article by Cantwell.   
 

THE CHAIRMAN: This will be C10. 
 
 
 
MR MORRIS: Obliged, sir, and the second is headed “Practice Parameters for the 
 
Assessment and Treatment of Children”, etcetera.  (handed) I take it this will be C11?  
 
 
 
THE CHAIRMAN: Yes.   
 

MR MORRIS: Professor Taylor, it might, I think, be most useful first of all to look at,  
 
I think it is prepared by you and Peter Hill, “An Auditable Protocol for Treatment of 
 
ADHD” which should appear in C10, the handwritten 313 in the bottom right-hand 
 
corner, co-written by you and Peter Hill? 
 

That is correct, yes. 
 
 

When was this published? 

A Dear 
me! 
 
 
 

I cannot find it on the document. 
 

It will be in the CV. I think that was probably 1999.  Let me check on that.  2001. 
 
  
 
 

So this is a protocol that was published after most of the events with which we are 

dealing in the charges here? 
 

Yes, that is right, yes. 
 
 
 

Over what period of time did you and Peter Hill write this protocol? 
 

Over about a year. 
 


So what do you say about the application of this protocol to the current 
 
management of ADHD? 
 

Yes, I would think that this is intended as standards for current management in 
 
every respect except that is takes no account of the most recently introduced drugs. 
 
 
 

We will in due course look back to earlier literature which may be more relevant 
to the standards in the mid/late 1990s? 

A Yes. 
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Can I take us to various parts of it.  Page 313 at the very bottom paragraph 
 
 
 
 
 
“The recent large MTA treatment trial in North America has not yet been 
 
fully reported and the interpretation is proving somewhat problematic. 
Nevertheless on this and other recent work principles have merged which 

are important.   
 
 
 
. 
Medication is best titrated against adverse and desirable effects 
 
rather than given on a pre determined milligram or per kilogram basis, 
 
 
 
. 
Desired effects should include improved education achievement 
and social relations within the peer group as well as behavioural  control.   

 
 
. 
Psychological treatment adds only moderately to optimise 
 
medication dosage, but can be of value for selected targets , 
 
 
 
. 
Psychological treatment reduces the dose of medication occasion 
 
required.” 
 

Since this was written have developments altered, where those principles have correctly 
 
emerged from MTA treatment? 
 

I think they would still stand.  I think there would be no controversy, except, 
 
perhaps, about the third, which is that there would still be room for debate with some 
 
people considering that psychological treatment is of considerable value in its right and 
 
can add to optimised medication dosage. Further analysis of the study has suggested the 
best results are obtained when you do have a combination of medication and behaviour 

therapy. 
 
 
 

Further down on page 314, the fifth full paragraph: 
 
 
 
“Although medication is the most powerful treatment in terms of effect 
 
size, not all cases will need it, not all families accept it and not all children 
will be suitable for it.  Psychological intervention may prove sufficient. If 

it is not, there is evidence for the effectiveness of an individual constructed 
 
elimination diet.”   
 
 
 
You go on to deal with diet issues.  But there emphasising a point that you have already 
 
made that medication is the most powerful? 


That would still be the view.  There has been a recent development of consensus 
European guidelines which suggests that medication should be the first therapy for the 
 
most severe cases, those most closely approximating to the rather narrow definition of 
 
Hyperkinetic Disorder, and for the wider group there are options in therapy negotiation 
 
between familiar and prescribing professionals about which kind of plan you start with. 
 
 
 

At least in so far as we are dealing with the more severe cases the more recent 
thinking has tended to back medication; Dr Cosgrove's type of approach against those 

who might have taken a different approach? 
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A Yes, 
yes. 
 
 
 

The bottom of page 314 to flag this up: 
 
 
 
“We have omitted consideration of classroom management techniques 
 
because these are best implemented by Education rather than Health 
Service professionals. They have been shown to be effective and need to 

be deployed as a component of treatment.”   
 
 
 
Again do you stand by that comment? 
 

Yes, that would be even clearer now, yes. 
 
 
 

Moving into the management protocol that you refer to here, you start from page 
315 and running on you talk about assessment, obtaining base lines, on page 316 you 

indicate physical examination towards the top of that page and a number of tick boxes in 
 
respect of that kind of examination.  For what purpose are you saying that examination 
 
should be carried out? 
 

For two key purposes.  Perhaps the most important is following the future course 
 
of medication, for detecting unwelcome effects which the medications may have upon 
 
growth and upon the cardiovascular status.  Secondly, for detecting other problems which 
may be significant in and child development, which may be associated with ADHD, such 

as in (Inaudible), which though not necessarily a part of is quite often associated and may 
 
well be a reason for considering physiotherapy, occupational therapy or the like in the 
 
management of the whole child's problem. 
 
 
 

Moving on if we may, that is under the heading assessment, we move on to 
 
treatment on page 317, various basic handling framework, for example, referred to there, 
basic handling practices: 

 
 
“If this is insufficient, proceed to consider medication.”   
 
 
 
Over the next page, page 318, just over halfway down, “Obtain baselines”, and you there 
 
indicate amongst other things weigh and measure height, plotting on growth chart.  Is that 
for similar reasons to those you have outlined already? 
 

Yes, it is, it is emphasising at the point where you start medication you need to 

make these measures again in order to have an up to date baseline for evaluating 
 
continuing effects.  It is only minority of children whose height and weight are affected 
 
by medication, but it is a significant minority and it is one of the concerns about the use 
 
of the drugs that gives rise for caution. 
 
 

Then you would consider and might move to titration of methylphenidate, Ritalin 

we see at the bottom of page 318. On page 319 and certainly those references to 
 
monitoring now, perhaps a sixth of the way down, the  paragraph beginning: 
 
 
 
“Monitor with regular questionnaires from parents and school.  See below 
 
for checklist. Need to establish  
 
 
a. 
symptomatic and behavioural  gain 

 
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b. 
performance improvement gain (academic, peer group) 
 
 
 
c. 
adverse effects.   
 
 
 
After 2-4 weeks (depending on availability of teacher questionnaires) 
 
review personally and enquire about beneficial and adverse effects.” 
 

You talk about possibly then increase in dosage.   
 
 
 
“After approximately a further four weeks (i.e. 6-8 weeks from baseline) 
 
review personally and enquire about beneficial and adverse effects.   
 
 
 
You talk ten about the possibility of increasing dosage. A little further down: 
 

“Continue to monitor at home and school with questionnaires. Ask 
 
specifically if child is dazed or perseverating (dose-related side-effect).  
 
After approximately two further weeks (i.e. 8-10 weeks from baseline), 
 
consider 
 
 
 
1. 
whether effect obtained in health and education gain terms 
 

2. 
if so, and if child weighs more than 25kg, consider increase to 
 
20mgmorning, 20mg midday,  5-10mg mid-afternoon.” 
 
 
 
Just so we understand where we are up to there, that in terms of dosage then, you are 
 
considering a total dosage of perhaps 45 to 50 milligrams at that stage? 
 

Yes, that is correct.  One only gets to that point if this considered to be still room 
for improvement.  That is to say, for most children there will have seen substantial benefit 

on the lower doses.  So that in the large MTA trial, that you referred to before, the 
 
average daily dose was of the order 30 milligrams a day, three doses of ten milligrams 
 
each.  So it is only if there is inadequate improvement at that point that one goes on the 
 
higher dose level. 
 
 

Yes.  Just in passing so that we note it, footnote 20, which is on the line: 
 
 

“Adjust afternoon dose according to difficulties or discontinuation 
 
rebound reaction”,  
 
 
 
Footnote 20: 
 
 
If CVS is more can add clonidine 5—250 micrograms as evening dose, 

utilising drowsiness side-effect, increase dose with caution.” 
 
 
 
What then is the purpose of the clonidine being added in that situation? 
 

In that situation it is to counteract one of the possible problems that the stimulants 
 
can produce which is that the child is losing sleep and is kept awake at night.  When that 
 
appears one makes other advice first.  Perhaps one adjusts bedtime routine.  One 
introduces bedtime routines.  Make sure the child is not hungry when they go to bed. 

Common sense measures of that kind.  If they do not work, then what we are suggesting 
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at that time was that clonidine was a suitable sedative to be using. Since then that would 
 
probably have changed.  Nowadays most practitioners would now use the most recent 
 
technique of giving melatonin as the sedation. 
 
 
 

I am sorry, I jumped back in time: 
 
 
“After approximately two further weeks (i.e. 8 – 10 weeks from baseline)” 

 
 
We read some of that and the possibility of increase to 45 to 50 milligrams per day. 
 
A Yes. 
 
 
 
 
Q       Further down again: 
 
  
"Enquire about desired and undesired effects at school and home 

  
 
Monitor home and school with questionnaires monthly until 6 
 
months, then 6 monthly 
 
  
 
Review personally, weighing and measuring height at least six 
 
monthly". 
  

Now in general terms, without dealing with the individual patients for a moment, it would 
 
appear that or may appear that in a number of cases Dr Cosgrove was reviewing patients 
 
over the telephone.  What do you say about telephone monitoring and review? 
 
A       Well, there is a place -- as part of the overall package some of the monitoring can 
 
indeed be done by telephone, and that is especially the case when parent and families are 
 
living at some distance from the prescriber as would have been the situation in this case. 
  

Q       Yes, precisely so.  Yes. 
 
A       However, there are some things that you cannot get solely from parental report.  In 
 
particular parents do not necessarily know about problems at school, because they are 
 
reliant upon teachers telling them and teachers may not want to stress the  negative that is 
 
happening with a child, and there are some things that may only appear on the 
examination of the child.  We have mentioned perseveration and being dazed.  The issue 
 
there is that for a minority of children they may appear to be much improved, in the sense 

that they are stiller and they are quieter, but that is not accompanied by true improvement 
 
in cognitive performance because in effect they are over-faced. They may be staring at 
 
the teacher, but they may not be taking in what the teacher is saying.  So, it is possible to 
 
have a rather subtle effect at that point for which you need to see the child yourself.  You 
 
cannot just tell by report, because everybody may say, "Yes, things are much better". 
  

Q       What about physical monitoring and review in terms of weight, height 
 
measurements and such like? 
 
A       Yes, these do not -- I think these do not require specialist investigation. 
 
  
 
Q       Yes. 
 
A       So, they are NICE recommendations - the National Institute for Clinical Excellence 
recommendations - and it is quite possible to set up a shared care system in which the 

specialist has initiated the treatment and established the early dose, but then there is a 
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shared care system with General Practice in which the family doctor would then be the 
 
person who was monitoring the height, the weight, the blood pressure and the pulse rate. 
 
   
 
Q       Yes. 
 
A       And the ECG if that were necessary in the individual cases. 
 
  
Q       Yes, yes.  And turning over on to the next page I think, essentially having reached 

those levels of dosage you have referred to, then in this algorithm or protocol you would 
 
consider substituting dexamphetamine for methylphenidate at this stage? 
 
A       Yes, yes. 
 
  
 
Q       Now, as indicated, published in 2001 and so not something that Dr Cosgrove could 
 
have available to him at the relevant time.  Do you say, or what do you say though about 
the standards there referred to in terms of monitoring?  The initial investigation and 

monitoring? 
 
A       Yes.  Well there is discussion within the profession, and some areas and some 
 
clinics have taken the view that the frequency of monitoring that is called for here is 
 
higher than can be delivered with resources available and that sometimes stakeholders 
 
such as the purchasers of service need to decide that a lower level of monitoring is 
 
necessary.  And so I think that is against the evidence, because I think that the evidence is 
that there is a proportion - a sufficiently high proportion - of children who will develop 

either adverse psychological effects or adverse physical effects that that does need 
 
monitoring.  And  there is very good evidence that the more carefully you monitor the 
 
dose and the more carefully you get the dose correct for the child, which may mean a 
 
small dose for some children and a large dose for others, the more you individualise the 
 
dose to the child that makes a very big difference to the quality of response the children 
 
obtain. 
  

Q       Yes. 
 
A       So, if anything I think the evidence it would be in favour of even more detailed 
 
monitoring than is in this protocol. 
 
  
 
Q       Yes. 
A       But there is a compromise to make between what is best for the children and what 
 
is affordable. 

  
 
Q       Yes, I understand.  I understand.  Now, could I then turn to some older literature 
 
that may tell us a little about standards in the mid to late 1990s.  First of all, can I look at 
 
Professor Cantwell's article, "Attention Deficit Disorder:  A Review of the Past 10 years", 
 
which is Page 286, the first page I think of C10.  In the bottom left-hand corner of Page 
286, we can see that this was accepted for publication on 12 September 1995 and we can 

see that Dr Cantwell is Joseph Cantwell, Professor of Child Psychiatry at UCLA 
 
Neuropsychiatry Institute? 
 
A       Yes.  He was probably the most distinguished figure in the field, but he died 
 
recently sadly. 
 
  
 
 Q       Right.  Now, there is a great deal of information in this article and I just want to 
take you briefly to one or two parts of it if I may.  Could I ask you first to look at Page 

292, please, and again all references are to the handwritten page numbers.  In the 
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left-hand column, the final paragraph, beginning this: 
 
  
 
"The primary psychopharmacological agents used to treat ADD 
 
are the CNS...", 
 
  
 
And that is central nervous system? 
A       Central nervous system, yes. 

  
 

 
  
 
"... stimulants.  The prototype drugs are dextroamphetamine 
 
methylphenidate..." (which we know is Ritalin) "... and pemoline. 
 
There are a number of amphetamines including 
methamphetamine and dextroamphetamine, but 

dextroamphetamine probably enjoys the greatest use.  
 
Methylphenidate is probably used more than any of the other 
 
stimulants.  At least 70% of children will have a positive response 
 
to one of the major stimulants on the first trial.  If a clinician 
 
conducts a trial of dextroamphetamine, methylphenidate, and 
 
pemoline, the response rate to at least one of these is in the 85% 
to 90% range, depending on how response is defined". 

  
 
 At the top of the next column: 
 
  
 
"While it is clear that the medications target classroom behavior, 
 
academic performance, and productivity, there is also good 
 
evidence to show that ADD ...", 
  

and I am sorry that I have read through this without noting that subtle distinction between 
 
ADHD and ADD.  Perhaps just assist us with that, if you would be so kind? 
 
A       There was a change in the classification system.  The disorder that had previously 
 
been referred to as ADD (Attention Deficit Disorder) later became known as ADDH 
 
(Attention Deficit Disorder With Hyperactivity), and most recently in the most recent 
change of the classification system, the DSM4, it became known as ADHD (Attention 
 
Deficit Hyperactivity Disorder).  Going along with those changes in name there were 

minor differences in the wording of how the criteria for it were expressed, but I think that 
 
these are differences without very much significance. 
 
  
 
Q       Yes?. 
 
A       They have been attempts to refine the diagnosis, but they are referring essentially to 
the same condition. 

  
 
Q       I am obliged.  I am obliged.  So, if we just pick it up again there in that sentence: 
 
  
 
"... there is also good evidence to show that ADD children  with 
 
oppositional and conduct symptomatology and aggressive 
 
behaviour also respond positively in these areas as well". 
  

A little further on: 
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"The main message is that stimulants are not 'school time drugs'.  
 
They should be used throughout the waking day and on the 
 
weekends as well". 
 
  
 
And a little further on: 
  

"Side effect profiles may be better for one child with one drug 
 
than another, but in general all stimulants share side effects of 
 
decreased appetite, insomnia, stomachache, headache, and 
 
irritability.  Most side effects will dissipate with time and many 
 
can be managed with various types of manipulation". 
 
  
Just pausing there for a moment, do those comments that I have there read out reflect then 

standard thinking at the time of this article? 
 
A       Yes, yes. 
 
  
 
Q       Could I also turn you to Page 294, again in the same article, and just again I want to 
 
ask you whether you think that the passage I am now going to read reflects good and 
 
up-to-date thinking at the time of this article.  The left-hand column: 
  

"It is now accepted that a multimodal approach to therapy that 
 
uses both psychosocial intervention and medication has the 
 
greatest chance of alleviating the multiple symptoms and domains 
 
of dysfunction with which ADD children present.  Medical 
 
treatment and psychosocial treatment have complementary 
 
effects. Thus a wider range of symptoms may be treated than with 
either intervention alone.  Psychosocial intervention may improve 

symptoms during the period of time that medication has worn off. 
 
The use of both interventions together may lead to lower 
 
medication dosage and a less complex psychosocial intervention 
 
program than with either treatment alone"? 
 
  
A       That was definitely the standard view in American practice at that time.  In English 
 
practice at that time, as we have said, probably most Child Psychiatrists would not have 

accepted that medication had as large a role as was being put in that, but it represents the 
 
mainstream of American type thinking  - of ADHD thinking - at that time. 
 
  
 
Q       Right. 
 
A       And there were many other things at the time that went in support of it.  The 
American Psychiatric Association gave evidence to Congress and so on that that would 

be the standard view. 
 
  
 
Q       Now may I move on from that document to the next one in this Exhibit C10, Page 
 
296, "Clinical guidelines for hyperkinetic  disorder", again I think with your name at the 
 
top of the list of authors of this article in "European Child & Adolescent Psychiatry".  
 
Could you just explain what this article represents? 
A       Yes.  This was an attempt to be reaching a consensus about the more European 

style of practice, which is perhaps the more conservative style especially with regard to 
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medication than the American style. 
 
  
 
Q       Yes? 
 
A       And so this was drawing upon people from psychiatry and psychology and 
 
neurology from different European countries, and it was a series of meetings, it was 
 
reviewing the evidence - the evidence base - for the different forms of treatment available 
and it was trying to come to consensus recommendations on the basis of that. 

  
 
Q       Yes. 
 
A       And the process has recently been repeated for an upgrade and that is in press at the 
 
moment. 
 
  
 
Q       Right, right.  And you have mentioned Hyperkinetic Disorder earlier on, that 
classification, but just again so that we understand why it is referring to Hyperkinetic 

Disorder rather than ADHD? 
 
A       Yes.  Well essentially because Hyperkinetic Disorder is the term that is used in the 
 
international classification of  disease, which is the one that governs official practice and 
 
indeed governs -- it is the one that is officially adopted nationally here. 
 
  
 
Q       Yes. 
A       The term that is used there is Hyperkinetic Disorder and ADHD is the wider term 

used in the American classification, but in practice most clinicians usually use the term 
 
ADHD rather than Hyperkinetic Disorder.  There is a confusion and often a confusion in 
 
practice about whether people then are referring to a broad ADHD or a narrow ADHD 
 
definition, but I do not think that particular problem is going to be germane to the case. 
 
  
 
Q       No, I understand.  Turning if I might to Page 303, handwritten 303 in this article, 
there is a section headed "Psychopharmacological treatment", and I think it is clear if one 

analyses the lead-up to this that you are here dealing with the position of children?  I 
 
think you deal separately with the issue of adult pharmacological - 
 
psychopharmacological - treatment later on and we will come to that? 
 
A       Yes. 
 
  
Q       Just if I might read just part of this paragraph: 
 
  

"There is a massive evidence base from controlled trials for the 
 
effect of methylphenidate over treatment periods up to a year and 
 
in doses of up to 60 mg daily.  The effect size is large:  in  excess 
 
of 1 standard deviation", 
 
  
and you go on to deal with two other stimulants and something about the nature of the 

testing.  Then at very or nearly the very bottom of the left-hand column: 
 
  
 
"The effects of stimulants are not only on hyperactive behaviour; 
 
they also produce beneficial results in tests of cognitive 
 
performance, academic productivity, oppositionality, and social 
 
interactions with parents and peers". 
  

And then a little further down, or in fact the very bottom of the right-hand column of 
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Page 303, you talk about dosage: 
 
  
 
"The effect is brief and repeated doses are necessary.  To obtain 
 
symptom control over a 12-hour day, three doses are usually 
 
needed; but sometimes practical considerations dictate a twice 
 
daily dose, and the frequency and dose should be titrated 
individually according to clinical response.  For children of 6 

years or more a good schedule for the 1st week is 5 mg thrice 
 
daily.  If the response is less than optimal, the dose can be 
 
increased in the second week, e.g. to a thrice daily schedule of 10 
 
mg, 10 mg and 5 mg, and then if necessary to 15 mg, 15 mg and 5 
 
mg.  For children weighing more than 25 kg then one can proceed 
 
to a further week of 20-20-10-mg.  The best dosage is then 
judged, the child continued on it, and times of administration 

adjusted to give the steadiest control.  In most circumstances,  we 
 
regard the maximum daily dosage as 60 mg; but this is not 
 
established by trial data". 
 
  
 
Now pausing there and that 60 mg figure, and we will see another figure appearing a little 
 
later on, could I ask for your view on the maximum daily dosage? 
A       Yes.  I would now put it in terms of mg/kg doses, rather than absolute doses. 

  
 
Q       Yes? 
 
A       And that would imply that for some larger people the dose was a little higher than 
 
that. 
 
  
 
Q       Yes. 
A       So, we would now say that the maximum dose was 0.7 mg/kg per dose on the basis 

of two or three doses each day. 
 
  
 
Q       Yes. 
 
A       Nobody in the States uses doses that are higher than that. 
 
  
Q       Yes. 
 
A       Partly because of legal concerns. 

  
 
Q       Yes. 
 
A       And so, partly because of that, we do not have very much knowledge of what 
 
happens with the higher doses. 
 
   
Q       Yes. 

A       We do know that the increase of adverse effects is greater the higher the dose, not 
 
surprisingly. 
 
  
 
Q       Yes. 
 
A       And the experience of those people who have used high doses is that you get no 
 
benefit in terms of increasing dosage. 
  

Q       Yes. 
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A       And so the ceiling, which would work out at about 60 mg a day for the average ten 
 
year old child - more for a teenager. 
 
  
 
Q       Yes? 
 
A       That ceiling is established really by custom and practice, rather than by rigorous 
 
trial evidence.  And it is possible occasionally to go up above that dose.  I think the most I 
have ever prescribed is 85 mg per day in an older teenager. 

  
 
Q       Yes. 
 
A       One concern -- several concerns come in with the higher dosages, especially the 
 
increasing risk of hidden adverse effects in the mental state.  For instance, hallucinations 
 
start to appear and children may very well not speak about them spontaneously.  The best 
 
dose for cognitive performance - for understanding, for schoolwork and that kind of thing 
- may very well be lower than the best dose for reducing behaviour.  So that  if you have 

the highest dose to increase behaviour - I am sorry, to improve behaviour - that may not 
 
be in the best interests of the child's overall development. 
 
  
 
Q       Yes. 
 
A       We have also learnt since then that tolerance does develop to the medication in the 
 
course of the day, so that high doses may have a counterproductive effect in that each day 
some tolerance to those doses develops and then each night, when you are off the 

medication, then that tolerance is withdrawn.  So that with high doses you may get into 
 
very much diminishing returns for beneficial effects, but not for adverse effects. 
 
  
 
Q       Yes, thank you.  Well, that is helpful.  I mean, just we bear in mind this.  That it is 
 
no part of the charges of course against Dr Cosgrove that any particular prescription or 
 
any particular dosage here was excessive, but when we deal with individual patients in 
due course - probably on Wednesday of next week as I have indicated - I will ask you to 

consider further the particular dosages that may have been prescribed in particular cases. 
 
A       Yes, exactly.  I do not think that one should.  I don't think that it is appropriate to be 
 
putting an absolute ceiling  --- 
 
  
 
Q       Yes? 
A       --- if an individual child is doing very well on the  higher dose and is having no 
 
adverse effects, but I think it is quite proper to make individual decisions about the child's 

response. 
 
  
 
Q       I am obliged for that indication.  How though, if at all, does a higher dosage bear on 
 
the issue of monitoring? 
 
A       Well, because adverse effects increase with increasing dosage, then when you are 
going above standard levels then essentially you are in tiger country.  You are in 

uncertain waters.  You know the adverse effects are greater, but it is hard to quantify that. 
 
 So, essentially what that calls for is that you need to be much more careful with it.  An 
 
enhanced level of monitoring would be indicated.  And the indications for monitoring, 
 
that are in the practice guidelines by Professor Hill and myself that you mentioned before, 
 
those are intended only to apply to the ordinary range. 
 
  
Q       Yes. 

A       Not to a very high dose. 
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Q       I understand.  And, just referring to this European-wide consensus or 
 
documentation that we were at, in terms of what is said about monitoring there could I 
 
refer you to Page 304 that again clearly is following on from the heading about 
 
psychopharmacological treatment.  In the right-hand column, under the heading 
 
"Precautions and monitoring": 
  

"We regard all the stimulants as contraindicated in schizophrenia, 
 
hyperthyroidism, cardiac arrhythmias, angina pectoris, and 
 
glaucoma, and, of course, when the drug has previously caused 
 
hypersensitivity.  Caution is needed in the presence of 
 
hypertension, depression, tics (or a family history of Tourette's 
 
syndrome), epilepsy, pervasive developmental disorders, severe 
mental retardation, or a history of drug dependence or alcoholism. 

  
 
Monitoring should include recording blood pressure and pulse (at 
 
each adjustment of dose, then every 6 months), height weight and 
 
appetite (6 monthly) with maintenance of a growth chart; tics, 
 
depression, irritability, lack of spontaneity, withdrawal, and 
 
excessive perseveration at every visit". 
  

That ethic rather ties in with the protocol that you have referred to earlier in terms of 
 
monitoring? 
 
A       Yes, it does, and like that it was a consensus decision. Many of us on that panel 
 
were wanting a more frequent dosage, but this was what was considered feasible. 
 
  
 
Q       Frequency of monitoring? 
A       A greater frequency of monitoring, yes. 

  
 
Q       I understand, yes. 
 
A       But this was what was considered a sort of minimum acceptable standard. 
 
   
 
Q       Yes.  And I mentioned that adults were considered separately here, and I think at 
Page 305 there is a heading "Adults": 
 
  

"Recently, data have appeared on effectiveness and dosage for 
 
adult patients.  Some well-controlled studies have shown that 
 
adults are sometimes helped by methylphenidate"? 
 
  
 
A       Yes. 
  

Q       So, there we have evidence in the 1990s of adult treatment using methylphenidate? 
 
A       Yes.                            
 
 
 
Q Of 
studies and research into that.  I am obliged for that.  Now, if we may move on to page 327 in 
 
this bundle - 327 and following.  That represents, I think, an extract from a text book called Paediatric 
Psychopharmacology edited, I think, by Professors Amman and Whaley.  Is that correct? 
 
A Yes. 

 
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Medication”: 
 
 
 
“The decision to use stimulant medications with children 
 
should not be made lightly, despite the efficacy of these 
 
medications and their relative safety with children.  As we 
 
nave noted elsewhere the diagnosis of ADHD should not 
constitute automatic drug treatment.  We suggest 

following several rules as aids in making this decision.” 
 
 
 
Just so that I understand this, in this range of opinion that you say there was, particularly 
 
in the 1990s, as to psychological therapy on the one hand and pharmacological therapy on 
 
the other hand, where does this text book lie? 
 

This is the pharmacological end of the spectrum.  This is representing what would 
be the mainstream American view in the widely prescribing situation. 

 
 

Yes.  At page 329 - and I am sorry to pick around a little bit like this but we can 
 
all go away and read it all if we need to, but I am hoping to draw out those parts of the 
 
literature that are most relevant.  On page 329, again the hand-written 329, one sees the 
 
heading, “Prescribing and Titrating” and the second paragraph: 
 
 
“The first choice of medication is usually methylphenidate 

because of its greater documentation in research, proven 
 
efficacy across a wide age range and greater dose-
 
response information.” 
 
 
 
Again, we see I think that would appear from this literature a fairly widely held view that 
 
methylphenidate is the first choice if one is using drugs.  Over on the right-hand column  
at the very top, below the table, at the top of the text on the right-hand side of 329, talking 

about dosages: 
 
 
 
“Some investigators have reported total daily dosages of 
 
as high as 60 to 70 mg, although we rarely go beyond 30 
 
to 40 mg per day in our clinic.” 
 
 
So again, without saying there is a ceiling - and I am not contending that - but again we 

see evidence here of 60 or slightly over 60 as being a typical maximum dosage? 
 

Yes, that is right and the more or less equivalent, modern version, of 7 mg/kg, is 
 
not a thing that American practitioners would go beyond. 
 
 
 

Yes.  Could I ask you to look at page 331?   
 

“Maintenance on Medication 
 
 
 
a. 
Assessing Progress 
 
 
 
Once a child’s optimal dosage is established, then some, 
 
preferably all, of the above measures should be collected 
periodically throughout the school year to evaluate the 

need for dosage adjustments or the onset of side effects.  
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The vast majority of the questionnaires need only be 
 
readministered every several months or so.  However, it is 
 
usually a good idea to review items from the Side Effects 
 
Questionnaire each month when the parents call to obtain 
 
another prescription.  In addition, at each monthly contact 
 
(usually by telephone) a checklist of questions is reviewed 
with parents to assess continued drug efficacy.” 

 
 
We are, as I think you have already indicated, talking about the United States here in 
 
terms of assessing progress.  How does this kind of practice compare with what was 
 
considered usual in the United Kingdom at this time? 
 

I think the disagreements were essentially about when you started medication.  
 
Once the medication was started, then it would be the same recommendations.  It would 
be the same view here.  The disagreements were about who should have it, not how it 

should be given. 
 
 
 

I understand.  Further down under “Side effects”: 
 
 
 
“c.  
Side Effects 
 
 
These should be asked about at every monthly contact, 

and the parents should be informed in advance about the 
 
presenting symptoms of any serious side effects, e.g. 
 
depression, weight loss, induction of tics or, with 
 
pemoline, hepatic damage.  For children receiving 
 
pemoline, at six month intervals or whenever suspicions 
 
are prompted by symptoms, blood should be drawn for 
liver function tests given the finding that this drug may 

adversely affect liver functions.”   
 
 
 
Clearly that is not relevant here. 
 
 
 
“This is no substitute for a review of possible presenting 
symptoms of such dysfunction at each monthly visit. 
 
 

d. 
Reassessment 
 
 
 
Approximately every 3 to 4 months that a child is on 
 
medication, it is advisable to administer a more thorough 
 
follow-up clinic examination.  During this time height, 
weight, blood pressure and heart rate can be recorded to 

determine potential side effects and any blood tests done.  
 
Parent and teacher ratings should be collected concurrent 
 
with this visit as well.” 
 
 
 
It may be a slightly different interval but it is, as I understand it, the same kind of review? 
 

It is the same kind of review.  That is essentially what would be happening in 
office practice in America, where family doctors are very often treating the ADHD 

themselves, so it would not be quite the same as in clinical practice over here.  We would 
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expect more of a partnership between the specialist clinic and the family doctor, so it may 
 
be more relevant to private practice over here than to NHS practice, but essentially it is 
 
the same consideration.  Here they are, for instance, talking about the monthly visit to the 
 
clinic and some of this might very well be done over here by the monthly visit to the 
 
family doctor with the clinic seeing every six months rather than every month or every 
 
three months.  
 


Yes, I follow.  Can we finally refer to the American Practice Parameters, the 
 
separate document that is exhibit C11.  This, just to keep us all on our toes, does not have 
 
the hand-written page numbers on it.  It has the page numbers that end with the letter ‘S’ 
 
and I shall refer to those typed ones in the bottom right-hand corner. 
 
 
 
At the bottom left-hand corner I think we see that the copyright date of this article is 197. 
 What do these Practice Parameters represent, Professor Taylor? 


These represent the sort of consensus about American practitioners comparable to 
 
the way of going about the European consensus that we saw earlier.  It was being done 
 
under the auspices of the American Academy of Childhood Psychiatry. 
 
 
 

Could I ask you to look, please, at page 95S.  Perhaps rather hidden in the top left-
 
hand corner paragraph half way through - I do not want to read all of it but a little over 
half way through that paragraph we see the sentence, do we not: 

 
 
“The usual range for methylphenidate is 0.3 to 0.7 mg/kg 
 
per dose, rounded to the nearest 2.5 or 5 mg? 
 
A Yes. 
 
 
 
 

That confirms the point you were making earlier about American practice and the 
dosage? 


We have now followed them in terms of mg/kg doses rather than in absolute 
 
doses. 
 
 
 

I understand.  Could I ask you to look, please, slightly earlier in this document at 
 
page 92S.  We see in the left-hand column: 
 
 
“Monitoring Medication Efficacy 

 
 
Multiple outcome measures are essential, using more than 
 
one source, setting and method of gathering data.  
 
Premedication baseline school data in behaviour and 
 
academic performance should be available.  The clinician 
should work closely with parents on dose adjustments and 

should obtain annual academic testing and frequent 
 
reports from teachers.  A brief checklist such as the CAP 
 
profile is invaluable in obtaining teachers’ reports of 
 
medication efficacy.  A practical schedule includes 
 
weekly ratings from teachers and two ratings per week 
 
from parents: one for Monday through Friday and one for 
weekends.  Curriculum based measures and academic 

performance ratings are useful for monitoring progress in 
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academic subjects.  Measures of academic productivity 
 
and accuracy administered in the office, such as brief 
 
readings and maths tests may be useful in assessing drug 
 
effect because of their similarity to tasks expected of the 
 
child at school.  Protocols have been developed using 
 
direct observation and other measures in the school setting 
for determining in the optimal dose for children with 

ADHD who have normal IQ and for children with mental 
 
retardation and ADHD.  A structured side effects checklist 
 
can be used…” 
 
 
 
There, as I understand it, emphasising the importance of review on the academic side? 
 

Yes, that is correct and again, in principle, similar considerations would apply 
over here, though I think we would not be able to get quite the same frequency of 

involvement from teachers as would be the case in the United States because of the rather 
 
heavy loads on teachers that are already there in terms of the educational system, but 
 
certainly teacher reports are essential.  I think the weekly report would be a council of 
 
perfection over here. 
 
 
 

Following on from that, again, on page 92S, headed “Stimulants” there is a long 
passage, none of which, you will be pleased to know, I am going to read, which actually 

includes that reference to maximum dose.  There is a long passage dealing with the 
 
stimulants and possible side effects of those stimulants.  It deals with dosage in 
 
considerable detail, does it not? 
 
A Yes. 
 
 
 
MR PEARCE:  I will pause with Professor Taylor at that point, sir on the basis, as I say, 
that I will proceed to deal with individual patients and individual charges in due course.  

Rather dry background setting there but hopefully of some assistance to the Committee 
 
and introducing the literature. 
 
 
 
THE CHAIRMAN:  Thank you.  I know that we have not completed the taking of 
 
evidence form Professor Taylor but we are getting into a slightly unusual situation.  On 
the basis of the evidence led so far, Mr Morris, are there any points that you want to 
 
cross-examine Professor Taylor on? 

 
 
MR MORRIS:  Sir, no.  I prefer to reserve my cross-examination until next week.  
 
 
 
THE CHAIRMAN:  In that case we will pause in hearing evidence from Professor 
 
Taylor.  We can excuse him for the present but I would remind you, Professor Taylor, 
that you remain under oath until we meet again next Wednesday. 

 
 
MR PEARCE:  I am much obliged, sir.  It is my hope that my next witness was here.  She 
 
was not actually when we came into the Committee room but that came as no surprise to 
 
us.  We anticipate she will have arrived in the meantime.  I wonder whether you would 
 
just allow us a few moments to speak to her and to confirm that she is here first and then 
 
speak to her and come back and call her. 
 

THE CHAIRMAN:  Certainly.  Roughly how much time are you requesting?  Is it 
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sufficient time that we can justify it for the Panel to go elsewhere? 
 
 
 
MR PEARCE:  In this building, yes.  There are advantages for you but disadvantages for 
 
us in this building.  I think you are relatively close now compared to as you were before.  
 
We are a lot further than we were before.  I think five minutes, sir. 
 
 
THE CHAIRMAN:  That is fine.  We will have a break just now. 

 
 
THE LEGAL ASSESSOR:  Perhaps if I could just give the standard advice as this is the 
 
first adjournment we have had since the beginning of the evidence.  My advice is that you 
 
do not discuss the evidence amongst yourselves during the adjournment.  This is to avoid 
 
discussions taking place between the totality of the Committee.  It is quite important that 
 
when you do consider evidence, you all consider it together. 
 

The Committee adjourned for a short time 
 
 
 
MR PEARCE:  I am obliged, sir.  I call Miss Wendy Samways, whose evidence relates to 
 
charges 7 and 8. 
 
 
 
WENDY ANNE SAMWAYS Sworn 
Examined by MR PEARCE: 

 
 

Can you give the Committee your full name, please? 
 

Wendy Anne Samways. 
 
 
 

Miss Samways, what is your current occupation? 
 

I am Complaints and Patient Advice Liaison Service Manager for Oxfordshire 
Mental Health Care NHS Trust. 

 
 

Were you in that post in September 2000? 
 

I was Complaints Manager at that time.  
 
 
 

There should be a bundle of documents to your right.  Could I ask you to look in 
that bundle under tab 7?  Page 1 of tab 7, we see a letter dated 29 September 2000 with 
 
your name at the bottom of it? 


That is correct. 
 
 
 

Is this a letter that you wrote? 
 

It is indeed, yes.  
 
 

Just, firstly, so that you understand, we are using anonymised names for patients 

in the course of the hearing but in fact the anonymised names or letters are different to 
 
those that appear in the correspondence.  The particular patient with which we are 
 
concerned here is being called Patient E? 
 
A OK. 
 
 
 
 

So that you understand.  Just first of all, so that we can read through this letter: 
 

“Dear Dr Cosgrove, 
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Re Patient E 
 
 
 
I would be grateful if you could provide me with copies of 
 
any medical records that you hold regarding E.  This Trust 
 
is, with the help of an independent expert, currently 
reviewing the way in which we manage E’s care and 

treatment following his referral to the Trust’s Department 
 
of Child and Adolescent Psychiatry and it would be 
 
helpful to have any information from you which would 
 
aid this review.  We will, of course, meet your reasonable 
 
costs for the photocopying of the clinical notes.” 
 
 
Now, so that we understand the background, how did it come about that the Trust was 

carrying out a review of Patient E’s treatment? 
 

We had received a complaint from the parents some time previous to that and had 
 
had several attempts at trying to resolve it through local resolution.  After a meeting 
 
between myself, the parents and the Associate Director of Clinical Governance, we all 
 
agreed that it would be appropriate to have an independent expert review the care and 
 
treatment and the family at that time were in agreement with that. 
 


To what did the care and treatment relate?  To what condition did the care and 
 
treatment relate in patient E? 
 

He had been diagnosed with ADHD.  
 
 
 

In general terms do you recall what the complaint was about the care and 
 
treatment? 

There were several aspects to the complaint, as far as I recall.  Failure to diagnose 

ADHD, failure to adequately provide care and treatment for patient E and lack of support 
 
for patient E and the family in general, is my recollection. 
 
 
 

You indicated that the parents agreed - patient E’s parents agreed - to the Trust 
 
instructing an independent expert? 
A They 
did. 
 
 


Who had the Trust instructed, or who were they proposing to instruct? 
 
A Dr 
Kenyon. 
 
 
 

Do you know what Dr Kenyon’s field of practice is? 
 

Yes, she was a child psychiatrist who had some expertise in ADHD. 
 


Could I ask you then, please, to look at pages 2 and 3 in division 8.  Was this a 
 
letter that you received from Dr Cosgrove in response to that letter of 29 September to 
 
which we have referred? 
 

Yes, it is. 
 
 
 

I have already read this letter out, I think, in full to the Committee this morning, 
so I do not think we need to read it again.  Can I ask you this.  From your involvement as 

Complaints Manager at that time, as far as you were concerned, was the investigation and 
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review that was being carried out, in the words used by Dr Cosgrove, “a cover-up of 
 
grossly inadequate care” that the child had received? 
 

No.  It was not.  We were trying to resolve the concerns and the parents had 
 
agreed to have an independent review.  We had selected a consultant child psychiatrist 
 
who was not known to us at all.  We had gone to a firm of solicitors and asked them to 
 
recommend somebody and then we had asked the family, the parents, to approve or not 
that choice.  We do not - my organisation, Oxfordshire Mental Health NHS Trust, works 

hard to try and resolve complaints and I would not be in that position if I thought that we 
 
were attempting a cover-up of any sort. 
 
 
 

Thank you.  If you would wait there, Mr Morris on behalf of Dr Cosgrove may 
 
have some questions for you. 
 
 
Cross-examined by MR MORRIS 

 
 

Miss Samways, you say the parents agreed this form of review? 
 
A Yes. 
 
 
 

Do you have any documentation in relation to your dealings with the parents in 
 
this regard and the fact that you put to them the name of the proposed independent 
reviewer with their agreement? 


I cannot recall that.  I do not have the file with me today.  What I do recall is that 
 
we went to meet the parents at their home, that we spent a considerable amount of time 
 
with them, a letter was sent, I cannot recall who from, I would either have been myself, 
 
the associate director of Clinical Governance or the Chief Executive, noting our meeting 
 
with the parents and the outcome of that.  I liaised quite closely with the parents at that 
 
time about who would carry out the independent review.  I cannot remember if that was 
done in writing, it would be my normal practice but I cannot remember because it was 

such a long time ago. 
 
 
 

If I were to suggest to you that the parents did not want this form of review and 
 
were not happy with it, what would you response to that be? 
 

Well, that is not how or what they said to us, I mean, when we met with the 
 
parents it was clear they were unhappy, they were appeared to have had quite a difficult 
time, we were grateful to them really for continuing to engage with us in this process. 

They had been offered the opportunity to follow the NHS complaints procedure and go to 
 
an independent review panel, but they wished to pursue this option first, whilst still 
 
retaining the right to have an independent review panel if they wished. 
 
 
 

Their concerns, I think you have outlined them, were that the failure to reach a 
diagnosis of ADHD for too long a period of time.  Is that right? 


That was one of their concerns. 
 
 
 

The subsequent care and treatment which was offered to their child in relation to 
 
that? 
 
A Yes. 
 
 

And the lack of support given to the family to help them cope with his behaviour 

and illness? 
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A Correct. 
 
 
 

It was that that triggered the review.  Can you help us with this, I do not know to 
 
what extent you were involved with the review itself that was conducted by Dr Kenyon, 
 
did she see the parents? 
 

I do not believe so, no. 
 


Do you know of any reason why that is so? 
 

Yes, as far as I can recall that was not part of what we had agreed with the 
 
parents.  It was to be a review of the documentary evidence, i.e., the medical records and 
 
any other records that we could provide, so it was not about meeting with the individuals,  
 
Dr Kenyon did not meet with any of the doctors that had been involved in treating care 
 
either. 
 


Were the parents content that the review went forward on that basis, that they 
 
would not have the opportunity to speak to the reviewer? 
 

They did not express to the contrary. 
 
 
 
MR MORRIS: Thank you.  
 
 
Re-examined by MR PEARCE 

 
 
MR PEARCE: One or two matters arising out of that, if I might, Miss Samways.  You 
 
made mention of the independent review panel.  How did the review you were carrying 
 
out differ from an independent review panel? 
 

We had offered -- independent review panel is, if you like, stage two of the NHS 
 
complaints procedure and there is a clear process to follow in setting up -- in requesting 
and the granting of an independent review panel.  In offering an independent expert 

review, if you like, of the documentation we were still at that stage engaging with the 
 
family at the first stage of the complaints procedure, that is local resolution. The family, 
 
as far as I was aware, understood this and I believe one of the letters sent from the Chief 
 
Executive noted that if after that review, if you like, they were still unhappy day could 
 
request an independent review panel in line with the NHS complaints procedure. 
 
 

You were asked about the parents attitude to not being spoken to by Dr Kenyon.  

When this independent expert review was being established, were the parents made aware 
 
that Dr Kenyon would not be speaking to them? 
 

I cannot actually recall.  As far as I can recall, my understanding certainly, and I 
 
am sure it was the same of the parents, that this was a review of documentation rather 
 
than  
a meeting with lots of people.  That would be carried out by an independent review panel 

in stage two.  I was sure that we made clear this was a documentary review rather than 
 
meeting with individuals. 
 
 
 

Before you received this letter that we see at division seven, pages two and three, 
 
had anyone expressed any concern that you were aware of about the nature of the review 
 
that was being carried out at that time? 

No. Not as far as I was aware at all. 

 
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MR PEARCE: I have no further questions. 
 
 
 
THE CHAIRMAN: I will check if Members of the panel have anything.  There are no 
 
questions so that concludes your evidence.  Thank you very much for coming to assist us. 
 
  
 
 
MR PEARCE: In sharp contrast to events in January we are proceeding too quickly now, 

sir.  So much so that our next three witnesses we have are due to attend at 2 o'clock, but 
 
certainly they were not here when we were outside earlier.  I wonder whether you would 
 
consider taking an early lunch on the assumption that they are here early? 
 
 
 
THE CHAIRMAN: We will agree with that.  We will break now and recommence, or try 
 
to recommence at quarter to two.  Thank you.   
 

The Committee adjourned for lunch 
 
 
 
MR PEARCE: I am obliged, sir.  Dr Holme, please.   
 
 
 
CHARLES OLIVER HOLME sworn 
 
Examined by MR PEARCE 
 


Could you give the Committee your full name? 
 

Dr Charles Oliver Holme. 
 
 
 

What is your current post? 
 

I am a consultant paediatrician and the Royal Devon and Exeter Hospital in 
 
Exeter. 
 


You were formally employed by the Salisbury NHS Trust at Salisbury District 
 
Hospital? 
 

That is correct. 
 
 
 

What was the post there? 
A The 
same. 
 
 


Dr Holme, I want to ask you about your involvement with a patient whom we are 
 
calling Patient A, I appreciate that may bear no relation to his actual name or the letters of 
 
it.  In respect to this child we have a bundle of medical records which I would like to refer 
 
you to.  Just to explain for the point of view of the Committee, we have not copied these 
 
records in full yet because we were not entirely sure how many we needed to refer to, if 
you will bear with us in terms of inviting Dr Home to have a look at relevant parts of the 

records, then we can copy those as necessary.  The alternative is to copy 139 pages of 
 
which we will be referring to only a small number.  If the Committee is happy with that? 
 
 
 
THE CHAIRMAN: Mr Morris? 
 
 
 
MR MORRIS: Sir, I have seen the bundle, thank you very much.  My solicitor is busy 
copying some of the pages at the very moment, which I will be using in cross-

examination.   
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THE CHAIRMAN: It would be necessary to copy all 130 odd pages? 
 
 
 
MR PEARCE: No, it would not.  To be honest, we could pick them out.  The alternative 
 
course is to pick them out and to photocopy them now.  At least you get them all in one 
 
go. 
 

THE CHAIRMAN: There is some merit in that.  It would be helpful to have a short break 
 
to allow that to happen. 
 
 
 
MR MORRIS: Perhaps we might combine our two photocopying efforts to one bundle. 
 
 
 
THE CHAIRMAN: I think that would be a good idea.  We will adjourn again and you 
will let us know when you are ready. 

 
 
MR PEARCE: Yes.   
 
 
 
THE CHAIRMAN: Dr Holme, we are going to have a short adjournment, you are under 
 
oath so you should not be discussing your evidence with anyone during this break.  
 
 
The Committee adjourned for a short time 

 
 
MR PEARCE:   I am so, sir, that that took longer than we anticipated.  It was a little more 
 
complex to fit all the pages together and get good copies of everything, but we are now 
 
ready to go.  Can I introduce, as I think C12, a new exhibit which is extracts from the 
 
medical records of Patient A. 
 
  
(Copies of the document were distributed

  
 
THE CHAIRMAN:   Thank you. 
 
  
 
MR PEARCE:   And the typed page numbers reflect the fact that these are extracts from a 
 
fully paginated bundle.  Some have had to be written in because of the way the 
photocopying has worked, but that explains the numbers: 
 
  

Q       (To the Witness)  Dr Holme, it is apparent I think from the first page of C12, which 
 
is numbered 30 at the bottom, that Patient A is a boy, date of birth 12 November 1987 we 
 
see? 
 
A       Yes. 
 
  
Q       I think your involvement started if we look through to the page that is numbered 

104, and there is a letter to you from on the next page we can see it is Dr Margaret 
 
Vereker, is it, Consultant Child and Adolescent Psychiatrist? 
 
A       Yes. 
 
  
 
Q       Dated 20 March 1995.  She sets out something of the background and just over 
 
halfway down Page 104: 
  

"Patient A had also had significant behavioural and emotional 
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difficulties with an abnormal pattern of attachment.  However, 
 
there has been considerable improvement since his adoption two 
 
years ago. 
 
  
 
Mr and Mrs A have asked me to specifically assess his level of 
 
attention and activity and to consider the use of stimulant 
medication (Ritalin)". 

  
 
Dr Vereker makes some comments about that and then she says this in the next 
 
paragraph: 
 
  
 
"I have a number of reservations about the use of Ritalin, as it is 
 
found to be less useful where there is a significant amount of 
emotional disturbance, contributing to the picture". 

  
 
And then over on the next page: 
 
  
 
"I have agreed with Mr and Mrs A that I would consider a trial of 
 
Ritalin ... I have undertaken an assessment of base lines of 
 
behaviour and activity levels and...", 
  

and then: 
 
  
 
"Mr and Mrs A have concerns about Patient A's physical health  
 
and would value your opinion about his growth and 
 
development". 
 
  
Is this letter how you first became involved in Patient A's care? 

A       That is correct. 
 
  
 
Q       And I think you responded by a letter typed on 24 April 1995, following a clinic on 
 
20 April 1995, and that letter is Pages 102 to 103 in this bundle.  You set out various 
 
features of your examination of Patient A and you conclude, the top of Page 103: 
  
 
"I think he is fit for regular Ritalin Therapy but he would need 

regular checks on height, weight and blood pressure, presumably 
 
these could be arranged through his own General Practitioners 
 
Surgery". 
 
  
 
And I think following that referral is it right that in fact Patient A was started on Ritalin - 
methylphenidate? 

A       I believe so by Dr Vereker's team, yes. 
 
  
 
Q       By Dr Vereker's team.  Now, could I ask you to look at Page 95 and 96 in this 
 
bundle? 
 
A       Yes. 
 
  
Q       A letter dated 3 May 1996, which we see on Page 96 is signed by Dr Cosgrove.  It 

is clear by now that Dr Parry, who I think we can probably reasonably take to be A's 
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General Practitioner, has made a referral to Dr Cosgrove in respect of A's condition and 
 
that Dr Cosgrove has diagnosed ADHD.  And does Dr Cosgrove then set out, at the 
 
bottom of Page 95 and on to Page 96, a proposed prescription of Ritalin? 
 
A       Yes. 
 
  
 
Q       Could I ask you about the middle of Page 96?  It there says: 
  

"I understand from Mrs A that Dr Vereker is concerned about his 
 
weight which although it has not dropped has not increased 
 
either.  However, I have been told that his weight is on the 50th 
 
centile, and this does give us a lot of leeway in raising the dose of 
 
Ritalin". 
 
  
Could I ask you then to look at Page 93? 

A       Yes. 
 
  
 
Q        Is this a letter from you to another General Practitioner at the same surgery in 
 
Whiteparish, Salisbury, dated 22 May 1996? 
 
A       Yes, it is. 
 
  
Q       And do we there see in the second paragraph a reference to A's "... head 

circumference at 55.2 cms is over the 97th centile for his age, whereas his height and 
 
weight are both between the 2nd and 9th centiles"? 
 
A       That is correct.  That is what I have written, yes. 
 
  
 
Q       And is that how you found Patient A at that time? 
 
A       Yes. 
  

Q       What then do you make of Dr Cosgrove's reference to him understanding, or his 
 
having been told, that A's weight is on the 50th centile on or around 3 May 1996? 
 
A       Well, I was not quite sure where he had got that information.  Whether he had 
 
actually weighed this patient in his own clinic or not, it would appear not.  I think he must 
 
have taken word of mouth information from somebody. 
  
 
Q       I see.  Now that letter from Dr Cosgrove that I have just referred to, Pages 95 to 96, 

is copied to you and to Dr Vereker. You will then I think have become aware, and indeed 
 
you refer on Page 93, to Dr Cosgrove's involvement? 
 
A       Yes. 
 
  
 
Q       You also say in the last major paragraph on Page 93: 
  

"Margaret Vereker joined me for a major part of the consultation 
 
and at the end we agreed that the management of the Ritalin 
 
dosage would be left to Dr Cosgrove at The Bristol Priority 
 
Clinic.  Input on behavioural and cognitive training would remain 
 
with Mrs Corrigan, the Child Care Specialist"? 
 
  
A       Yes. 

  
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Q       And so what, if any, involvement were you to have in the management or 
 
monitoring of Patient A having regard to the prescription of Ritalin? 
 
A       What I would normally do on this occasion is see the patient roughly every six 
 
months just to ensure that appropriate services were being received and that the child was 
 
maintaining good general health.  And if I had a need to communicate with say education 
 
in a statutory role because of any advice in terms of special educational needs then I 
could do that and, if I had anything to share with Social Services, I could do that.  We did 

agree that the management of the Ritalin dosage would be left to Dr Cosgrove. 
 
  
 
Q       And what about the monitoring of Ritalin? 
 
A       Well that, again, would have been -- I guess would have been the GP's 
 
responsibility in terms of checking weight, height and blood pressure, etc. 
 
  
Q       Right. 

A       But I am not sure if any clear arrangement was made between Dr Cosgrove and the 
 
GP.  You know, normally in practice in the NHS we would have a shared guidelines 
 
agreement with GPs which we would both sign - both parties would sign.  So, I do not 
 
know if that happened. 
 
  
 
Q       Right.  But you did not take responsibility for that monitoring? 
A       No, no. 

  
 
Q       And you are not clear whether the GP did, or not? 
 
A       No, I think that is an unclear area. 
 
  
 
Q       Right, yes.  Now could I ask you, please, to have a look at Page 74 in the bundle.   
 
This is a letter dated 10 July 1996 from Dr Cosgrove to Dr Parry, General Practitioner: 
  

"Dear Dr Parry, 
 
  
 
Since I wrote to you last, I have had three telephone appointments 
 
with Mrs A regarding A.  I have taken the Ritalin dosage up from 
 
10 mg om ...", 
  
 
which I understand means in the morning? 

A       Yes. 
 
  
 

 
  
 
"... 10 mg lunchtime; 5 mg 3 pm; 5 mg 7 pm to 15 mg om; 15 mg 12:15 pm; 10 mg 3 pm; 
7.5 mg 7 pm". 

  
 
Just to do our maths there for a moment, that is an increase from I think 30 mg per day to 
 
47-and-a-half, if my maths is accurate, mg per day.  "His appetite ..." -- Oh, I am sorry.  
 
Carrying on reading from there: 
 
  
 
"He is less hyperactive except in the evenings after 7 pm. School 
are very pleased with his behaviour, concentration and motivation 

since the last dosage increase.  They have noticed his self-esteem 
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has improved.  He is less of a management problem at home 
 
except in the mornings before the first dosage and in the 
 
evenings. 
 
  
 
His appetite has dropped and his mother does not think that he is 
 
eating sufficient through the week.  She thinks he is thinner and 
intends to ...", 

  
 
well I had not noticed that I could not read that word. 
 
  
 
THE CHAIRMAN:   I think it is "weigh". 
 
  
 
MR PEARCE:   Sir, would you just give me a second because I had not noticed that that 
was not clear.  Yes, "weigh".  It is clearly "weigh" in the original - w-e-i-g-h: 

  
 
"... him.  Also his asleep time has not improved being between 
 
10:30 and 11:30 p.m.  He has been having some headaches 
 
recently which might be due to insufficient sleep.  (His mother is 
 
to get his eyes tested).  In view of his poor appetite and 
 
wakefulness, I have decided to add a  low dose Risperidone to his 
 Ritalin.  I have asked his mother to give him 0.5 mg om and 0.5 

mg 3 p.m., and I will have a telephone appointment with her in 
 
about ten days after he starts the Risperidone". 
 
  
 
So, did you understand that in July 1996 Patient A was started with a dose of risperidone? 
 
A       Well, that letter was not copied to me.  I saw this patient -- well I am not entirely 
 
sure when I had last seen him, but presumably I had last seen him in the clinic 
appointment which you have previously referred to. 

  
 
Q       Yes. 
 
A       So, the letter was not copied to me and so, unless there was a telephone call which 
 
is not recorded, then ... 
 
  
Q       Right.  Well, let me deal with it another way.  If I ask you to look at what I think 
 
will be the next clinic appointment - it is Page 88, I think, in this bundle -- that appears to 

be a letter from you to the General Practitioner Clinic on 13 November 1996? 
 
A       Yes. 
 
  
 

 
  
"Patient A is making good progress and his attention is at a level 

at which he can function.  He is able to control ..." (presumably 
 
his) "... impulsivity within certain limits and can concentrate 
 
unaided for up to ten minutes.  His blood pressure today was 
 
100/70 and his growth satisfactory with his weight at 23.7 kgs 
 
being on the 9th centile and his height 124 cms being between the 
 
2nd and the 9th.  His drug treatment at the moment consists of a 
total of 60 mg of Ritalin a day, plus 1/2 tablet bd of 

Risperidone"? 
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A       Yes, I think that must have been the first time I knew about the addition of 
 
risperidone. 
 
  
 
Q       I understand.  I understand.  If I may then take you on from there, you were seeing 
 
Patient A, what, about every six months? 
A       Yes. 

  
 
Q       If I can ask you to look, please, at Page 128 in the bundle, is this your record? 
 
A       Yes, it is. 
 
  
 
Q       All right.  What was your understanding of the dosage of risperidone as at 14 May 
 
of -- I think this is 14 May 1998, a clinic on that day is it? 
A       It looks as if it had gone up to 1 mg twice daily, whereas previously it had been half 

a mg. 
 
  
 
Q       Yes.  And in terms of the Ritalin dosage, what does that appear to be at this stage? 
 
 A       I have written down that it was 30 mgs at 7 a.m., 30 at 11, 20 at 14:00 and 20 at 
 
17:00 making a total of 100 mgs a day. 
 
  
Q       Could I ask you, please, just to look at Page 73 for a moment.  I appreciate this is 

not your document and you may not have seen it at the time, but I just want to ask your 
 
understanding of it if I may.  It appears to be a note from Dr Cosgrove, dated 23 March, 
 
and so a couple of months before that attendance.  Looking there at what is said in respect 
 
of Ritalin, does it appear to be indicating that it is 30 mgs at 7:30 a.m. and 10:30 a.m., 20 
 
mgs at 1:30 p.m. and at 4:30 p.m. and 10 mgs at 7:30 p.m., or am I misreading it? 
 
A       Yes, I think that is correct. 
  

Q       All right.  And again I will be corrected on my maths if I am wrong, but that 
 
appears to be 110 mgs administered there? 
 
A       Yes. 
 
  
 
Q       But your understanding was 100 mgs as you have recorded? 
A       Yes. 
 
  

Q       Could I ask you then, please, to turn to Page 129 in this bundle.  Again, is this your 
 
note of a clinic this time on 18 November of 1998? 
 
A       It is. 
 
  
 
Q       And what, if anything, did you understand about clonidine at this stage? 
A       I understood that Dr Cosgrove had suggested a trial of a third medication, 

clonidine, but I did not have details of the dosage, and that that had been instituted fairly 
 
recently, I think, to that date. 
 
  
 
Q       Might I then turn to Page 77 in the bundle.  The numbers at least in my copy are 
 
difficult to read, but the one that immediately follows Page 76 in spite of all the gaps in 
 
this.  It is a letter I think from Dr Holme, dated:  Letter typed 26 May 1999 and clinic 20 
May 1999.  Do you see that, Dr Holme? 

A       Yes. 
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"Patient A is now taking extremely high doses of 
 
Methylphenidate, 30 mgs at 7 am, 30 mgs at 11 am, 30 mgs at 
 
14.00 and 30 mgs at 17.00.  He then takes 10 mg at bedtime.  In 
addition he is on Risperidone 1 mg twice daily and Clonidine at a 

dose which I assume is 100 ...", 
 
  
 
and is that microgrammes "... at night"? 
 
A       Yes. 
 
  
 
Q       And just doing our maths there, pausing for a moment, that totals I think 130 mgs 
of methylphenidate per day? 

A       Yes, yes. 
 
   
 
Q       A little further down if I may, the fourth paragraph: 
 
  
 
"Weight and height today continue on the 9th centile, A's weight 
 
was 29.7 kgs which is up slightly from last time.  I noted a 
baseline tachycardia of 120, blood pressure 120/80, mother told 

that he had just had his Ritalin dosage". 
 
  
 
Pausing there for a moment, could you explain for those who do not understand what a 
 
baseline tachycardia of 120 means? 
 
A       Well, effectively it is his resting pulse. 
 
  
Q       Right.  And is that high, normal or what? 

A       Yes, that is high for a twelve year old. 
 
  
 

 
  
 
"I am arranging for a routine full blood count and test of liver 
function.  We need to keep a very close eye on Patient A with 
 
these extremely high doses of Ritalin". 

  
 
What was your understanding of the monitoring that Dr Cosgrove was carrying out? 
 
A       I understood it to be telephone monitoring by contact with the patient's mother. 
 
  
 
Q       And where did you gain that understanding from? 
A       From the mother's description. 

  
 
Q       Following that clinic and the references made in that letter, did you have concerns 
 
about Patient A's medication? 
 
A       I had concerns because we were now well above the upper limit that was 
 
commonly regarded as safe.  The BNF refers to an upper limit of 60 mgs a day, and in a 
 
twelve year old boy we were above twice that limit on a combination of three drugs. 
  

Q       Did you have any concerns about the combination of drugs? 
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A       The use of risperidone I think at that time was not common practice in treating 
 
ADHD.  It has become slightly more common recently.  It is an atypical antipsychotic 
 
drug which in general is safe, but it can lead to side effects like bowel disturbance, 
 
abdominal pain and what is called a tardive dyskinesia.  It is a muscle spasm, really, 
 
which would be unusual at the dosages that were being used.  It is normally only used I 
 
think in circumstances where the behaviour is causing considerable concern and where 
there is a strong suspicion or at least a strong element of aggression.  It is my 

understanding from Dr Cosgrove's practice that it seemed to be added as a sort of add-on 
 
extra to counterbalance the appetite suppressant effect of methylphenidate.  And so you 
 
are treating a child with methylphenidate, where you get appetite suppressant, and so you 
 
are then adding some risperidone which makes you gain a bit of weight.  So, you are 
 
using one drug to counteract the effect of another. 
 
   
Clonidine has got a long established role in ADHD and it is generally safe if monitored 

effectively, and the combination of methylphenidate with clonidine is a well-established 
 
combination, but there have been anecdotal reports in the Medical Press from the States 
 
particularly, I think, of sudden death in patients taking that combination and there does 
 
need to be close monitoring of pulse and blood pressure.                                                     
 
                                         
 

So as a result of your concerns did you make contact with Dr Cosgrove? 

I did, yes. 

 
 

If we have a look at pages 68 and 69, there is a letter from Dr Cosgrove to you 
 
dated 3 July 1999.  I think from the documents I have seen, it is not actually apparent how 
 
this letter comes about, if you like - how it comes about that Dr Cosgrove was writing to 
 
you then.  Do you recall why that was? 
 

I think I wrote to him and expressed my concerns, if I remember it correctly. 
 


In any event, Dr Cosgrove writes to you in these terms: 
 
 
 
“I had the opportunity of meeting A with his mother on 30 
 
June in Bristol.  A looked well and alert.  His appetite is 
 
very good, his mother reports, as a result of the 
Risperidone.  He is growing in height and his weight is 
 
satisfactory.  He is getting to bed at about 8.00 p.m., 

asleep by 10.00 p.m. and wakes at 7.00 a.m.  His mother 
 
says that he is sleeping very much better on the Clonidine 
 
0.1 mg;  he is calm from 8.00 p.m. onwards. 
 
 
 
I took his BP” 
 

- blood pressure, I think -  
 
 
 
“…and his pulse rate on four separate occasions - two at 
 
the beginning of the session and two some 20 minutes 
 
later.  The first two pulse rates were 113 and 120 per 
 
minute and the second two were 111 and 116 per minute.  
These figures clearly corroborate the 120/minute that you 

obtained and they would not be due to excitement or 
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anxiety as we considered on the phone.” 
 
 
 
If we can just pause there for a moment, does it appear that you had a telephone 
 
conversation with Dr Cosgrove at some stage? 
 

I must have done, I think, yes. 
 
 
Q  

“I asked his mother to try taking his pulse and it would 
 
appear that she does not find this too easy, so that her 
 
previous readings of 60 and always less than 100 are 
 
unreliable.  A’s BP was 114/75.   
 
 
 
I think that we have to assume that the methylphenidate 
presumably through its noradrenergic component…” 


Noradrenergic, yes.  
 
 
 
Q  
 
“Noradrenergic component is responsible for this 
 
tachycardia and I told Mrs A that I did not feel that it 
 
could be ignored.  This, however, leads to problems 
because we know that his behaviour deteriorated 

markedly when the Ritalin is reduced. 
 
 
 
Nevertheless I have asked her to reduce the Ritalin to 20 
 
mg 7.30 am, 25 mg 11.00 am, 30 mg 2.00 pm, 25 mg 5.00 
 
pm of about 20 mg in the day.” 
 
 
Now just pausing there for a moment with the maths, it is not entirely clear to me - it may 

be clear to others but it is not clear to me - what that sentence means.  If it means that the 
 
reduction is to a total of the 20, 25, 30 and 25, that would indicate, as I understand it, a 
 
reduction to 100 mg? 
 
A Yes. 
 
 
 

Others may read it differently but it may be being stressed that that is a reduction 
 
of about 20 mg in a day, which might suggest that it was previously 120.  You have made 

a record of 130 mg in any event.   
 
 
 
“If there is no significant reduction in pulse rate but the 
 
behaviour worsens, then I have discussed with Mrs A 
 
using a low dose beta blocker, such as a non-
cardioselective propranolol.  Using 10 mg doses at 10 mg 

dose increases where necessary would be a reasonable 
 
step forward in reducing his pulse rate without losing the 
 
immense benefit of the Ritalin.  As we discussed on the 
 
phone, the school appealed to Mrs A to increase the 
 
Ritalin dosage once more when she reduced it for a while. 
 
 So we are in a little bit of a cleft stick here. 
 

A’s godmother is a nursing sister who, together with Mrs 
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A, will monitor his pulse rate.  For further corroboration, I 
 
have suggested that they get their pulse rate readings 
 
checked at the surgery using a sphyg.” 
 
 
 
What is a sphyg? 
 

A Sphygmomanometer.  It measures blood pressure. 
 

Q  
 
“I have used propranolol with Ritalin in children with 
 
good effect and would have no problem in providing a 
 
private prescription to slow his heart rate to a reasonable 
 
level should this be necessary.” 
 
 
Was Patient A’s care subsequently transferred to a colleague, a psychiatry colleague in 

another Trust for an overview of his treatment plan? 
 

It was at some point in that year, yes, because I had a telephone conversation with 
 
the child psychiatrist in Southampton.   
 
 
 
MR PEARCE:  I am obliged.  Thank you very much.  If you wait there Mr Morris on 
 
behalf of Dr Cosgrove will have some questions. 
 

Cross-examined by MR MORRIS: 
 
 
 

Dr Holmes, can I take you back to May 1996? 
 

For the record, my name has not got an ‘S’ on it.  
 
 
 

I do apologise, Dr Holme.  May 1996, 3 May we have Dr Cosgrove writing to A’s 
GP and we have that at 95/96.  That letter of his, which sets out his diagnosis of ADHD 

and his treatment that he was going to start the patient on, is copied both to yourself, Dr 
 
Vereker and Mrs Corrigan, the childcare specialist? 
 

That is correct. 
 
 
 

You then see, if I am right, the patient ten days later on 13 May in a clinic.  I think 
your clinic notes we see at page 125 and the letter you write subsequent to that clinic at 
 
pages 82 and 83.  Just looking at 125, please, am I right in thinking that we have got an 

entry 13 May 1996?   
 
A Yes. 
 
 
 

New letter, seen with Dr Margaret Vereker.  Is that your writing? 
 

It is, yes. 
 


Can you just run us through the entries you have made there, please, because 
 
obviously it is easiest coming from you? 
 

This consultation was in response to a new referral.  I noted mother’s concerns 
 
about the patient’s physical status, the size of his head, certain unusual facial features, his 
 
rather loose-limbed gait, learning difficulties and his attention deficit problems for which 
 
he was under Dr Cosgrove.  Physical examination was generally satisfactory.  
 


When you did your examination, I think you found that he was less inattentive 
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than before.  Is that right? 
 

Yes.  That is presumably compared to when I had seen him once before in April 
 
of that year - April of the year before, wasn’t it?  1995. 
 
 
 

Are we right in thinking that by that time Patient A was on the Ritalin prescription 
 
as advised by Dr Cosgrove in his letter of 3 May? 

Yes, must have been. 

 
 

Then I think you noted his height and weight.  Is that right?  Or was that nurse 
 
noting that, on the left-hand side? 
 

Yes, that is correct. 
 
 
 

“Weight 21.5, height 121 cm.  2-9” - I anticipate that is the centile range? 

Yes, that is correct, yes.  

 
 

It appears to be in different writing.  Is that your writing? 
 

That is my writing.  It is probably in different writing because I suspect what I did 
 
was looked at the growth chart at the end of the clinic and perhaps used a different pen. 
 
 
 

You were happy to see him again in six months’ time? 

That is correct, yes.  

 
 

You said in answer to my learned friend that you did not take responsibility for 
 
monitoring him in relation to medication he was receiving but, as a matter of fact, did you 
 
not actually monitor him over the months and years as far as his condition of ADHD and 
 
the effect that the medication was having on that? 
 

I did but I guess in perhaps a rather second-hand way because I was not directly 
responsible for the prescribing and therefore I would not have monitored him, say, on a 

monthly or six weekly basis but I would have certainly checked his blood pressure, pulse 
 
and weight whenever I saw him.  I could not, because of the demands on clinic time, see 
 
him as often as perhaps would have been best practice, simply because of lack of clinic 
 
availability. 
 
 

Right but when you did see him you certainly addressed the issue of the condition, 
 
the medication he was receiving and what effect it appeared to be having on the patient? 


Yes, that was my duty of care, was it not, on the occasions I saw him. 
 
 
 

All right.  I would just like quickly to run through those, if I could.  As a result of 
 
that clinic I think you wrote to the GP, Dr Gotham on 22 May.  I think we see that at page 
 
93.  I may have said 83 earlier but I meant 93, where I think you set out your findings 
from the clinic.  Is that right? 

A Yes. 
 
 
 
 

You copy that letter to, amongst others, Dr Cosgrove? 
 

That is correct.  
 
 
 

I wonder if you could help us with this.  It is not a letter that you wrote but I do 
not know whether you can assist with this.  On 12 July 1996 at page 89, Dr Vereker wrote 

to Patient A’s mother: 
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“Thank you for your kind letter of 11 June 1996.  I am 
 
sorry if it appears that there was bad feeling about A’s 
 
transfer to the care of Dr Cosgrove.  As we discussed, I 
 
am very happy for A to be seen by Dr Cosgrove and I was 
 
pleased to hear that he is doing well. “ 
 

Can you help us as to what certainly from the point of view of the parents appeared to be 
 
some bad feeling on the part of Dr Vereker about the transfer? 
 

You are asking me to go back several years and there is no documentation of what 
 
the circumstances were.  I am not sure that I can help you.  Dr Vereker may have felt that 
 
she had very good reason for prescribing Ritalin at a certain level and then it could be that 
 
she was upset that a GP had made a referral to a private practitioner perhaps without 
referral to her.  I am not entirely sure.  That could have been the issue. 

 
 

Then you see him again about six months later.  If you look at page 125, 13 
 
November 1996.  This presumably would have been with him and his mother or father or 
 
both? 
 

Yes.  It was usually the mother.  
 
 

You set out there the dosages that he was on, time that he was receiving them, 

functioning well.  Help us with your writing thereafter.  “Attention at a level at which he 
 
can function”? 
 
A Yes. 
 
 
 
 

“Can control impulsivity within limits.  Concentrates unaided ten minutes.  Had a 
 
good holiday.”  Then you go on on page 126, blood pressure 100/70 growth, tick? 

Yes, inasmuch as his weight and height were maintained in the same centile 

channels.  They are on the left-hand column, 23.7, ninth centile and height the second to 
 
ninth.   
 
 
 

Then you write a letter incorporating those findings at page 88 to the general 
 
practitioner with a copy to Dr Cosgrove and the main and perhaps only problem that you 
were addressing in the clinic here would appear to be the problem of hyperkinetic 
 
disorder? 

A Yes. 
 
 
 

In relation to monitoring that disorder and its medication and treatment, I think 
 
you make reference to specific hospital - Maudsley Hospital - guidelines? 
 

That is correct, yes. 
 


Were those guidelines specifically for the management of medication treatment of 
 
ADHD? 
 
A Yes. 
 
 
 

Six months later, 15 May 1997, page 126, you are seeing him again, I think.  Is 
 
that right? 

That is correct.  

 
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You established the medication he is on, that there is a telephone check with Dr 
 
Cosgrove every two months and then you have, am I right in thinking you have a sort of 
 
checklist - concentration and you comment on that? 
 

Yes.  I just said the dose impact of an individual dose is apparent.  In other words, 
 
I usually asked the parent or carer, “Can you see an effect from the medication within a 
 
certain time?”  I record their response. 
 


Then you ask about and enquire about impulsivity, “Less marked, verbal control 
 
better, may take time out when he can’t cope.  Levels of activity still high.”  You ask 
 
about his sleeping and check on his appetite? 
 

That is correct. 
 
 
 

Again, I think you are checking that his height and weight remain within the 
centiles at which they were at the start of medication? 


That is correct, yes. 
 
 
 

Then you write again on 19 May, we see that at pages 86 and 87, incorporating 
 
your findings and a copy to Dr Cosgrove and specifically in relation to weight and height 
 
you comment that they are both progressing between the second and ninth centiles as 
 
before and you note his blood pressure.  If we can move on, then, please, to November 
1997 at page 127.  I think he has changed schools at this time, has he not? 


Yes, I think he must have done.   
 
 
 

On the pro forma height/weight box, again it appears to be between the second 
 
and ninth centiles? 
 

That is correct, yes. 
 
 

You go through your checklist in relation to concentration, impulsivity and 

restlessness.  Can you help us with what you have written there? 
 

It looks as if those were written that the school were having to work on his 
 
concentration and try and support him.  He was best, he was concentrating best mid-way 
 
between tablet dosages, so in other words at a time when the tablets were well and truly 
 
in his system but at other times it looks as if his concentration wavered. 
 
 
Q Impulsivity? 


Likewise, variable and emotional levels up and down.  We know that children can 
 
get more emotional on these higher doses of methylphenidate. 
 
 
 
Q The 
restlessness? 
 

It appeared to be dose-dependent.  Again, irritability  can be a sign, in fact, of 
methylphenidate. 

 
 

What were you reporting there?  That the restless increased depending on the dose 
 
or that the restlessness decreased? 
 

I cannot remember, I am afraid.  I cannot remember. 
 
 
 

Look at your letter following that clinic, page 84 and 85, I think a little more 
information from you there, A's mother is awaiting reports on how well he is doing from 

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the point of view of concentration and impulsivity at school.  She points out he does 
 
appear to be at his best at midway point between dosages: 
 
 
 
“The present dose of Ritalin is two or three tablets in the morning, 3 at 
 
midday, two at 3.30, 1 in the early evening.  In addition, he takes 
 
Risperidone 0.5 mg in the morning, 1 mg in the evening, he does appear to 
be generally quieter in the evenings nowadays 

 
 
…height and weight progressing well between second to ninth centiles.” 
 
 
 
Blood pressure 70.  14 May 1998 you see him again, page 128.  Height and weight 
 
remain within second to ninth centiles.   
 
 
And the dosage that you note there is one hundred, is that correct? 


Yes, that is correct. 
 
 
 

Risperidone, one milligram, twice daily.  Is that a comment related to the Ritalin 
 
of three hour gap instead of four? 
 

Yes, between the dosages, yes. 
 
 

Underneath that you have written: 

 
 
“Improved impulse control /social”? 
 

Presumably social responsiveness. 
 
 
 
Q And 
learning: 
 
 
“Sleeping is difficult sometimes. 

Confident in approaching adults.”   
 
 
 
14 May. 20 May you are writing again to the GP, 82, 83 with a copy to Dr Cosgrove 
 
confirming that growth is continuing between the second and ninth centiles.  Full blood 
 
count and liver function tests ordered last time, both normal.  You are seeing him again 
on 18 November, page 129.  Height and weight, what are you writing next to that on this 
 
occasion? 


I think mum generally commented that there had been ups and downs over the 
 
past few months. 
 
 
 

I meant in relation to the height and weight? 
 

The weight was just above ninth centile, so it was in the ninth to twenty-fifth 
centile bracket and the height was 90. 

 
 

So it has moved up somewhat in terms of centile? 
 

Yes, but, I mean, these slight variations are not statistically significant. You have 
 
got to cross a couple of centiles to be significant. 
 
 
 

Page 80, you are writing again to GP together with Dr Cosgrove, confirming that 
his growth is satisfactory, blood pressure well maintained: 

 
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“Understand he is on Clonidine at weekends”, 
 
 
 
not sure of the effect of that of that yet.   
 
 
 
Then 20 may--- 
 

Could I point out that in that letter I did highlight the increased amount of 
aggression he was showing and this could well have been a side effect from the 

methylphenidate at that dosage. 
 
I pointed out that he was getting wound up very readily and was showing physical 
 
aggression.   
 
 
 

Did you think at the time that that might be a side effect of the--- 
 

Well, it was that level of dosage, I was concerned about it.  I was beginning to get 
concerned. 

 
 

You have not noted that in your letter to the GP or Dr Cosgrove? 
 
A I 
said: 
 
 
 
“…the time has come to re-open negotiations with Social Services for 
 
some respite care.” 
 


How did that comment suggest to anyone that you were concerned that this could 
 
be the side effect of the medication? 
 

Well, it was difficult to be certain.  I mean, at that time I did not have enough 
 
evidence to be certain about it.  I knew because of this boy’s complicated background and 
 
many social concerns, I wondered if it was primarily a social problem but it could have 
 
been a bit of one and a bit of the other. 
 


If you had had some concern that it might be a bit of one and a bit of the other, 
 
would you not only have been suggesting a possibility of respite care but getting in touch 
 
with Dr Cosgrove to suggest that? 
 

Well, I copied my letter to him.  I never used to get a letter back. So Dr Cosgrove 
 
would have noted my comments. 
 
 

On 20 May 1999 you see patient A again at page 130, height and weight in the 

ninth centile. Is that correct? 
 
A Yes. 
 
 
 

Then you note Dr Cosgrove  had suggested increasing Clonidine in the evening, 
 
you note the tachycardia: 
 

“Behaviour always on edge with sister”? 
 
A Yes. 
 
 
 

Then you set out the Ritalin prescription of 110, Risperidone and clonidine? 
 

Ritalin was 130. 
 
 

I beg your pardon, 130, and you write on page 77 on 26 May to the General 

Practitioner with a copy to Dr Cosgrove: 
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“A is now taking extremely high doses of methylphenidate.”   
 
 
 
Do you have that page? 
 
A Yes. 
 
 

I think as a result of those concerns you, as you have said, certainly spoke with  

Dr Cosgrove on the phone? 
 
A Yes. 
 
 
 

But you probably wrote to him, you think? 
 

I think I did. 
 
 

Do you have a copy of that letter now? 


No, I do not, no. 
 
 
 

Did you accept that at the time your view of this child was that he was a 
 
challenging and complex child with the severe attentional difficulties? 
 

He came from a very disturbed background with, from my recollection, abuse in 
 
the early years, and probably a failed attachment. All of these events would have coloured 
his personality and his emotional development.  To what extent, I mean, I think I agreed 

that he did had ADHD, but it had to be considered against the complex of other problems 
 
and also his management was made difficult by the fact that we had very little response 
 
from Social Services in terms of support. 
 
 
 

If we can move on to October 1999, page 131, I think this is probably not your 
 
writing? 
A No. 

 
 

Then we will find out whose writing that was, but if you look at page 58 for a 
 
letter, no, sorry, this is a letter from the General Practitioner Dr Parry.  It is clear that  
 
Dr Parry was trying to get a second opinion and that patient’s mother is keen to see  
 
Dr Eyre at Swindon, a paediatric psychiatrist.  I will take you to 20 December 1999, it 
appears that Dr Eyre saw the patient page 50 to 51.  Page 51 he talks of three issues 
 
affecting, the child, first is his early abuse prior to being placed with his parents.  It is 

clear that he was adopted? 
 
A Yes. 
 
 
 

Second issue is learning difficulties.  Third issue, that of his medication regime: 
 
 
“It does seem that apart from tachycardia A has been well.  In theory the 

tachycardia could relate to the stimulant medication Ritalin or to the 
 
hypotensive effects of his Clonidine.  It is however common practice 
 
amongst specialists to prescribe Ritalin and clonidine together.  I am 
 
however not familiar in my own practice of the triple combination which 
 
A is taking. I am informed by the mother that Dr  Cosgrove suggested to 
 
use a beta blocker in order to combat the tachycardia, thus resulting in a 
regime of g four medications. 

 
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Then various options are set out. One option is to ask for an opinion from a paediatric 
 
cardiologist.  The second one is to start again, seek an expert opinion from either 
 
Professor Taylor or perhaps Professor Hill.   
 
 
 
I think the former option was pursued, if we can go to page 49, where unfortunately it is a 
 
rather badly copied letter from the consultant paediatric cardiologist, who talks about the 
ECG, a copy of which he was sent which was taken on 9 December 1999: 

 
 
“I understand A has significant problems and it is therefore important for 
 
him to be on Clonidin, Risperdone and Ritalin. What I don’t have a feel 
 
for is what extent is he tachycardic and what extent does that affect him.  
 
The ECG that you had kindly sent shows a low atrial rhythm at a rate of 95 
 
bpm.  This is a physiological variation where the atrial beat is initiated 
from the lower part of the right atrium and this is often exists with periods 

of sinus rhythm where the atrial beat arises from the sinus node.  A heart 
 
rate of 95 is slightly faster than average for a baseline heart rate of a 
 
sixteen year old but is not unusual to record such heart rates during a 
 
consultation. 
 
 
 
Symptomatic sinus or low atrial tachycardia would not warrant 
pharmacological therapy in paediatric practice.  It is possible these 

medications might cause a slight rise in baseline hear rate but I think it is 
 
most unlikely that this would lead to any symptoms. I would not normally 
 
advise any further action on the basis of the ECG that I have seen but if 
 
there is a feeling that he is unduly tachycardic a 24 hour tape me be helpful 
 
in documenting this.”  
 
 
So he, on the basis of the ECG available to him, did not appear to be too concerned about 

the condition of the patient? 
 

I am not sure this is a major issue.  Is this the major issue? 
 
 
 

Well, am I right? Is that a fair summary? 
 

It may well be. This is fresh to me, but I am not entirely sure that this is the major 
issue. 
 
 


I think by that time you had moved off, had you, to? 
 

To Exeter, yes. 
 
 
 

So summarising it, again, on a six monthly basis you were certainly monitoring 
 
the medication? 

I was monitoring when I saw him.  I did not give a guarantee to monitor him 

continuously in between times. 
 
 
 
MR MORRIS: Thank you very much. 
 
 
 
MR PEARCE: No questions in re-examination, sir. 
 
 
THE CHAIRMAN: There may be some questions from members of the panel.   

 
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Questioned by THE COMMITTEE: 
 
 
 
DR STANLEY: Back to page 130, may I ask about your starred comment at the bottom 
 
of the page there because I am not sure what that means? 
 

I, at this stage, was seriously concerned about the, I suppose the principles and the 
 
ethics of -- for which we really did not, had not received clear guidance on where 
practitioners stand in relation to private practitioners suggesting/recommending a course 

of treatment to a General Practitioner with the patient also being seen by an NHS hospital 
 
consultant.  I was not at all clear where responsibility lay for the consequences of 
 
prescribing.  There did not appear to be a shared agreement.  There was not a documented 
 
shared agreement to my knowledge between Dr Cosgrove and the General Practitioner 
 
whereby -- at least the only agreement seemed to be that Dr Cosgrove would send a copy 
 
of his private prescription and expect the GP to dole them out on the NHS subsequently, 
so there was an initial private prescription and then an NHS one from the General 

Practitioner.   
 
 
 
Now, where does the GP stand in relation to risk - clinical risk - when the consultant in 
 
private practice was recommending the drug at twice or over twice the upper limit of the 
 
normal recommended dose, and was engaging in serious polypharmacy and, indeed, at 
 
one point recommending four drugs; two of which were going to be counteracting the 
effects of the first? 

  
 
And so I had serious concerns about where we stood ethically in this situation and I think 
 
we needed a clear direction as to which way we were going, and I was looking to the GP I 
 
guess to give a bit of a lead here because the GP was in prime responsibility, I suppose, of 
 
the child.  Would it not be best if this child was entirely within the NHS and the child was 
 
actually managed by a team of people working together, who wrote letters to each other 
and corresponding?  I do not recall, except perhaps on one or two occasions, ever 

receiving a letter from Dr Cosgrove telling me what the alteration in dosage was. 
 
  
 
Q       Thank you.   Now, I am not sure what I interpreted here as "COH"? 
 
A       That is any initials. 
 
  
Q       So, it is "Please speak to COH", and that is you? 
 
A       That is me, yes. 

  
 
Q       Right.  So, I am sorry, but whose writing is it? 
 
A       That is my writing in case anybody else had picked up the notes and was going to 
 
deal with a situation that they would need to refer to me. 
 
  
DR STANLEY:   Yes, I see.  Thank you. 

  
 
THE CHAIRMAN:   (To the Witness)  Yes, the questions I want to put are along a similar 
 
line. As I understand it, the initial prescription of Ritalin was made by Dr Vereker? 
 
A       Yes, that is correct, on NHS. 
 
  
 
Q       Right. 
A       Well, within the documented guidelines. 

  
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Q       And this was after you had undertaken a physical assessment of Patient A? 
 
A       Yes, she wanted my opinion as to the physical state of the child. 
 
  
 
Q       And that prescription having been started by Dr Vereker, am I correct in thinking 
 
that you would have an ongoing monitoring role at approximately six monthly intervals? 
 
A       That is what I suggested I would do, yes. 
  

Q       Yes. 
 
A       Yes, I was very happy to work in concert with Dr Vereker because I saw her on a 
 
regular basis and we worked in the same hospital. 
 
   
 
Q       Yes.  You also suggested that there would be certain duties put on the General 
 
Practitioner to monitor between the six month assessments you did? 
A       Yes. 

  
 
Q       Is that correct? 
 
A       That is correct. 
 
  
 
Q       Were these done? 
 
A       I would hope so.  I mean, certainly for example in Exeter we have written 
guidelines and shared -- you know, each party signs that they will do their bit.  I do not 

recall that we had similar shared guidelines in Salisbury in those days, but the 
 
understanding I think on the part of the GP would be that the weight and the blood 
 
pressure should be monitored. 
 
  
 
Q       Would the referral back from the GP to you be on the basis of abnormality, or 
 
routine normal assessments? 
A       I am sorry, I did not catch you? 

  
 
Q       Yes.  If the assessments done by the GP were satisfactory, would you expect to 
 
hear that they were satisfactory? 
 
A       Not necessarily, no.  It would have been -- no.  I mean it would have been nice to 
 
hear, but I would have certainly expected to hear if they were abnormal. 
  
 
Q       But you would expect to hear if they were abnormal? 

A       Yes. 
 
  
 
Q       Right.  The psychiatric oversight of this patient having moved from Dr Vereker to 
 
Dr Cosgrove, am I correct in saying that you continued to monitor in exactly the same 
 
way as you would have monitored if the patient was still under the care of Dr Vereker? 
A       Yes, that is correct.  That is correct. 

  
 
Q       And you --- 
 
A       But --- 
 
  
 
Q       I am sorry. 
 
A       Sorry, go on. 
  

Q       And you kept Dr Cosgrove informed in relation to copies of letters, etc.? 
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A       Yes, it was my routine practice to copy my clinic letter to him whenever I saw the 
 
patient. 
 
  
 
Q       Yes.  But the return the other way was not as prolific? 
 
A       No. 
 
  
THE CHAIRMAN:   Thank you very much. 

  
 
 Mr Pearce? 
 
  
 
MR PEARCE:   No, thank you. 
 
  
 
THE CHAIRMAN:   Well, that concludes the evidence.  You are now free to go.  I thank 
you very much for attending to assist us. 

  
 
(The witness withdrew
 
  
 
THE CHAIRMAN:   The Panel had a reasonable break, but I am conscious of the fact 
 
that the Legal Teams did not have a break. Are you wanting a break before we go on for a 
 
bit more? 
  

MR PEARCE:   Not personally, sir.  Effectively I did have a break whilst the documents 
 
were photocopied. 
 
  
 
THE CHAIRMAN:   Yes, all right. 
 
  
 
MR PEARCE:   Dr Al Shabnder, please. 
 

DR KAIS MOHAMER KHALID AL SHABNDER Sworn 
 
Examined by MR PEARCE: 
 
  
 
Q       Could you give the Committee your full name, please? 
 
A       Kais Mohamer Khalid Al Shabnder. 
  
 
Q       Dr Al Shabnder, what is your current occupation please? 

A       I am an Associate Psychiatrist. 
 
  
 
Q       And by whom are you employed? 
 
A       By the Bromshire(sic) NHS in Wales. 
 
  
Q       All right.  Were you in 1999 employed as an Associate Psychiatrist by 

Pembrokeshire and Derwen NHS Trust? 
 
A       Yes. 
 
  
 
Q       Could I ask you, please, to look in one of the bundles of documents that is there.  It 
 
is called C8.  It is not one of the ones that you have brought in.  It will be one of those to 
 
the right of you and it may have handwritten on it "C8", do you see that? 
A       Yes. 

  
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Q        Could I ask you, please, to look behind Tab 3?  Do you see Tab 3? 
 
A       Yes. 
 
  
 
Q       And do you see a letter --- 
 
A       Yes. 
 
  
Q       --- dated 3 December 1999 on notepaper from the Bristol Priority Clinic? 

A       Yes. 
 
  
 
Q       And three pages on is it signed by Dr Cosgrove? 
 
A       Yes. 
 
  
 
Q       And do you see that on the third page it says, "cc Dr K R Shabnder", and there is 
reference to other parties there? 

A       Yes. 
 
  
 
Q       Do you see that? 
 
A       Yes. 
 
  
 
Q       Did you receive a copy of this letter --- 
A       Yes. 

  
 
Q       --- in or around December 1999? 
 
A       I did, yes. 
 
  
 
Q       Now, I want to ask you first of all a little bit about the examination to which this 
 
letter refers.  Have you re-read this letter recently, Dr Al Shabnder? 
A       Yes, I know it. 

  
 
Q       And are you acquainted with its contents? 
 
A       Yes, yes. 
 
  
 
Q       The patient to whom it refers for purposes of anonymity we shall call Patient B in 
the course of this hearing, if we can. Do you recall having an appointment to see Patient 
 
B? 

A       Yes. 
 
  
 
Q       And do you recall much about that appointment now, or consultation? 
 
A       Yes, I do.  I do remember, but I do not know what specifically you want me to 
 
remember? 
  

Q       No, no, that is all right.  I am just asking in general terms do you recall it? 
 
A       I do remember it, yes. 
 
  
 
Q       Right, okay.  And B, I think, was an adult patient? 
 
A       Yes. 
 
  
Q       According to this letter here, we see on Page 1 of Tab 3 that Dr Cosgrove speaks of 

Patient B having poor concentration, short attention span and distractability? 
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A       Yes. 
 
  
 
Q       Are those features of Patient B that you recall? 
 
A       He did say he have all these.  On Mental State Examination he did have some, but 
 
not all. I do remember him saying that he have the following, 1, 2, 3, 4, 5.  It is not a 
 
matter of me eliciting them one by one. 
  

Q       He said he had these symptoms? 
 
A       Yes.  He came very determined that he has 1, 2, 3, 4, 5,  he did name the diagnosis 
 
and he did ask for the treatment. 
 
  
 
Q       What diagnosis did he name? 
 
A       Attention Hyperactivity Syndrome. 
  

Q       And what treatment did he request? 
 
A       He requested stimulant, as far as I remember. Psycho-stimulant medications. 
 
  
 
Q       All right.  Did you prescribe such medication? 
 
A       No, I did not. 
 
  
Q       Right.  Now let me just, if I can, take you to the second page of this letter from Dr 

Cosgrove.  I think it is clear -- you tell me if I am wrong, but I think it is clear that the 
 
person to whom he is referring as being the Psychiatrist whom the Patient B saw was 
 
indeed you? 
 
A       From the letter that is what I understand, yes. 
 
  
 
Q       Yes.  Now dealing if I can with the allegations in turn, the paragraph the second 
from the end of Page 2 here begins as you will see: 

  
 
"There is some importance in this ..." (that is to say in who it was) 
 
"... since whoever Patient B actually saw, he found him to be rude 
 
and quite unhelpful". 
 
  
First of all, were you rude in the course of this consultation? 
 
A       No, I was not. 

  
 
Q       Were you, in your judgment, unhelpful in the course of the consultation? 
 
A       No.  If you put unhelpfulness, he asked me to prescribe this -- to give the diagnosis 
 
and prescribe the medication.  I did not. 
 
  
Q       You did not do what he asked you to do?  Give the diagnosis he asked and to give 

the prescription he asked for? 
 
A       But had I done this it would not be helpful. 
 
  
 
Q       Yes. 
 
A       That is what I am saying. 
 
  
Q       I understand.  And carrying on in the same paragraph: 

  
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"Patient B describes him ..." (that is to say you)"... as being a 
 
scruffily dressed man in his fifties or possibly his forties". 
 
  
 
Were you scruffily dressed? 
 
A       It is very unlikely, to be honest with you.  I mean, I do not see a reason why I 
 
would be scruffily dressed. 
  

Q       I take it you cannot recall what you were wearing then? 
 
 A       I mean I do not dress like a TV star, but I do not -- nobody ever have said that I 
 
look scruffy.  I do understand people come to see me wearing best they have and so I do 
 
try to wear reasonable good things. 
 
  
 
Q       Yes. 
A       I always wear a tie and I always wear ... 

  
 
Q       Yes. 
 
A       I do not know what -- I do remember this very well, it is in the letter, and I have 
 
been thinking about it. 
 
  
 
Q       Yes? 
A       I do not know where it has come from. 

  
 
Q       Right.  It is suggested in this next sentence: 
 
  
 
"The appointment got off to a bad start in that this doctor sped on 
 
ahead so that Patient B found himself at the top of some stairs 
 
with no one in sight and not having a clue as to where to go". 
  

Do you recall that you did that in this consultation? 
 
A       There is a secretary at the beginning of the corridor. 
 
She tells the patient either to wait, or to come in along, and she either has done any of 
 
those two.  I was not with him at the time, but I do not think that ever could happen 
 
because it is not in the interests of anybody for just leaving somebody there without -- I 
was not there, if you ask me, and so I do not know to be honest with you, but it is not 
 
likely.  That is my conclusion here. 

  
 
Q       Did you rebuke him?  The next sentence suggests that you rebuked this patient, 
 
saying that you had been waiting for him. However that may have come about, did you 
 
rebuke him saying that you had been waiting for him? 
 
A       I do not remember.  It is unlikely again, but I do not honestly remember. 
  

Q       Now, in the next paragraph we see that reference is made to you asking Patient B to 
 
subtract seven from 100 and then seven from 93.  It is not actually stated whether he was 
 
asked to continue repeatedly subtracting seven from the answer, but would you have done 
 
that? 
 
A       I might well have done that.  This is part of the Mental State Examination.  I 
 
remember him saying that his memory is not very well.  This is one of his, you know, 
presenting complaints. You know, one of the many presenting things that he was saying. 

And one of the things I do is, you know, sometimes I might well ask that, but before I do 
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this I tell them, "Look, you know, I have to do this". 
 
  
 
Q       Yes? 
 
A       And we do it and I never had any problems doing it. 
 
   
 
Q       Okay.  So, the answer is you may have done it? 
A       I might well have done it, yes. 

  
 
Q       And you do on occasions? 
 
A       Yes, yes. 
 
  
 
Q       Yes.  At the top of the next page it is said that you said, "There's nothing I can do 
 
for you"? 
A       There is no way.  You know, knowing the patient and knowing the circumstances, 

it is not for anybody's best interest to say that.  This would be very stupid, you know?  He 
 
came in to find out an answer and ask me specifically about something and, you know, 
 
you only alienate people by saying things like this. 
 
  
 
Q       It is suggested that you said that this patient may or may not have deficit 
 
syndrome? 
A       In the diagnosis I wrote that it is one of the differential diagnoses, but it will be 

very immature to diagnose him that at this point in time without at least doing some 
 
investigation and rolling out other possible things. 
 
  
 
Q       Can I be clear about what condition it is you are saying was one of the differential 
 
diagnoses here? 
 
A       Attention Deficit Hyperactivity Syndrome.  This could be one of his differential 
diagnoses, you know, what he have, but to reach such if you like one of the big diagnoses 

in psychiatry because of the implication of treatment, then you need to rule out other 
 
psychopathology.  And, to be honest with you, at that point of time my feeling is that to 
 
give that diagnosis is oversimplifying the whole case, yes?   That is the feeling of the 
 
team as well when we discussed it afterwards. 
 
 

It is suggested in this letter that you knew nothing about attention deficit 
 
hyperactivity disorder? 


No, that is wrong.  This is one of the things that comes up in examinations at the 
 
Royal College of Psychiatrists.  This is one of the articles.  I would not call myself a 
 
world expert about it but it is not something that you do not ever know about.  It is one of 
 
the things that one should know about but it is one of the things that you know that it is 
 
not one of the bread and butter illnesses that you rush into diagnosis and treatment 
immediately.  This has consequences.  This has serious medication afterwards.  It needs 

follow-up.  When you take a diagnosis like that you need to be reasonably firm, 
 
reasonably happy about it.  
 
 
 

How often do you see children in consultation? 
 

I do not. 
 
 

You are not a child psychiatrist? 


No.   I know this is one of the domain of child psychiatrists and child 
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paediatricians but they do continue in adult life and it is one of the differential diagnoses 
 
in so many things.  Even a personality disorder, which is bread and butter in psychiatry, 
 
you have to at least think of this. 
 
 
 

Just to be clear on that specific point, I think it may be being suggested in this 
 
letter that you were saying that ADHD cannot be a diagnosis in an adult.  It does not say 
it expressly but it might be read that way? 


It can.  It can continue to adulthood. 
 
 
 

It is suggested that you said that you wrongly said that Patient B was well-
 
motivated.  Do you remember what you identified in respect of this patient’s motivation? 
 

You see, what psychiatrists mean about motivation is that he is goal-oriented in 
 
what he do to satisfy his inner needs.  That is what motivation means.  If you take this 
patient, yes, he is.  He has inner needs and he is pursuing them and that is what I mean by 

good motivation.  
 
 
 

It is suggested that you were professionally incompetent, either in this 
 
consultation or more generally, but take it that it refers for the moment at least to this 
 
consultation.  Do you agree with that? 
 

No.  I do not agree.  No, I do not agree. 
 


You have indicated that you would not make a diagnosis, it would be wrong, 
 
immature, you say, to make a diagnosis at that stage.  What if any further investigations 
 
might properly be made before a diagnosis was reached in that? 
 

Well, in psychiatry, you see, the investigation is to go and ask about the 
 
background.  You ask relatives, you ask next of kin, you ask community psychiatric nurse 
 
to go and see the patient at home and report back.  You have a general feeling of what is 
going on.  You see, diagnosis means nothing without taking the background and the 

circumstances, so you have to put the background, who the patient is and that gives you a 
 
final diagnosis that puts everything into perspective.  
 
 
 

I understand.  
 

You have to understand why and you certainly have to ask next of kin, you have 
to ask CPN, people to go to his home, you have to see him again and have a feeling of 
 
how this is developing as well.  Seeing the patient once is a flash in time and to make 

such a huge diagnosis, in my opinion, you need to know more, you have to know more.  
 
 
 

How did you respond to receipt of this letter, Dr AlShabnder? 
 

Normal.  I think first you deny that it has happened, then you start to be angry and 
 
then you try to live with it. 
 


This letter we know was sent to the general practitioner and copied to, I think it is 
 
Patient B’s parents.  Did it come to your attention that the contents of the letter were 
 
known about more widely than those people? 
 

Aberystwyth is a very small place.  It is not like Manchester here, or London.  
 
Everything with anybody is known to everybody everywhere.  We have the outpatient 
 
clinic is above a day hospital where all patient comes in in day hospital and this letter has 
been found with other patients who sit in day hospital.  I have seen people in the street 

who reminded me, “Yes, somebody says all this in the letter.  What do you think?”  We 
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have people in Aberystwyth, I think like anywhere else, who are anti-psychiatry as that 
 
has been described and they used this as one of their main weapons, if you like.  It has, I 
 
would say big, very big consequences because it is a small place, everybody knows 
 
everybody’s business and something like this will be known.  It will be the talk of the 
 
moment for a long time, if you like.  It is very bad for the psychiatry, for medicine, down 
 
there. 
 

MR PEARCE:  Thank you.  I have no further questions at the moment but Mr Morris on 
 
behalf of Dr Cosgrove may have some questions. 
 
 
 
Cross-examined by MR MORRIS: 
 
 
 

Doctor, this letter that was sent to you and the only other recipients were the 
patient and his wife.  Is that correct? 


It says here, “c.c.” to those people, yes. 
 
 
 

The description of the consultation with you obviously did not come directly from 
 
Dr Cosgrove.  It is Dr Cosgrove reporting, presumably, what your patient had said to 
 
him?  Would that be fair? 
 

But I - can I add something to this one? 
 


Yes, of course. 
 

Dr Cosgrove made a judgment from what the patient had said and he made his 
 
judgment very clear that I am medically negligent.   
 
 
 
Q Right. 
 
 

And the whole service is bad and that is all judgment built on one person, if you 
like.  

 
 

He was coming to a conclusion upon what he had been told by his patient? 
 

The conclusion he reached is very serious and anybody coming to that kind of 
 
conclusion should at least listen to the other side of the story.  
 
 

But you would accept that, subject to your criticism he should have listened to the 
 
other side of the story, his conclusion was based on what he had been told by the patient, 

whether that conclusion is wrong or right? 
 

It seems to be.  It seems to be. 
 
 
 

You said in relation to the findings that Dr Cosgrove made when he saw the 
 
patient, together with his wife, in consultation, that some but not all of those findings 
were ones that you had elicited.  Is that right? 


I am sorry, I missed it.  Would you kindly repeat it? 
 
 
 

Yes.  I think Mr Pearce when asking you questions started off in relation, at the 
 
beginning of Dr Cosgrove’s letter to the GP and you, that the patient and the patient’s 
 
wife told him about poor concentration, short attention span and his distractability and I 
 
think you were asked whether or not you found or you recognised those as symptoms 
when you had seen him? 


Symptoms, yes.  He volunteered saying that, yes, but they are not signs.  
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Help us as to what other, if we can look through the history that Dr Cosgrove 
 
took, please.  We go on, “He finds reading very difficult and has to re-read each line two 
 
to three times before the contents sink in.  His wife told me that he reads little and has 
 
never read a book in their 22 years of marriage.”  What, if any, findings did you make in 
 
relation to his reading ability? 

Whether he can read or write, you mean?  I know that in the interviews he could 

not shake my hand in the normal way, so he would not be able to hold a pen and write.  I 
 
remember him making a fist and shaking my hand and saying that, “I could not open my 
 
fingers.” 
 
 
 

When you saw him and he had this list of symptoms which he felt amounted to 
 
what he called a deficit syndrome, did you seek to investigate there and then to see 
whether or not you could confirm it or exclude it? 


Yes.  That was the next step, yes.  
 
 
 

The conclusion you wrote, did you exclude it? 
 

I wrote that it is certainly one of the differential diagnoses.  It has to be considered 
 
but not considering and ruling out others would be serious, may be far more serious. 
 
 

What steps did you put in place - you said that he needed further investigations.  

What steps did you put in place further to investigate? 
 

We had what we called DMT meeting, where everybody in the team, social 
 
worker, community psychiatric nurse, other doctors, usually GP as well sit and we 
 
discuss the case.  As you know this gentleman, this patient is very well known in 
 
Aberystwyth.  Everybody knows him, so everybody contributed in painting, colouring in 
 
the picture of the patient and his background and who he is and what has been going on. 
 

Then the conclusion then is that if he was happy that we can send a psychiatric nurse to 
 
his home and see how things are there, that is one of the investigations and to see him 
 
again in outpatient clinic after discussing it with the GP, who has to be involved as well.  
 
So, to follow the case, keeping that in mind and building the picture up.  That is what the 
 
conclusion came up.  
 
 

Did you make any arrangements to see his wife? 


His wife will be part of the picture. She will be invited to the outpatient clinic by 
 
the community psychiatric nurses.  This is common procedure.  She is next of kin.  
 
 
 

Not something you specifically ask for, though? 
 

It is routine, if you like. 
 

Q Routine? 
 

If she does not come the next time, it will be possibility of going seeing him with 
 
her at home or why or there is something.  
 
 
 

Doctor, I know you do not accept the accuracy of the account that was given by 
 
the patient to Dr Cosgrove, but just help me with this scenario.  If that account was 
accurate, would it show, in your view, a lack of knowledge on your part and a falling 

short of the appropriate standard of a psychiatrist? 
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It is a big “if”.  If all this is true and I was rude and I was not proper and I was that 
 
idiot, yes, if all this is true. 
 
 
 

If it is true? 
 

Then the consequences is what? 
 
 

That you would not have been acting competently as a psychiatrist? 


I would not have been acting as a doctor at all, not only a psychiatrist.  Yes.  
 
 
 
MR MORRIS:  Thank you. 
 
 
 
THE CHAIRMAN:  Mr Pearce? 
 
 
MR PEARCE:  I have no re-examination. 

 
 
THE CHAIRMAN:  Doctor, the members or the Committee may have some questions for 
 
you. 
 
Questioned by THE COMMITTEE: 
 
 
 
MR MATHARU:  Good afternoon, Dr AlShabnder.  I have just one question for you.  
You received this letter from Dr Cosgrove and you told us that although you were angry 

with the contents of the letter, you actually said that you learned to live with the letter.  I 
 
am just wondering why you did not actually take it further?   
 

I did discuss it with the Clinical Director.  I did discuss it with colleagues in the 
 
Trust.  I thought they did tell me that they will be appropriate matters taken but in what 
 
way do you mean take it further?  In what way?  What does taking it further mean?  On 
 
what level? 
 


We have heard Dr Cosgrove says you are medically negligent. Obviously it would 
 
be natural to be angry if somebody accuses you of being negligent but you actually said 
 
that you just learned to live with it, you did not take it any further.  I am just trying to 
 
clarify why? 
 

If you mean that I take legal action - is that what you mean?  It is not my way.  I 
do not take legal action against anybody.  I think it is wrong.  I do not do that at all. 
 
 

MR MATHARU:  Thank you, doctor.  That is fine. 
 
 
 
THE CHAIRMAN:  Mr Pearce, do you want to come back? 
 
 
 
MR PEARCE:  I do not want to make a speech at this stage, sir, but just in the light of the 
question that was raised there - and I do not want to open a can of worms but, of course, it 

is fair to say in terms of what action has been taken that this matter is now before this 
 
Committee.  I simply make the point, without making a speech. 
 
 
 
THE CHAIRMAN:  I think the point that Mr Matharu was trying to draw out was, did 
 
any action come at the immediate time from the doctor and we hear that no immediate 
 
action took place and he has given some explanation as to why.  
 

MR PEARCE:  I understand that, sir, thank you.  I have no further questions in re-
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examination, sir.  
 
 
 
THE CHAIRMAN:  That concludes your evidence, doctor.  Thank you very much for 
 
coming to assist us.  I will be guided in relation to timing.  
 
 
 
MR PEARCE:  We are fairly optimistic, I think, that Dr Humphreys, who is the one 
remaining witness I intended to call today, the one remaining witness who is here, will be 

very short. 
 
 
 
DR SEAN WALLACE HUMPHREYS Sworn 
 
Examined by MR PEARCE: 
 
 
 

Could you give the Committee your full name, please? 

Sean Wallace Humphreys. 

 
 

Dr Humphreys, are you a general practitioner.  Is that correct? 
 

That is correct, yes. 
 
 
 

Where do you currently practise? 
 
A Aberystwyth. 
 
 


Did you practise as a general practitioner in 1999 in Aberystwyth? 
 
A I 
did. 
 
 
 

Could I please ask you to look in the bundle that is headed C8, which is I hope in 
 
front of you, behind tab 3.  Do you there see a letter from Dr Cosgrove dated 3 December 
 
1999 addressed to you? 

I do.  

 
 

This letter clearly relates to a patient, a patient who we, for the purposes of this 
 
hearing and in order to preserve anonymity, are calling Patient B.  Was Patient B a patient 
 
of yours? 
 
A He 
was. 
 
 

Have you familiarised yourself with this letter recently 


I have.  
 
 
 

When you received this letter, what was your response to the contents of it? 
 

My immediate reaction was I was incredulous.  I had not actually seen a letter 
 
quite like this before and I have not seen one since.  Normally as GPs we tend to speed 
read the letters which I did on this occasion and, as per my statement, the initial part of 

this letter I thought was entirely in keeping with a normal GP/consultant correspondence, 
 
as it were, but turning on to page 2 and page 3 of the letter, I became increasingly 
 
concerned at the tone and the content of the letter. 
 
 
 

I take it those parts that you refer to a psychiatrist, who we are fairly clear was Dr 
 
AlShabdner? 

That is right. 

 
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What was your concern about the content? Why was that a matter of concern to 
 
you? 
 

I think that the letter -- Dr Cosgrove in this letter appeared to be making personal 
 
comments about Dr AlShabdner which were hearsay, i.e, the patient had made these 
 
comments supposedly to him and also casting doubt about his professional and clinical 
 
competence.  I noted at the end that a copy was sent both to Dr AlShabdner and to the 
patient concerned, which heightened my concerns. 

 
 

Yes.  Did you have experience of Dr AlShabdner in medical practice? 
 

I did, he was a local associate specialist and had, therefore, seen a number of my 
 
patients over preceding years.  Aberystwith is a small town and as such the medical 
 
practitioners within Aberystwith tend to know each other reasonably well. 
 
 

What opinion had you formed of Dr AlShabdner? 


I thought he was an excellent practitioner.  He seemed ready and willing to see 
 
patients when asked and overall I felt the standard of his opinions that he gave to be 
 
excellent. 
 
 
 

You indicate that you had concerns about the contents of the letter.  Did you 
 
discuss those concerns with anyone? 

I did two things.  I passed the letter around the weekly practice meeting, the 

meeting of the partners that we have each Wednesday to discuss business and other 
 
matters I asked the partners for their views on the contents of the letter.  I spoke to my 
 
defence organisation to see what they thought my most appropriate response should be 
 
and I also asked whether I had any other obligations in terms of yourselves really. 
 
 
 

I do not think we are concerned with what they may have said, but subsequently 
after sharing your concerns in these ways did you take any action? 


I did.  I sent a letter to Dr Cosgrove thanking him for the clinical contents of the 
 
correspondence that he sent me, but stating that I was unhappy with other aspects of the 
 
letter.  Unfortunately I do not have a copy of that but I have record of the fact that it was 
 
sent.  I also picked up the phone and spoke to Dr AlShabdner and tried to ensure him that 
 
I had in no way impugned his reputation and that these comments were not originating 
from myself. 
 
 

MR PEARCE: Thank you. 
 
 
 
MR MORRIS: No questions. 
 
 
 
THE CHAIRMAN: Members of the panel? No questions from the members of the panel. 
 Dr Humphreys, thank you very much for coming to help us.  Not sure whether I should 

apologise that it was a rather short visit here? 
 
 
 
THE WITNESS:  Thank you.   
 
 
 
MR PEARCE: My prediction was accurate.  Those are the witnesses I have available 
 
today. 
 

 
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The availability of witnesses was discussed 
 
 
 
The committee adjourned until 9.30, Thursday, 10 June 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 

 
 

 
 
 
 
 


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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
 
Thursday 10 June 2004 
 
Held at: 
St James’ Buildings 
79 Oxford Street 
Manchester M1 6FQ 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Seven) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was not present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of TranscribeUK 
Tel No:  0208 614 5799) 
 
-------------------------------------- 
 
 
 
 

 
 
 
 
INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
DR DEBORAH JANE JUDGE Affirmed 
 Examined 
by 
MR 
PEARCE 
      

Cross-examined 
by 
MR 
MORRIS 
     

 
DR KAREN WILHEMENA MOSES Affirmed 
 Examined 
by 
MR 
PEARCE 
      

 
Cross-examined by MR MORRIS 
 
 
        
      
16 
 
DR MELINDA REBECCA THOMAS Affirmed 
 Examined 
by 
MR 
PEARCE 
 
     27 
 
 
DR ROBERT DOLBEN Affirmed 
 Examined 
by 
MR 
PEARCE 
 
     32 
 
APPLICATION TO ADMIT WITNESS STATEMENTS  
BY MR PEARCE  
 
 
 
 
 
 
 
34 
 
RESPONSE 
BY 
MR 
MORRIS 
 
     36 
 
 
 
 
 
 
LEGAL 
ADVICE 
       38 
 
DECISION 
 
 
 
 
 
 
 
 
43 
 
DR HELEN CHUBB, Statement read 
 
 
 
 
43 
 
DR STEPHEN DOVER, Statement read 
 
 
 
 
44 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:  Good morning.  When you are ready, Mr Pearce. 
 
 
 
MR PEARCE: Absolutely, sir, I am ready now to start with Dr Judge, please. 
 
 
 
DR DEBORAH JANE JUDGE Affirmed 
 
Examined by MR PEARCE
 


Dr Judge, could I ask you to give the Committee your full name, please? 
 

My name is Dr Deborah Jane Judge.  
 
 
 

Your occupation, Dr Judge? 
 

I am a consultant child and adolescent psychiatrist.  
 
 

Who is your current employer? 


My current employer is Avon and Wiltshire Mental Health NHS Partnership 
 
Trust.  
 
 
 

Were you employed by that Trust in May of last year? 
 

I was on a locum basis in May of last year.  
 
 

Could I ask you to have a look at one of the bundles of documents that I hope is to 

your right and should have written on it C8.  In C8 could I ask you to look, please, at tab 
 
10, page 7 thereof.  This is, I think, a clinical note relating to a patient and his mother and 
 
for the purposes of this hearing we are calling that patient Patient G.  Is this a note that 
 
you made on 16 May 2003? 
 

It is, yes.  
 
 

Did you see Patient G and his mother on that day? 

A I 
did. 
 
 
 

At that time, had Patient G been prescribed Risperidone and methylphenidate? 
 

He had, yes.  
 
 
Q By 
whom? 
 

The letter that I received from the GP and from what his mother also told me, the 

prescription had been made by Dr Cosgrove.  
 
 
 

If we just look back in that same division of that bundle to page 3.  Just so that we 
 
get a clear picture of this, you will have noted that there is an admission on this aspect of 
 
the case that Dr Cosgrove had seen Patient G and had prescribed Ritalin and Risperidone 
in February 2003.  Do we there see reference in a letter, which I do not think you will 

have seen at the time but a letter from Dr Cosgrove to a general practitioner relating to 
 
the patient dated 25 February 2003 and indicating a consultation on the 24th of that 
 
month? 
 
A Yes. 
 
 
 
 

Returning, if we can, to page 7 and your involvement, Dr Judge, how did it come 
about that you were reviewing Patient G? 


Patient G had been seen some months earlier at the clinic for an assessment 
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session by one of the clinic child psychotherapists.  
 
 
 

This is your clinic? 
 

Yes, so he was on the books of the clinic, as it were, waiting for what had been 
 
indicated from the initial assessment was family work and behavioural strategies and 
 
subsequently the GP wrote to the clinic with concerns about being asked to prescribe 
Ritalin and Risperidone together for a four year old and was specifically requesting a 

psychiatric review.  
 
 
 

Right, so we have identified that Ritalin and Risperidone were prescribed by Dr 
 
Cosgrove.  To the best of your knowledge before this date in May 2003, had anyone from 
 
your clinic prescribed Ritalin and/or Risperidone to Patient G? 
 
A No. 
 


Just looking through this note, if we may,  
 
 
 
“Mrs G and G attended.  Review of medication following 
 
GP referral.  Medication”  
 
 
 
- tell me if I am getting any of this wrong, please -  
 

“Risperidone 0.125 mg x 5 daily, methylphenidate 5 mg x 
 
5 daily.  Discussion with Mrs G of history and treatment.  
 
Happy with improvement in G’s behaviour but has lost 
 
weight, 1 kg since starting medication in Feb.” 
 
 
 
Just pausing there a moment so we are clear about that, Mrs G was saying that he son had 
lost 1 kg in the period from February to May? 


That is correct, yes.  
 
 
 
Q  
 
“Height and weight measured today in clinic.  Agreed to 
 
NHS clinic follow-up with a plan for gradual reduction of 
Risperidone medication.  Will need medical monitoring re 
 
medication.  Mother also open to clinic sessions re family 

relationships and behavioural strategies.  Risperidone 
 
0.125 mg tds.” 
 
 
 
Is that correct? 
 

That is correct.  
 


Just, for the benefit of Committee, can you say what that means? 
 

That we agreed at that initial session that the aim of me - one of the aims of me - 
 
continuing G’s follow-up was to reduce and rationalise the prescribing and so that we 
 
aimed to start that by reducing the Risperidone medication from five times daily dosage 
 
to three times a day dosage.  
 
 

Just for the non-medical members of the Committee, “tds” means? 


Three times daily. 
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And methylphenidate, 5 mg five times daily? 
 

That is correct. 
 
 
 

So it is the same dose of Ritalin, of methylphenidate, but a reduced dosage of 
 
Risperidone? 

That is correct.  

 
 

That is signed, I think, by you next to that prescription? 
 
A Yes. 
 
 
 

Then underneath that, is that three letters - does it say MSE or something? 
 

Mental state examination. 
 

Q I 
understand. 
 
 
 
“G played with Lego and drew at the table, settled in his 
 
behaviour.  Talked about school and teacher, likes 
 
school.“ 
 
 
That, then, I think is the end of the entry for that day 


that is correct. 
 
 
 

When you spoke to G - or rather G’s mother - in the course of that consultation, 
 
what did you find out about the monitoring of the medication that Dr Cosgrove had 
 
prescribed? 
 

She said that the further contact that she had had with Dr Cosgrove about the 
medication was via telephone contact. 

 
 

You spoke about concerns, I think, at this consultation.  What, if any, concerns did 
 
you have about the treatment of Patient G? 
 

The two broad angles of my concerns were that he was only four.  He weighed 17 
 
kg at the outset and he had lost 1 kg in weight since starting this combination of 
medication, so I had concerns about the impact of the medication on his appetite and 
 
growth.  Then, secondly, I had concerns that he had been prescribed these two sorts of 

medication after one assessment appointment with Dr Cosgrove.  My understanding 
 
about the use of Risperidone in attention deficit hyperactivity disorder is that it may be 
 
indicated in treatment resistant cases, so that I was concerned that this combination of 
 
medication had been prescribed after an initial consultation. 
 
 

Thereafter did you see Patient G from time to time in the clinic? 


I have done so, yes.  
 
 
 

And what was the progress of his weight thereafter? 
 

His weight continues to be a concern.  His current weight is, I believe, 16.3 kg and 
 
I have just agreed with his mother at the last appointment that I would refer him to a 
 
paediatrician to have his growth reviewed, so it has been an ongoing concern over the last 
year and I have raised at other intervals whether his mother would want this additional 

consultation with a paediatrician but previously she had said no, but it seems now, 
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because his growth really has not picked up that it would be appropriate to do that now. 
 
 
 
MR PEARCE:  I understand.  Dr Judge, thank you very much.  That concludes the 
 
question I want to ask.  Mr Morris, on behalf of Dr Cosgrove, will now ask you some 
 
questions. 
 
 
Cross-examined by MR MORRIS: 

 
 

Dr Judge, you said that your understanding was that G had been monitored by Dr 
 
Cosgrove over the telephone and I think you confirm that in your letter to the GP on page 
 
9 of tab 10, the second paragraph.   
 

That is correct. 
 
 

Then, after, if we go back to page 8, after the 16 May consultation you reviewed 

G with his mother on 6 June and you reduced the Risperidone to 0.125 qds - four times a 
 
day? 
 

Four times a day, correct.  
 
 
 

Instead of five? 
 
A Yes. 
 


Could not manage to reduce further because parents felt that G was more irritable, 
 
restless, unhappy.  School have not remarked on any change.  Then you set our your plan 
 
in relation to the medication.  11 July, “Good school reports.  After school manageable 
 
until 6.00 to 7.00”? 
 
A Correct. 
 
 

Then, “Medication regime.  Methylphenidate remains the same.”  Is that right?  

Five times a day at 5 mg? 
 

That is correct.  That is the current, on that date, yes. 
 
 
 

Did you change that?  We do not have a continuation of that. 
 

Can I refer to his clinical file?  I have the copy of his clinical file with me.  
 
 

Yes, if you want to complete that day’s consultation notes. 


I read out how it continues on the next page: 
 
 
 
“Weight loss, appetite a problem.  If anything eats most 
 
last thing at night.  ‘Seems to be sprouting thin blond hair 
 
all over’ in quotes, from his mum.  Plan, shift dose 
regime.  Query refer to community paediatrician due to 

weight loss.  Staying with grandma in Teesside for six 
 
weeks over the holidays.  Plan to review weekly by 
 
telephone contact whilst he is there and the 
 
methylphenidate to be shifted to three times a day 5 mg 
 
and 10 mg at night”  
 
 
So I began to shift the timing of the doses but did not change the total amount of 

methylphenidate.   
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“The Risperidone to be prescribed at 0.125 mg four times 
 
a day.  Aim for both three times daily, decrease evening 
 
methylphenidate.” 
 
 
 
So, that was advice given in the meantime over that six week period, that if the family felt 
that they could reduce the medication further, then that was advised. 

 
 

If I can just follow through in your notes over that summer, I can help the 
 
Committee, I have copies of the extract I wish to refer to.   
 
 
 
THE CHAIRMAN:  This will be D26.  (Produced
 
 

You see G again on 17 July, as you say, you shifted the methylphenidate to three 

times a day but the same total amount? 
 

That is correct. 
 
 
 

And Risperidone twice a day, again with the same total amount of half a 
 
milligram. Is that right? 
 

That is correct. 
 


You already mentioned that G was going to be away in the summer and you say: 
 
 
 
“Away now for the summer but mother will keep in telephone contact”,   
 
 
 
then did you monitor his situation by telephone over July and August?  I think there was  
 
a missed contact on 31 July? 
A Yes. 

 
 

Then on 7 August there was telephone contact.  You repeated the prescription.   
 
If we look over the page that I have copied, further on in your notes, it is attached to the 
 
page I have had copied as a telephone note of that was conversation. 
 
A Right. 
 
 

Do you have that? 

A I 
do. 
 
 
 

In relation to 7 August: 
 
 
 
“Appetite hasn’t changed.  Breakfast serial x 2 at 9 p.m. 16 kg - weight 
static.  Half tablet Risperidone.  Can be hyper & exuberant. Tearful at 

times.  Peaks & troughs.  Sleep.  By 10 p.m every night - improvements.”   
 
 
 
You were monitoring his weight and monitoring his behaviour and condition on that 
 
regime? 
 
A Yes. 
 
 

And if anything untoward by way of side effects or anything had been reported 

that would be obviously something you would wish to know? 
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A Yes. 
 
 
 
MR MORRIS: Thank you very much. 
 
 
 
MR PEARCE: No re-examination, sir. 
 
 
THE CHAIRMAN: Check if there are questions from members of the panel.  There are 

no questions.  That concludes your evidence, Dr Judge.  Thank you very much for 
 
attending.  As I say, it is a pleasure to get clinical notes that we can read.   
 
 
 
MR PEARCE: Sir, I call Dr Moses.  Her evidence relates to Patient C.   
 
 
 
Dr KAREN WILHEMENA MOSES affirmed 
Examined by MR PEARCE 

 
 

Could you give the Committee your full name, please? 
 

Karen Wilhemena Moses.   
 
 
 

Are you a consultant in child and adolescent psychiatry? 
 

I am, yes. 
 


From 1992 until the year 2003 were you employed by Gwent Community Health 
 
Trust in a post as a consultant in child and adolescent psychiatry at Saint Cadoc’s 
 
Hospital in Newport? 
 

Yes, I was. 
 
 
 

We are concerned with a patient whom we are calling Patient C? 
A Yes. 

 
 

So that we can identify what we are involved with, can I ask you to look at 
 
divisions four and five in the bundle headed C8 to your right.  We will go through the 
 
letters in some little detail in a moment, but for background, 29 May 1999, division four 
 
is a letter from Dr Cosgrove to Dr Rackham, who is a General Practitioner relating to the 
 
person we are calling Patient C, who is clearly a patient of Dr Rackham’s.  It is a letter 
copied to you on the bottom of the letter on page two and refers in the second full 

paragraph on page two to the fact that you have seen this patient.  If you turn over to 
 
division five, page one, there is a letter from you to Dr Cosgrove dated 1 July 1999, again 
 
about this patient: 
 
 
 
“Thank you for sending me a copy of  your letter on this boy.  At the time 
you saw him he was a day patient on our Children's Psychiatric Unit.” 

 
 
A  
Yes. 
 
 
 

What I want to ask you is what involvement had you had in the care of Patient C 
 
whilst he was on that unit? 
 

I was consultant to the unit, so that as part of the multi-disciplinary team we were 
looking after Patient C on a day patient basis.  He attended the unit from 9 until 3.30, five 

days a week and attended the school.  He was being assessed and treated.  We were 
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keeping constant records of his behaviour on the unit and we were managing him with 
 
behavioural techniques because he was seen as a youngster who would be likely to 
 
respond to that.  We were looking at all possible explanations for his difficult behaviour 
 
and this was thought to be the sort of behaviour that develops in young people who have 
 
not had appropriate environments, appropriate training environments and we were trying 
 
to put that right.   
 


That clearly covers your involvement during the period that Patient C was on the 
 
unit. Had you had some involvement with his care prior to that? 
 

Yes, I had.  I had initially seen him when he was nearly six when his mother 
 
brought him with a variety of complaints that seemed to focus mostly around his 
 
behaviour when we had contact with his father from whom she was separated. So the gist 
 
of that meeting was that this was a younger who was not too bad on the whole but when 
he met his natural father his behaviour was more difficult to manage.  I did not think at 

the time that that met any psychiatric diagnosis and did not think that the child needed 
 
further psychiatric follow up.  The child was then re-referred by the GP about a year later. 
 
 He saw my SHO at that time, she was also unable to make a clear diagnosis.  She did ask 
 
for school reports and then unfortunately she became sick so that there was a considerable 
 
delay before this youngster was seen again because the junior doctor was off sick and  
 
I was taking on her work as well as mine and his next appointment was postponed by a 
couple of months. 

 
 

Did you then see him? 
 

The next time I did see him was in the summer, in the August of 1998, seen for 
 
the second time as an out patient by me in the August of 1998.  Mother was expressing a 
 
lot of discontent about how this boy was getting on at school.  She was not happy about 
 
the feedback she was getting from the school, she was wondering about moving him and I 
did not feel that it was possible to get any proper school information at that time on which 

to base any diagnosis and I postponed my next appointment with him to the end of 
 
September on the basis that I would then have a month’s school assessment to go on as 
 
well as what mum was telling me about him at home.   
 
 
 
My third appointment with him was then at the end of September in 1998 when I did have 
information from the school to say that he was extremely difficult to manage.  I had other 
 
ongoing concern about him at school and at home.  I had the information that, I think, by 

then had been in three different schools.  I felt though that those were criteria for bringing 
 
him as a day patient to have a careful look at him because he was obviously in quite 
 
serious difficulties. 
 
 
 

We have the history you saw him thee times before he came on to the unit as a day 
patient.  Your SHO saw him once before she went off sick? 


That is correct. 
 
 
 

Could I ask you then, returning to the correspondence to which I have already 
 
referred, division four in the bundle, the letter of 29 May, 1999.  I have referred to the 
 
paragraph in the middle of the second page of the letter in which you are mentioned.  
 
Mentioned that you were seeing him and you will see the sentence towards the end of that 
paragraph: 

 
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“I am surprised that not more has been done for this  
 
poor child by the local specialist.”   
 
 
 
What was your response to receiving a copy of this letter from Dr Cosgrove? 
 

I felt hat there were a number of aspects that suggested that Dr Cosgrove had not 
 
understood and been aware of the actual facts of the case and that he had drawn 
conclusions and make disparaging comments the basis of really quite false understanding.  

I also felt from the tone of the letter that he had not even understood that Patient C was a 
 
day patient on a psychiatric unit at the time that he saw him. I thought that if that was the 
 
case that was a rather negligent assessment of a child. 
 
 
 

Can I ask you then to look at page one of division five.  Did you then write this 
 
letter to Dr Cosgrove? 

Yes, I did. 

 
 

There is another letter of that same date, 1 July, 1999 which I would like you to 
 
have a look at.  This is not in the bundle (same handed). 
 
 
 
THE CHAIRMAN: C13 for reference. 
 
 
MR PEARCE:  I am obliged.  Just reading through this letter, if we may, Dr Moses, this 

is a letter we see, the second page of which is a letter from you and on the first page we 
 
see it is to Dr Rackham, the general practitioner, I think, of patient C 
 
A Yes. 
 
 
 

The letter reads: 
 
 
“Dear Dr Rackham, 

 
 
Further to your telephone call this week, C was admitted to Pollards 
 
Well just before Christmas 1998.” 
 
 
 
What is Pollards Well? 

That is the children’s psychiatric unit. 
 
 

Q Yes. 
 
 
 
“He had shown severe behaviour problems at school for some time 
 
and was very disruptive and refusing to work. 
 
 
On the unit it was clear that C’s behaviour was oppositional and that 

he was inclined to be aggressive.  His mood was variable and at 
 
times he would comply with what was being asked but when, in a 
 
less good mood, he presented a considerable difficulty to 
 
management techniques. 
 
 
 
We were managing C by means of behavioural programmes and had 
not felt that drug treatment of this youngster was appropriate.  He 

was not seen as having an Attention Deficit Disorder but rather of 
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having a conduct disorder which we understood partially in terms of 
 
his life experiences. 
 
 
 
Unfortunately, when C’s mother took him to see Dr Cosgrove, staff 
 
felt that their behaviour management of C was entirely undermined.  
 
I could only agree with this, in particular as C’s response on the 
morning after he had seen Dr Cosgrove was to explain the piece of 

aggressive behaviour by saying that he had ADHD, as if this 
 
excused him from any responsibility for his behaviour. 
 
 
 
C was thus discharged from Pollards Well prematurely, in that we 
 
were expecting to work with him until the end of the summer 
 
holiday.  C’s mother was quite happy about his discharge from the 
unit at the time, though I fear that the fact that he has no school 

placement will create difficulties in the future. 
 
 
 
I do not feel able to continue C’s care under the present 
 
circumstances and are therefore discharging him back to you.” 
 
 
 
Can I ask you to explain that letter a little further?  Why was it that you felt no longer 
able to continue with C’s care? 


From my own clinical judgement and that of the whole multi-disciplinary team, it 
 
was not considered that C was suffering from ADHD and so the appropriate treatment for 
 
him would not have included Ritalin or Risperidone.  Dr Cosgrove had put him on both 
 
these medications and it is often not possible to continue being responsible for the care of 
 
the patient if another doctor has started treatment which is at odds with what one’s own 
 
clinical judgement would suggest. 
 


Could we just understand a little further?  Why do you say they were at odds? 
 

It was not that we had not thought of a diagnosis of ADHD.  It would be one of 
 
the things that we would certainly be considering in a difficult youngster, but time and 
 
again C’s behaviour did not show signs of characteristic of a diagnosis of ADHD.  I 
 
would not have felt it appropriate to treat him with these medications.  The basis of our 
management of him was behavioural; we were trying to retrain him, re-educate him, in 
 
appropriate social behaviours and children do not necessarily take the attitude that C took 

that “It’s not my fault”.  This lad had already been very much in the habit of refusing to 
 
take responsibility for his actions so that the medication was not only counter to what I 
 
thought was appropriate but it also made it virtually impossible to proceed with our own 
 
measures because he simply said “It’s nothing to do with me.  I’ve got ADHD, 
 
behavioural management is nothing to do with me.  I can’t help it”. 
 


I follow.  Could I then refer you, if I might, to pages 2 to 4 of division 5 in the 
 
bundle?  The letter dated 7 July from Dr Cosgrove to you, Dr Moses:  I think you are 
 
familiar with the contents of this letter, is that right? 
 
A Yes. 
 
 
 

I read this letter out in full to the Committee yesterday and there is no need to do 
it again now, but there are certain points in it I would like to take you to if I can.  First of 

all, in general terms what was your reaction to receiving this letter? 
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I was surprised and I was very taken back that any doctor could write what 
 
I thought was such a wholly unprofessional jeering letter to another doctor.  I was 
 
extremely upset to see that he had sent copies of it not only to the GP but also to the 
 
mother and dad of patient C, because that was, to me, totally counter to what I thought 
 
was appropriate medical behaviour.  My understand had always been that however much 
 
one disagrees with the views or management of another colleague that it is not 
appropriate to ridicule and disparage that colleague by including them in any letters to the 

patient or patient’s parents.  I was very taken aback by it and that is why I drew it to the 
 
attention of the GMC. 
 
 
 

I understand.  In point of fact, when did you draw it to the attention of the GMC, 
 
do you recall? 
 

I believe it was initially in 1999.  Sorry, I have not got a chronology here.  It was 
2 August 1999 initially, although I did not couch that formally as a complaint, I had 

assumed that one could ask the GMC for a sort of informal ruling and so I sent them the 
 
letter and said I was unhappy about this. 
 
 
 

It is my fault for leading you into this area.  We know that one way and another 
 
the Committee, from their general dealings in cases such as this and from some of the 
 
evidence that was heard in January of this case, know a lot about complaints proceedings 
and what goes on, but I simply wanted to ascertain when it was you first complained to 

the GMC and you say it was 2 August? 
 
A Yes. 
 
 
 

I am obliged.  Taking you back to the letter, just taking you to some specific parts 
 
of it.  On the first page of the letter, the page with the number 2 at the bottom of it, 
 
halfway down: 
 

“In regard to 1)” 
 
 
 
which is: 
 
 
 
“I did not elicit the fact that L was a day patient on your Children’s 
Psychiatric Unit”, 
 
 

“I was told by the GP, Dr J P Rackham, that C ‘has been under the 
 
care of Dr Karen Moses at St Cadoc’s Hospital’.  Put like that it 
 
could mean that he has been under your care but he is no longer.  
 
But anyhow, even if C was still under your care, the GP is entitled to 
 
ask for a second opinion and hence he states at the end of his referral 
letter to me:  ‘I would be grateful for your opinion”. 

 
 
Just so that we understand that, were you complaining that the general practitioner was 
 
asking for a second opinion?  Was that the complaint you were meaning to make, or the 
 
comment you were meaning to make? 
 

It was part of it.  I did not feel and I do not feel that it is appropriate for a GP to 
 
refer a patient to a second consultant when they are already under one consultant.  It does 
happen, but it is not good practice.  It seems even more bad practice when that patient is 

not just under outpatient care but he is in a day patient unit under the care of a team. 
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Moving on in the letter: 
 
 
 
“When I met Mr & Mrs C (C’s parents) I was told that C had been 
 
attending St Cadoc’s Hospital five days per week since November 
 
1998.” 
 

I think that would be right, would it? 
 
A Yes. 
 
 
 
Q Reading 
on: 
 
 
 
“I was also told that in the time of some six months, you had seen C 
only once.” 

 
 
Was that correct? 
 

No, that was not correct.  I would see the children on the unit informally quite 
 
frequently.  I do not know what that “once” refers to.  We had two other sorts of 
 
involvement with the children:  one was monthly reviews, which involved the families, at 
 
which I was sometimes present but sometimes it was left to the senior nursing staff or the 
junior doctors; the other was weekly team meetings, at which I was usually present, when 

we discussed the children but we did not bring them in – we do not have that practice. 
 
 
 

So C’s parents may not have known of all your involvement? 
 

They might not have known that, and I think one might have assumed that the one 
 
review which they attended that I was in was the only time that I saw him. 
 
 

Would they have known that you saw C informally? 


No, they would not. 
 
 
 

And you say that was with some frequency; approximately with what kind of 
 
frequency would you see the child? 
 

Weekly.  I would be on the unit a couple of times a week and in the school and the 
children would be about, and it was a small number – there were only about 12 children – 
 
so that one was aware and would see and be aware of them quite readily. 

 
 

Thank you.  Moving on in the same paragraph: 
 
 
 
“You had told his parents that you were going to prescribe a sleeping 
 
tablet at night for C.  This never happened!  You neither prescribed 
this medication you had promised nor did you explain to his parents 

why you had changed your mind and were longer going to prescribe 
 
it.” 
 
 
 

That is completely untrue for me, but I note in one of the review meetings that the 
 
person that led the review had queried sleep problems and medication, but I am afraid 
 
I cannot make out from the signature whether that was a senior nurse or a junior doctor.  
It would have been a review that I was not present at myself. 

 
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Had you yourself at any stage had any dealings with the issue of sleep? 
 

No, I did not. 
 
 
 

We see some comments about the sources of Dr Cosgrove’s information and the 
 
relevance of that at the bottom of page 2.  At the top of page 3 he said that he knew he 
 
was a day patient on your unit.  He goes in that first full paragraph at the top of page 3 to 
day: 

 
 
He had been there for six months; you had seen him only once” 
 
 
 
- you have dealt with that - 
 
 
 
“and he was getting worse and worse when he should have been 
getting better and better.” 

 
 
Can we deal with that sentence in two parts?  First of all, was he getting worse and 
 
worse? 
 

No, he was not getting worse.  I have looked very carefully at the nursing notes 
 
and he was very variable.  He would have several good days and he would have times 
 
when he was every bit as difficult in March as he had been in November.  But the general 
trend was that the nurses felt they were beginning to bring his behaviour under better 

control, and one of the things that would happen on the unit was that if a child was simply 
 
getting worse and worse the nursing staff would bring that to attention because they were 
 
certainly not happy to proceed with that sort of situation.  One of the best indicators of 
 
how a child was doing was or should have been was how often he got sent home, and 
 
I note that C was sent home from the unit a couple of times early on but I do not see any 
 
notes of that later on his admission.  So I would say he certainly was not getting worse 
but his behaviour was variable but that overall there was a trend to its improvement. 

 
 

The second half of what I was going to ask you was, is it right to say he should 
 
have been getting better and better? 
 

Well, there is no basis to say that as many children with conduct problems do 
 
quite badly even on a unit such as ours.  It was certainly not possible to deal with all the 
children with conduct problems.  What the child has already learned and the child’s 
 
current family environment and the general environment would play a bit part and we 

certainly did not ever suggest that, nor would any other child psychiatric unit suggest that 
 
they are going to improve every child with a conduct disorder. 
 
 
 

Carrying on into the next paragraph, references this “You are unhappy about my 
 
intervention with this boy”.  I think you have explained why you were unhappy and there 
is no need to go over that.  But the third sentence of that paragraph: 

 
 
“After all you told the parents that you agreed with C being 
 
prescribed Ritalin.” 
 
 
 
Was that correct? 
 

I am not sure where you are. 
 


I am sorry, it is the second full paragraph, the third sentence of that: 
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“After all you told the parents that you agreed with C being 
 
prescribed Ritalin.” 
 
 
 

I most definitely did not and nor did anyone else from the service, as far as I can 
 
see.  There was no occasion for them to have been told that by anyone from our service. 
 


The next sentence: 
 
 
 
“If you agreed with the prescription of Ritalin, why did you not 
 
prescribe it for him…” 
 
 
 
And I think you have explained what your management was.  The next two paragraphs 
deal with why you should be joyful and happy because his condition had improved 

following the prescription of Ritalin.  Did you have any first-hand knowledge of what C’s 
 
condition was after he left, after he stopped staying in the unit and was discharged from 
 
your care? 
 

No, I did not. 
 
 
 

Taking you to the bottom of page 3, the next paragraph of that page: 
 

“As regards 3), you are most unhappy with my false assumption that 
 
‘not more has been done for this poor child by the local specialist’.  
 
You first saw C when he was 5 years old when he was not eating, 
 
was thin, was having frequent tempers and when the parents were 
 
being called into school on a weekly basis.” 
 
 
First of all, that would correspond in age terms with the time of the first attendance; you 

said nearly 6 for his first attendance? 
 
A Yes. 
 
 
 

So he would have been 5? 
 
A Yes. 
 
 

Do you agree with the description that is given there: 

 
 
“Not eating, thin, frequent tempers, parents being called 
 
into school on a weekly basis”? 
 

Some of it but not all.  Would it help if I... 
 
 
Q Yes. 
 


It was mentioned that there were problems with eating, which mother told me she 
 
thought was probably due to the fact that his father had been in the habit of throttling him 
 
when he would not eat before.  When she actually came to me, this was not a problem and 
 
as I have said at the beginning, what mum was thinking was, to me, that his behaviour 
 
was difficult was after he had had visits to his natural father and it sounded, that was the 
 
main gist of that, that it sounded like an issue over contact which mum had about the boy. 
 


It is said that you made no diagnosis.  Is that correct? 
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That is right and that is used in this sort of critical way, but it is perfectly valid to 
 
make no diagnosis if there is none to be made.  
 
 
 

It is said that you did nothing that actually resulted in alleviation of this child’s 
 
malfunctioning? 
 

That is also right and the degree of his malfunctioning was not at all clear and not 
at all very marked.  I thought at that first appointment, it is not unusual to have a parent 

come who wants to do something about contact between their child and the estranged 
 
parent and it read very much like that sort of situation, where I was being told that this 
 
child was functioning badly after contact and that that was the issue. 
 
 
 

You saw him again when he was six years old and had one half hour’s talk with 
 
C’s mother.  If that is the second visit, would he have been six when you saw him the 
second time? 


Yes, I think he was six, yes.  
 
 
 

When he saw the SHO or when he saw you? 
 

Yes, this was April 1998, actually, that he was seen by the SHO. 
 
 
 

His date of birth is 27 July 1990? 
A Yes. 
 

 
 

We can look at it I the original - I know it has been crossed out but you can look 
 
at the records if needs be.  That would be that he was seven then, you say, in April 1998 
 
and that was which attendance, sorry? 
 

That was the second attendance.  
 
 

When he saw you?  The second time he saw you? 


The second time he saw me was August, I think, August 1998.  
 
 
 

There is reference to that being a one half hour’s talk.  Assuming it was his second 
 
consultation with you, would half an hour be a reasonable estimate of the length of it? 
 

Yes, it would.  It was a follow-up, really, for what should have been a follow-up 
by the SHO and that would very likely have been half an hour. 
 
 


There was a similar meeting, it is said, when he was seven years of age, so you 
 
had seen his mother three times in four years.  It was September, you said? 
 

That is correct.  
 
 
 

The third meeting, so he would have been seven then.   “What did you actually 
achieve by these three meetings?” asks Dr Cosgrove.  I think you have described that to 

us already.  I do not know whether you feel that you can add to what you have said? 
 

I feel that the nature of child psychiatry work is that one often achieves part of an 
 
assessment at a meeting and these had been three rather disparate meetings.  The first one 
 
was discontinuous with the others.  The second was a follow-up of the session that my 
 
SHO had started.  To do anything about him at that time would have needed school 
 
reports and assessments which were not available in the summer and so I waited until the 
third one, when they were available, when I took a measure which was already quite 

extreme and there are only, as I say there are only about twelve spaces there, I admitted 
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him to one of twelve spaces in Gwent because I could see that there were serious 
 
problems but I did not think they were problems to be diagnosed or to be giving 
 
medication to on an outpatient basis without further assessments. 
 
 
 

I see.  Moving on to the next page, the top paragraph, Dr Cosgrove says 
 
something about C’s behaviour at school and the fact that he was expelled from Durand’s 
Primary School after one month because of violence to other children.  The last sentence 

of this paragraph says: 
 
 
 
“Nothing you did or said on those occasions” 
 
 
 
- the times you saw him - 
 
 
“prevented his behaviour causing him to be asked to leave from 

two schools last year and from being admitted to St Cadoc’s.” 
 
 
 
It rather follows from what you say that you would essentially accept that and certainly 
 
you would not say it was a criticism? 
 

That is correct.  It is very often the case that one cannot put all these things right.  
 
It is quite mistaken to assume that if a child is going on having problems, that can be 
attributed to lack of appropriate help.  Sometimes it is not possible to do anything and he 

was still being assessed. 
 
 
 

The next paragraph I do not need to ask you to comment on.  You have 
 
commented on the matters relevant to that already.  Finally though, in what is the 
 
penultimate paragraph of this page, he says this: 
 
 
“I note that your letter is headed in bold, black capital letters 

‘Restricted and Confidential Information.’  You are a public 
 
servant being paid by public monies and employed in a public 
 
service. You are, therefore, publicly accountable and I will not 
 
have correspondence going between you and me that disallows 
 
the parents from knowing what is being said about them and their 
son, C.  I have ignored this restriction by quoting verbatim from 
 
your letter and by sending a copy of this my letter to you and to 

Mr and Mrs C and to Dr Rackham.” 
 
 
 
You have commented already about the letter being sent to the general practitioner and to 
 
the parents but can you explain why it was that your letter was, indeed, as we can see, 
 
headed in bold capitals, ‘Restricted and Confidential Information’? 

Because that is the practice in the Trust for which I was working then and the 

practice in the majority of similar Trusts.  It was not of my doing.  I would agree with it 
 
but it certainly was not of my doing and it would have been very difficult to have altered 
 
that. 
 
 
 

Why this particular letter?  Presumably not all letters are so headed? 
 

Yes, they are. 
 


They are?  It is a standard heading? 
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Yes, it is a standard heading. 
 
 
 

Nothing about its contents was relevant to the heading? 
 
A No. 
 
 
 
 
MR PEARCE: I understand.  Thank you.  I have no further questions for you, Dr Moses.  
Mr Morris on behalf of Dr Cosgrove may have. 

 
 
Cross-examined by MR MORRIS: 
 
 
 

Dr Moses, would you agree that it would appear from this letter of Dr Cosgrove’s 
 
which caused you to complain to the General Medical Council, it was effectively Dr 
 
Cosgrove being an advocate for the parents and reporting to you what he had been told by 
the parents, or the mother, perhaps? 


Are you referring to the one on Section 5? 
 
 
 

The 7 July 1999 letter, yes? 
 

No, I do not believe that this was in any way his being an advocate for the parents. 
 
 If felt that this was him having a very aggressive go at me for simply telling him that I 
 
was not entirely happy about what he had said and my relatively mild rebuke. 
 


Obviously his criticisms of you are one thing but as far as the facts of the matter 
 
are concerned, it would appear that he was reciting what he would have been told by the 
 
parents, would it not? 
 

In the first letter, certainly.  
 
 
 

Certainly in the first letter? 
A Yes. 
 

 
 

I just want to look at little closer at the history of the child during this period and 
 
see how accurate or not the parents’ recollection was and also to look at the issue of signs 
 
and symptoms of attention deficit hyperactivity disorder.  I have had copied some of the 
 
entries - not all - in the child’s notes and I would like you to have a copy.  
 
 
THE CHAIRMAN:  This  will be D29.  (Produced

 
 
MR MORRIS:  I am afraid, doctor, that we do not have these notes in chronological 
 
order, so we are going to have to skip around between pages.  The pagination is at the 
 
bottom right.  There are gaps in the pagination but at least the pagination follows in 
 
sequence.  77, the second page.  This is a consultation.  Is this your writing? 

It is, yes. 

 
 

I think this is when you saw the child on 11 July 1996 when, as you say, he was 
 
five, nearly six.  If we look at the bottom of the first page, there was a report from the 
 
school: 
 
 
 
“Seen not to concentrate, slow progress” 
 

- please correct me if I get your writing wrong - 
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“But does not seem to be a major management problem.  Some 
 
aggression at school with others, doesn’t get on very well with 
 
other people.” 
 
 
 
Over the page, 78:  
 

“Has pleasant times but can be very irritable and then 
 
aggressive”? 
 
A Yes. 
 
 
 
 

I think you wrote a letter following that to the general practitioner and we see that 
 
at page 148, 1 August 1996.  You set out what you had recorded in your clinic notes.  The 
second paragraph: 

 
 
“As far as school is concerned C is thought to have problems with 
 
concentration and can be aggressive to other children.  Not seen 
 
as a major problem.” 
 
 
 
The final paragraph on the next page, you bring up the discussion you have had about the 
question of contact with the father and concluded that you did not see any other remit for 

 child psychiatric intervention? 
 
A Yes. 
 
 
 

And had not arranged for any follow-up.  He is being referred back, if we look 
 
back to page 147, by his general practitioner to the service in March 1998 and he sees, I 
 
think you said, your Registrar.  If we look at 144 and 145 there is a letter from Dr Napier, 
your Registrar? 

A Yes. 
 
 
 
 

Is that to whom you are referring? 
 

Yes, it is. 
 
 

Then at that time the complaint was the mother, of difficult behaviour and 
 
overactivity and in the background a history of aggression and disruption, being quite 

destructive both to himself and to material possessions:   
 
 
 
“Things are also difficult at school.  He is disobedient in class and 
 
disruptive and does not work, either in class or do his homework. 
 
 His mother says he is very restless and is unable to watch a video 
all the way through or to concentrate and play on computer 

games. His mother feels he is constantly seeking her attention.” 
 
 
 
The inability to concentrate and the restlessness, those would be signs of attention deficit 
 
hyperactivity disorder, would they not? 
 

I think that is exactly where one of the huge difficulties here lies, that inactivity 
 
and recklessness are very general behaviours that are present in large numbers of 
children, particularly at quite young ages and what underlies them and how constant they 

are is very critical in deciding whether you give the child a diagnosis of ADHD or 
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whether you understand the restlessness and activity in some other way. 
 
 
 
Children who have had a very disturbed background, as this young lad had, may well be 
 
overactive and restless for reasons other than that they have ADHD.  It is one of the 
 
difficulties that causes confusion for parents, because they will read in magazines that 
 
restless, overactive children have got ADHD and can be helped with medication and if we 
treated everybody, every child who was restless and overactive with medication, we 

would have 10%, 20% of children on medication, which generally people would agree is 
 
inappropriate.   
 
 
 
The difficulty here is that one is using a very general term and then actually using it also 
 
to make a specific medical diagnosis which warrants medication.  So, even on Dr 
 
Napier’s description where she mentions concentration, it would be quite wrong to 
conclude from that that this child has ADHD.  It may be quite appropriate to look a bit 

more carefully, to keep an eye on him at school.  It would be appropriate to give the 
 
school a questionnaire to do to see how he rates on a whole specific block of questions 
 
about behaviour related to ADHD, but it would be wrong to conclude ADHD from that 
 
description. 
 
 
 

Let us continue.  Going through the report under “Schooling” on page 145: 
 

“As mentioned previously C is disruptive and disobedient.  His 
 
teacher feels that he is below average ability and he is due to see 
 
the Educational Psychologist. 
 
 
 
Development” 
 
 
- a description of the pregnancy -  

 
 
“ He was born normally and achieved his milestones when 
 
expected.  C was co-operative but fidgety and restless.” 
 
 
 
That would have been a description of him at the consultation, would it not? 

Yes.  It is put rather oddly there but it does look as though it is from what follows. 
 
 

Q The 
plan: 
 
 
 
“In Summary 
 
 
 
C is an eight-year old boy who has behaviour difficulties and 
finds his emotional problems superimposed on a difficult family 

background.  He is also overactive and appears to have quite poor 
 
concentration.  I plan to request a school report…” 
 
 
 
I think you then said that there was a hiatus because of your Registrar’s illness and if we 
 
go to 139, Dr Napier confirmed that in July 1998 and effectively passes the care of C to 
 
you? 

Yes.  You will notice that that letter doing that is a letter to mother’s solicitors 

because it was the solicitors at that point who were, if you like, trying to get some 
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movement because they wanted a report relating to this boy’s contact with his father. 
 
 
 

Right.  Then I think you see him for follow-up and I think we have your report of 
 
that at 134 and 135? 
 

Yes.  Can I mention paragraph 2 there, which is in error. 
 
 

You want to mention paragraph 2? 


Paragraph 2 is in error because I have looked back at the notes and I have said in 
 
paragraph 2 that mum said that she had considered transferring C to Mounton House 
 
School.  It was actually teaching staff who had considered that.  Mounton House School 
 
is a residential school for children with difficult behaviour and mum had already said to 
 
me in a previous meeting that she did not want him at Mounton House and it was the 
 
teacher who had said that, not mum. 
 


She was dead against that? 
 

She did not want that, yes.  
 
 
 

You concluded that letter by saying that you had: 
 
 
 
“…difficulty in pinpointing the issues here, together with C’s 
imminent move of school I thought the most appropriate thing 

would be to ask for a school report… and review towards the end 
 
of September.” 
 
 
 
We see, I think, your notes at page 66, the first page of this bundle.  You mention a 
 
telephone call to the school.  Is that 24 or 29 September? 
 

24, I think. 
 

Q 24 
September. 
 
 
 

Was that at the school’s request that you telephoned or was it--- 
 

No, at mother’s request.  She got in touch with the secretary to say there were 
 
problems. 
 
 

The problems were, if you can help us with what she had noted there: 

 
 
“In school - 3 days  
 
Then holiday for 1week.   
 
Since then major problems.   
 
He just won't do anything.   
 

Class of 34. He tries to disrupt entire class.   
 
Howls, bangs his head and breaks things. 
 
Was aggressive and rude at St Mary's 
 
But he had done some work there. 
 
Is above average IQ?”   
 
 
And how does the note continue? 

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It says that the only time he will work is if it is before lunch and the teacher 
 
insists, i.e., “You can't go to lunch until you finish this piece of work”, then he would do 
 
his work. 
 
 
 

“SN”? Special needs? 
 
A Yes. 
 

Q  
 
 
 
“…option to be pursued”? 
 
 
 
A Yes. 
 
 
Q  

 
 
“She feels place at”? 
 
 
 

That is Mounton House. 
 
 
 
Q  
 

“Would be best.”  
 
 
 
Who does “she” refer to? 
 

This is the teacher, Mrs Edwards. 
 
 
 

I think the plan is that you are going to see the child on the 30th? 

Yes, that is correct. 

 
 

Then if we go to 131, report of your consultation appears to have been on the 29th 
 
and you recite your telephone call there, do you not, with the teacher, experiencing major 
 
problems, refusal to do any work, disruption of classes, etcetera.  Then in the third 
 
paragraph you set out mother’s problem: 
 
 
“Although she experiences difficulties with C at home these are not at all 

on the scale of the difficult behaviour he shows at school.  …mother 
 
brought along some of C’s school work, and it does seem that he has a 
 
rather variable range of abilities.”   
 
 
 
So it appears from what the school were saying that he was above normal IQ but not 
performing to that level of intelligence? 


Interestingly that contradicts a previous school view, which was that he was of 
 
low ability. 
 
The most likely conclusion one would draw from that was that he has rather mixed 
 
abilities and as with a lot of youngsters their verbal intelligence, or to participate orally is 
 
much better than their written work and that causes confusion and emotional difficulties. 
 
 

You decide that because of these serious problems he should come in for 

assessment to Pollard Well? 
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Yes, that is right. 
 
 
 

We see the internal referral, page 119, I believe that is signed by you: 
 
 
 
“Description  of main problem: 
 
 
Mainly severe behaviour problems at school – Disruptive,  

refuses to work  -‘howls’, probably a learning difficult  
 
issue with behaviour secondary.   
 
 
 
Specific goals/aims: 
 
 
 
For assessment – general, educational 
As clear cognitive valuation as we can.”   

 
 
Then I think his first day at Pollard's Well, to get the exact date, if we look at 186, the 
 
nursing notes, 3 November, it may be 13, you have the originals there? 
 

No, no, I do not have the originals.   
 
 
 

Sorry.  I do not know if you your copy would assist any further as to whether that 
is 13 or 3 November? 


No, it does not. 
 
 
 

Some time in November he attends and that looks like the first day.  The second is 
 
the  following entry, 4.11.98, and you say that you would have seen the child on an 
 
informal basis from time to time during his stay there? 
 
A Yes. 
 


But did you make any notes of your view of the child--- 
 
A No. 
 
 
 

---during the informal viewings? 
 

No, that would not be normal.  What this was was very much a multi-disciplinary 
assessment to which everyone contributed and the notes that were made would have been 
 
ward round notes mostly and teaching notes, he would have spent essentially all his time 

in the school classroom with the teachers. 
 
 
 

While he was there you were asked by mother’s solicitors to write a report and 
 
you delegated that to one of the senior nurses there, Mrs Pope.  I am sorry, I am looking 
 
at page 128? 

Yes, I tried to and Mr Pope agreed to do that but he was then informed by the 

hierarchy that he could not do so, so it was I who wrote the brief report in the end. 
 
 
 

In writing that report you comment:  
 
 
 
“My own reporting on C, of course, depends on  
 
the observations of number of other staff on the unit”? 
 

A Yes. 
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So you were not able to rely on your own observations in relation to making that 
 
report? 
 
A No. 
 
 
 

So would it be fair to say you would not have seen anything of any clinical 
significance in your informal tour of the units? 


I think it is very difficult to see behaviour disorders in the course of small 
 
contacts.  Where you see them is when you are in continuing contact with the children 
 
and it is inevitably the nursing staff and the teaching staff who have that contact.  That is 
 
the part of the purpose of independent (Inaudible) like this is that at least somebody of a 
 
trained professional nature does get sort of exposure to the child which will allow them to 
 
draw some conclusions.  Otherwise my position is almost always that I am working only 
on other people's observations.  With this sort of a diagnosis I do sometimes see children 

who are very obviously ADHD, who one can see that when sitting with them for half a an 
 
hour.  But it is much more often the case that what is observed is in the course of the day 
 
and I would not see that, no. 
 
 
 

Then if we go to page 127, this is a home visit carried out by Staff Nurse Pope,  
 
I do not want to go into the detail of it, but the final paragraph the nurse comes out with 
his suggestions: 

 
 
“Suggested that boundaries is need to be far more consistent, as this would 
 
give C a sense of security.  Also suggest that uproar in C’s life may have 
 
caused him to have quite low self-esteem. To this end it was agreed  that 
 
appropriate praise should be given.  The suggestion was made that C may 
 
benefit from a behavioural programme and after this was agreed to by 
mother it was fully explained it would begin on 8 February 1999.  The 

overall impression was that of a family struggling with a difficult boy and 
 
in desperate need of guidance.”  
 
 
 
So difficulties still persisting as in February 1999? 
 
A Yes. 
 
 

Then can I take you to the part of the nursing assessment at 115.  There are a 

number of elements of this, I have picked out this one under cognitive development.  Just 
 
help us with this, the actual assessment is the top box, is it, then commentary at various 
 
intervals? 
 
A Yes. 
 
 

And the only row that it is marked is in relation to play: 

 
 
“Play is chaotic 
 
 5 4 3 2 1”  
 
 
 
Which way does the spectrum go? Can you help us with that, Dr Moses? 
 

It is an unusual way to do this.  Usually it goes, one would be the least chaotic, so 
that four is on the high end.   

 
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Then other side of that row: 
 
 
 
“Follows a task through from start to finish.”   
 
 
 
This is in the “Assessment Score +” column:   
 
 
“1 2 3 4 5”,   

 
 
again, how should we read that? 
 

Again, that he does not score very highly on that.  I think they have done it this 
 
way so that the minus scores will be -- so that the joint score will make more sense. 
 
 
 

Then looking at the nursing commentary, there appears to be a divergence on 
dates, on the one month comments box we actually have the date of the nurse’s signature 

as 4 March 1999, which would be at least three months after he had arrived on the unit. 
 
That would be correct, would it not? 
 
A Yes. 
 
 
 
Q  
 
 
“C’s play again shows a quite erratic pattern depending on his mood. He 

either plays well and enjoys it, or is completely obstructive.  He appears to 
 
have no coping mechanisms to control his behaviour.”   
 
 
 
Then a subsequent comment, and we do not know when that was, but presumably some 
 
time after 4 March, from another nurse: 
 
 
“C likes to take the lead. When things don't go his way becomes 

completely disruptive, disrupts the whole group.”   
 
 
 
If I can take you to over to page 118, which is another report from the Staff Nurse Pope, 
 
this is a request is it not for assistance to be given to the mother by social services? 
 

Yes, I believe it is. 
 
 

Unfortunately it does not appear that this letter is dated.   

 
 
THE CHAIRMAN: Dated 27.7.90? 
 
 
 
MR MORRIS: I believe that is the date of birth, is it not, Dr Moses? 
 
A Yes. 
 

Q Final 
paragraph: 
 
 
 
“Present home situation is very difficult as mum has quite a severe illness 
 
and is finding almost impossible to cope with C’s increasingly problematic 
 
behaviour. Obvious we at Pollard’s Well are doing what we can, but we 
 
are limited as regards both timescale and resources and I would be grateful 
if you could contact me regarding this.”   

 
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I do not know whether you can tell from the position of this letter in the notes as to when 
 
that might have been written? 
 

I believe it was quite late after Mr Pope’s home visit to the family. 
 
 
 

I was going to make that suggestion.  It would probably have been after that visit. 
 
 We know that was February.  Would it be fair to say, having run through those extracts 
from the notes, Dr Moses, that your staff at Pollard's Well were not having much luck 

with this boy in terms of treating him? 
 

Yes, I think we certainly had not by any means sorted this problem, but I would 
 
emphasise that it is not at all unusual with children with marked conduct problems.  We 
 
never suggested that we were a unit who could admit these children and put them right.  
 
What we felt was important was to do a good assessment, make sure there was nothing 
 
treatable being missed and do our best with behavioural methods and help the family, but 
that sometimes we would fail and that was not peculiar to the unit that I worked in then. 

 
 

Can I suggest that by this time, given the factors that we know about in this 
 
child’s history, the possibilities of ADHD and the need to consider medication should 
 
have arisen within the teams consciousness? 
 

Yes, it certainly would have done.  We had quite number of youngsters through 
 
the unit who would be seen as exactly that, as having ADHD, and we would use the 
admission to get them on to treatment and assess their responses.  That is why I 

mentioned this was not an oversight.  It was not that nobody thought about it.  It was that 
 
he did not present with the sort of symptom profile that would make this a likely 
 
diagnosis. 
 
 
 

I think you said that time and again he was not showing signs of ADHD? 
 

Yes, that is right. 
 


Is that right doctor? 
 
A Yes. 
 
 
 

Can I put this scenario to you and see what you say to it in this context, that there 
 
is an early onset and highly persistent pattern of poor behaviour, poor academic process 
in the school, in spite of a normal intellect, an account from the mother of being very 
 
restless, nursing reports and observations that he was chaotic in his play, unable to 

control his temper, rather than using it to obtain desired ends.  All those factors would 
 
suggest a possible diagnosis of ADHD, would they not? 
 

They are not specific factors and they are not very much pointing towards ADHD. 
 
 If you notice throughout the observations, C was at times able to concentrate.  I said he 
 
varied a great deal – he would have days or several days when he would concentrate, he 
would follow the rules, and then he would appear to be in a different mental state – he 

was more restless, more irritable, far more provocative, far less easy to control, and that 
 
very variable picture is very much not consistent with ADHD.  Children with ADHD are 
 
not able to concentrate/settle and they do not have very good days.  This lad did have 
 
some very good days.  When he first came in, interestingly, he presented very little 
 
problem for a while; he was quite manageable.  The schoolteachers, who were 
 
enormously experienced with ADHD, never saw his key problem as being attention 
deficit disorder.  I think there are a lot of children who are disturbed who also do not 

attend very well and do not concentrate, being very anxious, being upset, being 
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emotionally upset, and/or being unable to do with work, all upset concentration, but that 
 
does not allow one to make a diagnosis of ADHD and it certainly would not mean that the 
 
child should be treated with stimulants. 
 
 
 
MR MORRIS:  Thank you very much.   
 
 
MR PEARCE:  I have no questions. 

 
 
THE CHAIRMAN:  There are no questions from the Committee, so that concludes your 
 
evidence, Dr Moses.  Thank you very much for coming to assist us. 
 
 
 
(The witness withdrew) 
 
 
THE CHAIRMAN:  Could I suggest we have a break and reconvene at 11.35? 

 
 
MR PEARCE:  Yes.  You will hear the hesitation in my voice, and the hesitation is this.  
 
We have four witnesses lined up to give oral evidence this morning, with the plan being 
 
two this morning and two this afternoon.  We will make investigations as to when the two 
 
this afternoon are here; they are from Cardiff, I think, both.  They may be on their way; if 
 
they are already here, clearly we will go into that evidence.  If they are not, we will let 
you know what the position appears to be at 11.30. 

 
 
Can I say this?  I do not know what my learned friend thinks but I am increasingly 
 
confident that we will finish that oral evidence today. 
 
 
 
THE CHAIRMAN:  There may be good reasons but I think it is unfortunate that the 
 
witnesses are not here, knowing that they were to give evidence today – and I fully accept 
the unpredictability of the timing.  I seems to have been a pattern of this hearing and the 

previous hearing that we do not seem to be able to utilise our time totally effectively.  But 
 
if they are not here, they are not here and we cannot proceed.  Do you have any 
 
information about the witness who was being called at the beginning of the week? 
 
 
 
MR PEARCE:  Yes, we can work out her attendance so that that is on Tuesday morning. 
 
 
THE CHAIRMAN:  That is very good.  Could I also suggest at this point, in that case, a 

10 o’clock or 10.30 start if she is the only witness? 
 
 
 
MR PEARCE:  She will not be the only witness on Tuesday, as I understand it.  I think 
 
my learned friend is going to call two witnesses on that day as well. 
 
 
THE CHAIRMAN:  So we will aim to start at 9.30 then. 

 
 
MR PEARCE:  I think Tuesday will in fact be a useful day. 
 
 
 
THE CHAIRMAN:  It certainly sounds as though it is going to be a fuller day than it did 
 
at one point – it looked as if it was going to be an empty day.  That is fine.  So we are 
 
working on Monday being blank, the chances are we will finish the two witnesses today, 
so Friday is almost certainly a blank and Tuesday will be a 9.30 start. 

 
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We will have an indeterminate break at the moment.  Thank you. 
 
 
 
(The Committee adjourned for a short time) 
 
 
 
(The Committee adjourned for lunch)        
 
 
MR PEARCE:  Sir, thank you.  May I apologise that we start significantly later than 

I hoped we would be able to.  Dr Thomas and Dr Dolben are both here.  One of the 
 
reasons we have been delayed, for which I apologise, is that an issue has arisen about the 
 
medical records of patient A.  The position, as I follow it, is this, that my learned friend 
 
seeks to see those records, not necessarily in order to cross-examine but seeks to see the 
 
records for that patient from the hospital, from the Trust.  In December of last year the 
 
solicitors acting for Dr Cosgrove requested sight of those records.  At that stage, those 
acting for the Council were seeking to obtain consent from the patient.  Consent was not 

obtained, in the sense that there was no response from the patient, but it seems, to be 
 
frank with you, that both sides overlooked this point at the last hearing because the 
 
position in fact is not that dissimilar to what it was with patient A, in respect of which, of 
 
course, there was an abuse of process argument due to the non-availability or issues of 
 
consent relating to those records. 
 
 
The way I put the matter to my learned friend today is this – I think he is content to 

proceed for the moment (he will speak for himself); I think he is content to proceed with 
 
the witness for the moment.  What we will do in respect of this patient is to seek 
 
authorisation under the Medical Act which will permit us to obtain records without 
 
consent, and we will then provide them to my learned friend and, if necessary, seek to put 
 
them before the Committee – with, of course, the proviso, which you will recall from the 
last occasion that under Regulation 50 you might wish to indicate that you were happy to 
 
receive the documents notwithstanding the lack of consent.  You will remember that this 

was an issue in respect of patient A last time. 
 
 
 
I addressed you at length; I do not think there is any issue on the law here.  I cited 
 
authorities on the last occasion that said that it was, in most cases, strongly in the public 
 
interest for your disciplinary Committee to proceed with this Inquiry rather than have, as 
it were, stay proceedings where consent is not available to have sight of the medical 
 
records.  So I would repeat that for those reasons, in my submission, you ought to give an 

indication that you would happy to receive the records in evidence and, if so, we will seek 
 
that authority and seek to get those medical records just as soon as possible, and certainly 
 
we are hoping for Tuesday of next week.  Some people tell me I am overly optimistic.  If 
 
the records are not available next week then, of course, applications may follow from that 
 
or parties may have to take a different position.  I think my learned friend is perfectly 
entitled to reserve his position as to whether, for example, it would constitute an abuse of 

process to continue with that charge if the records are not available. 
 
 
 
THE CHAIRMAN:  Thank you very much.  I do recall that we actually referred to this 
 
issue in the determination in January, so I assume that that point was not picked up. 
 
 
 
MR PEARCE:  It was not picked up in respect of this patient.  We dealt with patient A on 
precisely the same point.  It was not picked up with patient F.  I am told my learned friend 

would seek to see patient H’s records, which fall into exactly the same category as 
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patient F with the exception that in fact his instructing solicitors have never requested 
 
them from us, but we are in the same position – that we do not have consent – so, equally, 
 
if my learned friend seeks to see those records we will follow the same course of action in 
 
seeking to obtain those for next week. 
 
 
 
THE CHAIRMAN:  Mr Morris. 
 

MR MORRIS:  Sir, I am in virtual agreement with my learned friend.  It was not an 
 
oversight on the part of the defence team not to include a submission in relation to patient 
 
F or, indeed, patient H on the last occasion because at that stage our understanding was 
 
that consent might have been granted or refused.  I just quote from a letter from Field 
 
Fisher Waterhouse to those instructing me dated 8 January 2004, where they say in 
 
relation to patient F that they have written a chasing letter to the patient in relation to the 
issue of consent and, in relation to patient H, that they were awaiting a response to the 

request for consent.  Obviously, had consent been formally refused I have no doubt I 
 
would have added those heads of charge in relation to the submission I made in relation 
 
to patient A. 
 
 
 
THE CHAIRMAN:  Thank you very much. 
 
 
MR MORRIS:  I confirm that I am happy that Dr Thomas gives evidence this afternoon 

but I reserve my position generally until receipt or otherwise of the notes. 
 
 
 
THE CHAIRMAN:  Thank you.  Do the members of the Panel wish that these records be 
 
obtained?  Yes.  Legal Assessor? 
 
 
 
THE LEGAL ASSESSOR:  I do not think I have anything to add. 
 

THE CHAIRMAN:  We will proceed at the moment and hopefully the records will be 
 
available for the hearing early next week. 
 
 
 
MR PEARCE:  I am obliged, sir. 
 
 
MELINDA REBECCA THOMAS, Affirmed 
 
 

Examined by MR PEARCE 
 
 
 

Could you give the Committee your full name, please? 
 

Miranda Rebecca Thomas. 
 
 

Dr Thomas, are you a registered medical practitioner? 


Yes, I am. 
 
 
 

Currently doing what? 
 

I am a GP retainer. 
 
 
 

I think between August of the year 2000 and February 2001 as part of your GP 
training you were working as an SHO to Dr Chubb? 

A Yes. 
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Is that correct? 
 
A Yes. 
 
 
 

Where were you working? 
 

I was working at Whitchurch Hospital and the Link Centre in Cardiff. 
 


Could I then ask you to look at the bundle which is headed C8, which is to your 
 
right, and division 9 of that bundle? 
 
A Yes. 
 
 
 

Is there, I think, a three-page letter dated 17 November 2000 to Dr Dolben  
 
– I think there is only one ‘e’; there is not one at the end.  At any rate, to Dr Dolben, who 
I understand is a general practitioner from whom we will be hearing shortly, signed by 

Dr Cosgrove and copied to Dr Chubb and, I think, yourself.  Is that correct? 
 

That is correct. 
 
 
 

This makes reference to a patient and for the purpose of these proceedings we are 
 
using consecutive letters of the alphabet and this patient we are referring to is patient F.  
 
I think patient F was a patient on the list of Dr Dolben who you saw in October 2000, is 
that correct? 


Yes, that is right. 
 
 
 

In what circumstances did you see patient F? 
 

He was referred to the community mental health team by his general practitioner 
 
requesting an assessment because he had been diagnosed with depression that, I think, 
 
was difficult to treat and also the patient had a concern that he might have adult Attention 
Deficit Hyperactivity Disorder. 

 
 

So I think you saw patient F.  Did you, during the course of the consultation, have 
 
a discussion with Dr Chubb? 
 
A Yes. 
 
 

Was Dr Chubb present during the consultation? 
 

No.  I spoke to the patient, took the history, and then I went to discuss the case 

with Dr Chubb. 
 
 
 

You then, some time after 17 November 2000, I take it, received a copy of this 
 
letter from Dr Cosgrove to Dr Dolben? 
 
A Yes. 
 


We see on the first page and a half or so that he deals with his consultation with 
 
patient F, his diagnosis, his prescription and suchlike.  Can I take you then to halfway 
 
down page 232, starting “He has been seen twice by Dr Melinda Thomas”?  I want to ask 
 
you to comment, if I may, on some of the things that are said in this letter.  Taking that 
 
sentence I have just read:  
 
 
“He has been seen twice by Dr Melinda Thomas, who works for 

Dr Helen Chubb, Consultant Psychiatrist.” 
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Is it correct that you twice saw patient F? 
 

No, I only saw him once. 
 
 
 
Q Continuing: 
 
 
“Between them, these two psychiatrists came to the conclusion that 

F has a Personality Disorder.” 
 
 
 
Pausing there for a moment, did you come to the conclusion that F had a personality 
 
disorder? 
 

No.  I did not come to that conclusion and I decided that we needed to see him 
 
again to decide what was wrong. 
 


Did Dr Chubb come to that conclusion, to the best of your knowledge? 
 

No.  She did not say to me that that is what she thought. 
 
 
 

Did you tell patient F that there was no medication for a personality disorder? 
 

No, I did not talk to him about personality disorder at all. 
 
 

Did Dr Chubb, to the best of your knowledge? 


No, she did not talk to the patient at all. 
 
 
 
Q Continuing: 
 
 
 
“He was told that referral would be made to a local psychiatrist who 
 
specialises in personality disorder.” 
 

Was F to be referred to a different psychiatrist? 
 

No.  After I had spoken to Dr Chubb, she said that we ought to find out some 
 
more about testing for ADHD in adults, so she suggested that we should contact one of 
 
the other psychiatrists who might know more about it to find out whether it was worth 
 
him being referred on to someone else and then to tell the patient that when we saw him 
again. 
 
 


Going back to the letter: 
 
 
 
“F did not feel that Dr Thomas listened to him when he talked about 
 
his personal understanding of ADHD.” 
 
 
Let us break that down into parts.  Did F talk about his understanding of ADHD? 

A Yes. 
 
 
 

Did you listen to him talking about ADHD? 
 

Yes, I did. 
 
 
 

This is obviously a reference to you: 
 

“She said that ‘a concentration problem is for messy kids’.” 
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Did you say that or something like it? 
 

I do not think I would have said anything like that.  I think I was trying to have a 
 
discussion with the patient about what ADHD is and my understanding of it, and I think 
 
I would have explained to him that it was a problem that may be seen in children and one 
 
of the main features was that they were disruptive and lacked concentration.  I did not say 
that it would necessarily be limited to that situation. 

 
 

He goes on to say, a little further down in the same paragraph: 
 
 
 
“It is ironic and, arguably, even medically negligent that F knows 
 
more about ADHD in adults than both these two psychiatrists 
 
combined!” 
 

Putting aside the question about how much Dr Chubb knows about ADHD in adults or, 
 
indeed, how much F knows about ADHD in adults, could I just ask you in terms of how 
 
much you knew about ADHD in adults?  Did you think your knowledge was 
 
commensurate with the post you were performing? 
 

I was not a specialist in psychiatry; I had heard about the possibility of ADHD but 
 
my understanding was it was disputed and it was a controversial issue to some extent, and 
it was not something that I knew an awful lot about, which is hwy I went to speak first to 

my consultant and then wanted to get some more information from someone with more 
 
expertise in the field. 
 
 
 

I understand.  Going on in the letter: 
 
 
 
“Dr Thomas came back from telling Dr Chubb about F (for the latter 
has never seen him)” 

 
 
- that corresponds with your recollection, I should say, that Dr Chubb did not see him? 
 

No, she did not. 
 
 
 
Q Continuing: 
 
 
“with a sentence of therapeutic nihilism to say, ‘The consultant 

thinks that you have got a Personality Disorder, which is not 
 
treatable’.” 
 
 
 
I think you may have answered the questions already, but just so as I am clear.  Did you 
 
say that the consultant thought he had got a personality disorder? 

No, I did not. 

 
 

Did you say to F that that was not treatable? 
 

No, I did not. 
 
 
 

Just reading through the next paragraph, if I may: 
 
 
“If F responds to treatment for adult-type ADHD, it will show that 

he ahs got a treatable disorder.  Since personality disorder is 
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untreatable, according to Drs Thomas & Chubb, it will mean that F 
 
does not have a personality disorder and that these two psychiatrists 
 
were wrong.  It will also mean that F was right in his tentative 
 
diagnosis of ADHD in himself, and that they were negligent in not 
 
listening to him and in not knowing about ADHD as a real condition 
 
in adults.  All this leaves room for a formal complaint to the Fitness 
to Practise Directorate of the GMC.” 

 
 
Putting aside the question of the logic that Dr Cosgrove is perusing there, can I ask you 
 
this?  Do you consider that you were negligent in your treatment of patient F on that 
 
occasion? 
 

No, I do not. 
 
 

What was your response to receiving this letter, Dr Thomas? 


I was quite upset when I received it.  I actually opened the letter and, having read 
 
it, I had to do a clinic, but afterwards went and showed it to Dr Chubb and discussed it 
 
with her.  Then after that I did not do anything further in terms of any action on the letter, 
 
but when I saw the patient had another appointment with me a few weeks later I asked for 
 
one of my colleagues to come and sit in with me on the consultation in view of the letter 
 
that I had received. 
 


Did that consultation go ahead? 
 

No, the patient did not arrive. 
 
 
 
MR PEARCE:  Thank you.  If you wait there, Dr Thomas, Mr Morris, on behalf of 
 
Dr Cosgrove, will have some questions, I think. 
 
 
MR MORRIS:  Sir I do not have any questions of this witness.  I am afraid I have to say 

that I may have some questions depending on receipt of the records.  I have to reserve my 
 
position. 
 
 
 
THE CHAIRMAN:  There are no questions from the Panel.  In the light of Mr Morris’s 
 
statement, that is the end of your evidence for today, Dr Thomas, but depending on the 
circumstances once the clinical notes are available it may be that we might have to recall 
 
you. 

 
 
MR PEARCE:  I think it might be appropriate if I just speak a little further to Dr Thomas 
 
about her availability next week.  I have some idea about it, but it is not something I have 
 
had an opportunity to explore in detail.  I know she is more readily available earlier in the 
 
week rather than later, but that may not necessarily fit very well with how we anticipate 
the week going.  So I would welcome the opportunity to speak to her briefly about that.  

I am more than happy – I know we are having such a stop and start day in this case and 
 
I apologise again for that.   
 
 
 
I believe that Dr Dolben, my other witness, will be very short - possibly significantly 
 
shorter that Dr Thomas, I think.  It cannot be shorter than Mr Morris was but I think that I 
 
will be shorter with Dr Dolben than I was with Dr Thomas.  If you prefer that we were to 
sit through and we will call Dr Dolben, deal with his evidence and then have a discussion 

with Dr Thomas? 
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THE CHAIRMAN:  We will take Dr Dolben’s evidence. 
 
 
 
MR PEARCE: I am much obliged, sir.  
 
 
 
THE CHAIRMAN:  You can now stand down from the witness stand.  Thank you very 
much, Dr Thomas. 

 
 
DR ROBERT DOLBEN Affirmed  
 
Examined by MR PEARCE: 
 
 
 

Could you give the Committee your full name, please? 
 

My name is Robert Dolben.  
 


Just sticking there on the question of your name for the moment, it has managed 
 
to be spelt differently in different document. 
 

I know.  It is a difficult name to spell.  
 
 
 

My understanding is that the correct spelling is D-O-L-B-E-N? 
 

That is correct, yes. 
 


I am obliged for that.  Dr Dolben, I think that you are a registered medical 
 
practitioner with a general practice in Cardiff? 
 

That is correct. 
 
 
 

Can I ask you to look at the bundle immediately under your arm, I think which 
 
should be headed C8 hand-written in the corner, which has a number of tabs and in 
particular under tab 9 there is, I think you will there see, a three page letter from Dr 

Cosgrove to you with your name misspelt, dated 17 November 2000.  Is that correct? 
 

That is correct.  
 
 
 

That letter refers to a patient who I think was a patient of yours.  Is that so? 
 

That is right, yes. 
 
 

For the purposes of the proceedings before the Committee,  we are referring to 

patients by consecutive letters of the alphabet and this patient we are calling ‘F’, so that 
 
you are clear for anonymity purposes.   In any event, could I just ask you about this letter. 
 
 Having read this letter you will have noted, I think, that Dr Cosgrove - the bottom of 
 
page 231, the first page of the letter - considers that F has attention deficit hyperactivity 
 
disorder and he indicates, does he not, on page 232, that he was making out a private 
prescription for Ritalin? 

A Yes. 
 
 
 
 
Q  
 
 
 
“I will have a series of telephone appointments with him 
 
in order to monitor his progress and to find the optimum 
dosage and frequency through the day.” 

 
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Do  you see that sentence? 
 
A Yes. 
 
 
 

Did Dr Cosgrove either in this letter or at any other time, ask you to carry out 
 
monitoring of either the condition of attention deficit hyperactivity disorder or the 
 
prescription that he was writing out? 

No, I cannot recall he did.  

 
 

Could I ask you to look at page 233.  The last proper paragraph of the letter: 
 
 
 
“I have made out a specimen prescription for Ritalin but I 
 
know that he would very much appreciate it if you would 
 
copy it down on to an NHS scrip.  On each occasion that I 
alter the dosage I will send him a fresh specimen 

prescription to bring to you.” 
 
 
 
Let me just understand what that means, particularly for those non-medical members of 
 
the Committee and, indeed, myself.  Clearly there is a financial advantage to a patient if 
 
the prescription is issued under the NHS, or there may be a financial advantage? 
 
A Yes. 
 
 


I take that to be an invitation from Dr Cosgrove for you as a general practitioner 
 
to be issuing a prescription under the NHS in order to be of financial benefit to the 
 
patient? 
 

I assume that was the case, yes. 
 
 
 

Had you issued a prescription, what responsibility would you have had, if any? 

Generally the prescriber of a drug retains responsibility for monitoring side 

effects, monitoring response of the drug.  There may be cases where protocols may have 
 
been agreed with, for example, hospital consultants and under those circumstances where 
 
protocols are in place, then we are happy to prescribe drugs on behalf of a hospital 
 
consultant.  
 
 

Was there any protocol in place between you, your practice and Dr Cosgrove? 
 
A No. 
 

 
 

Either generally or for this particular patient? 
 

No.  This is the first time I had ever received any correspondence from Dr 
 
Cosgrove.  
 
 

If you turn back a page to page 232, starting from half way down that page, there 

is a passage beginning, “He has been seen twice by Dr Melinda Thomas” and the a 
 
passage which relates to that consultation with Dr Thomas and to the conduct of Dr 
 
Thomas and Dr Chubb.  I think it is fair to say that it, I think, is essentially admitted that 
 
it makes a number of criticisms of those two doctors.  What was your response to 
 
receiving that letter and reading that passage? 
 

I was very surprised.  As I said, it was the first time I had ever received 
correspondence from a consultant so openly criticising the practice of other physicians or 

psychiatrists.  I was surprised particularly on the basis that this is the first time that Dr 
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Cosgrove had actually, I believe, met the patient in question and I do not believe that Dr 
 
Cosgrove had any real evidence or knowledge of the therapeutic relationship between the 
 
consultants in Cardiff and the patient in question.  
 
 
 

I understand.  Thank you very much, Dr Dolben.  Mr Morris on behalf of Dr 
 
Cosgrove may ask you some questions.  
 

MR MORRIS:  I do not have any, sir. 
 
 
 
THE CHAIRMAN:  Are there any questions from the Panel?  There being no questions, 
 
that concludes your evidence, Dr Dolben.  Thank you very much for coming to assist us. 
 
 
 
MR PEARCE: Thank you, sir.  The position, then, now is as follows.  I will speak to Dr 
Thomas about her availability next week.  I think that is essentially a matter for me and 

my side and, to a certain extent, my learned friend’s side.  I do not think we will need to 
 
invite any input from you.  
 
 
 
The position otherwise is this.  As I indicated before, I know have two remaining 
 
witnesses to give evidence orally - Patient D’s mother, or putative mother, who we will 
 
now call on Tuesday morning and Professor Taylor for the remainder of his evidence on 
Wednesday.  We will seek to fit into that timescale a point at which Dr Thomas will be 

recalled if necessary, but you will immediately see the problem that if we do not know 
 
about the availability of the records until Tuesday, then we risk either getting her here on 
 
Tuesday and her not being asked any questions, or alternatively problems later in the 
 
week with timescales.  We are acutely aware of the issue of completing this case next 
 
week, if that is at all possible.  I assure you we will have that in the forefront of our 
 
minds. 
 

In terms of timetable on Tuesday, my learned friend and I have discussed that at a little 
 
greater length this morning.  You raised the issue of sitting slightly later on Tuesday.  It 
 
appears to us, I think, speaking to each other, that from our point of view - or from my 
 
learned friend’s point of view - Mrs D will not be a long witness.  His witnesses, I think, 
 
are arranged to attend at midday, if I recall. 
 
 
MR MORRIS:  They are arriving at about one, sir, to be ready for two o’clock. 

 
 
MR PEARCE: I understand that Mrs D will not be in the witness box for the whole 
 
morning.  It follows from that - and this is clearly a matter of convenience and it makes, 
 
I have to say, no difference to me but it may make a difference to the Committee and 
 
there may be cost and other benefits - to us starting a little later on Tuesday, if you wish 
to do so.   

 
 
THE CHAIRMAN:  Would 10.30 be a reasonable starting time? 
 
 
 
MR PEARCE: I would think we are very confident that that will not affect the completing 
 
of the evidence.  
 
 
THE CHAIRMAN:  It gives two hours or so for Patient D’s mother and then the other 

witnesses can be taken in the afternoon.  I am trying to make the best use possible of the 
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time available.  I think if we go for a 10.30 start that should be adequate. 
 
 
 
MR PEARCE: Yes, sir.   I think that there is one remaining matter that, from my point of 
 
view, I would ask you to consider this afternoon, which is dealing with witness 
 
statements of two witnesses who I think I have mentioned previously where I indicated I 
 
would be applying to read those witness statements. 
 

I am told by my learned friend that he is not in a position to consent to agree to that and 
 
therefore I take it that I have to make application to you to receive this evidence and we 
 
might conveniently, I think, as a starting point, look at what the rules have to say on this 
 
point.  I have no doubt that you and your Committee have been referred before to Rule 
 
50(1) of the Procedure Rules, if I can call them that. 
 
 
“The Professional Conduct Committee may receive oral, 

documentary or other evidence of any fact or matter 
 
which appears to them relevant to the enquiry into the 
 
case before them provided that, where any fact or matter 
 
is tendered as evidence which would not be admissible as 
 
such if the proceedings were criminal proceedings in 
 
England, the Committee shall not receive it unless, after 
consultation with the Legal Assessor, they are satisfied 

that their duty of making due enquiry into the case before 
 
them makes its reception desirable.” 
 
 
 
The position here, sir, is that I am dealing with the statements of two witnesses who are 
 
unavailable to give evidence during the course of this hearing because of their absence on 
 
holiday.  Those two witnesses, so that you can get some sense of the ambit of their 
evidence, are, first of all, Dr Helen Chubb, who is relevant to charge 9, the area of 

evidence with respect to which we have just heard from Dr Thomas and to a limited 
 
extent from Dr Dolben. 
 
 
 
I do not want by the back door to introduce evidence that I do not have permission to 
 
introduce so can I just put it in, I hope, general terms in this way, that as you have already 
heard, Dr Chubb did not meet the patient and her evidence does not relate to any other 
 
dealings with Dr Cosgrove other than receipt of that letter that you have already looked at 

in respect of Dr Thomas.  The purpose of her evidence, if I may say so, relates to the 
 
comments made in that letter and her response to those comments. 
 
 
 
Can I make this clear sir, since this is sometimes relevant to consideration.  In the event 
 
that you refuse permission for this evidence to be adduced before the Committee, I will 
contend and will be contending in my final submission in any event, that this head of 

charge is made out on the basis of other evidence, including the admissions of the doctor, 
 
so that, to put it another way, the charge does not stand or fall - in our submission it does 
 
not stand or fall - on the evidence of Dr Chubb and, if you refuse permission, it will not 
 
inevitably follow that I do not proceed with that evidence. 
 
 
 
Sir, the second area or the second witness in respect of whom the same application is 
made, is Dr Dover.  Dr Dover’s witness statement relates to head of charge 11 about 

which, other than my opening, you have heard nothing thus far.   
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It might again be convenient for you just to look at charge 11 and to see the ambit of that 
 
which is alleged by the GMC and that which has been admitted on behalf of Dr Cosgrove. 
 
 You will recall that I read, I think in full, to some length at any extent, from a letter that 
 
appears at division 11 in the bundle and you will note, sir, that it has been admitted on 
 
behalf of Dr Cosgrove that he saw this patient, that he wrote to the general practitioner 
with a copy of the letter to H’s parents and to Dr Dover, that he admits that he made those 

three comments set out at (c) and that he admits at (d) (iii) that the comments were likely 
 
to cause the reader to doubt the knowledge or skills of Dr Dover. 
 
 
 
The purpose of calling Dr Dover, sir, again without giving evidence through the back 
 
door, is to express his response to receiving that letter.  Again, so that the position of the 
 
Council is clear, in the event that you were to refuse permission, we would say that that 
which is already admitted in respect of this charge potentially makes out the allegation of 

serious professional misconduct and furthermore, that that which is already admitted 
 
supports the contention that the doctor’s acts were unprofessional and unsustainable and 
 
therefore we would contend, even in the absence of the evidence from Dr Dover, that the 
 
charge is made out.  Yet again, the charge does not stand or fall upon the evidence of Dr 
 
Dover being received by the Committee, in our submission. 
 
 
Sir, the position we have taken, so that you are clear on what attempts have been made, as 

it were, to obtain these witnesses, notwithstanding their apparent unavailability, the view 
 
that has been taken on behalf of the General Medical Council, in my submission rightly, 
 
but it does not matter whether it is right or not, it is simply the view that was taken is that, 
 
given that this is an adjourned hearing when people have previously been making 
 
themselves available in any event, where witnesses had reasons not to be here we could 
 
not reasonably expect them to rearrange holidays and attend and therefore we took no 
steps further than establishing that they were not available before we took the view that 

we would only apply to read their evidence. 
 
 
 
I trust, sir, that that assists the Committee in the background to how we come to make this 
 
application and the grounds upon which we seek your permission to receive the evidence. 
 
 
THE CHAIRMAN:  Thank you very much.  Mr Morris. 
 
 

MR MORRIS:  Sir, obviously it is preferable for witnesses to attend unless their evidence 
 
is agreed and the reason for that preference is obvious.  It enables the Defence to cross-
 
examine those witnesses, which I may - and I can only say I may - wish to do so, 
 
depending on what if any notes I receive in relation to the particular patients with whom 
 
they had dealings either directly or indirectly. 
 

I am, therefore, at a potential disadvantage if those witnesses are not available to give 
 
evidence and it is on that basis that I resist this application.   
 
 
 
THE LEGAL ASSESSOR: If can just ask one question.  Do you know where the 
 
witnesses are on holiday? 
 
 
MR PEARCE: Yes. 

 
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THE LEGAL ASSESSOR: Are they outside the United Kingdom. 
 
 
 
MR PEARCE: One in Corsica and one in France.   
 
 
 
THE LEGAL ASSESSOR: I note that the terms of Rule 50 provide that: 
 
 
 “The Professional Conduct Committee may receive oral, documentary or 

other evidence of any fact or matter which appears to them to be relevant.” 
 
 
 
I do not think there would be any argument here that their evidence is relevant, but there  
 
is a proviso that the evidence would have to be admissible in criminal proceedings in 
 
England.   
 
 
Have either counsel addressed their minds to the question of whether their statement 

would be admissible under Section 23 of the Criminal Justice Act 1988? 
 
 
 
MR MORRIS: Sir, I had rather assumed that because my learned friend was relying on 
 
Rule 50 he had conceded that the evidence was not admissible under the Criminal Justice 
 
Act because my reading of the proviso is that it applies in circumstances where the 
 
evidence is not admissible, or would not be admissible if proceedings were criminal 
proceedings, and the Council then has recourse to this Rule so as to allow the Committee 

to receive in evidence evidence which, if these were criminal proceedings, would not be 
 
admissible.  As my learned friend only relied on Rule 50 I rather assumed--- 
 
 
 
MR PEARCE: There is a very good reason why I rely on Regulation 50 alone; if these 
 
were criminal proceedings I might well be able to rely on Section 23, that is true.  
 
Regulation 50 is clearly far broader than Section 23 in potential ambit and, therefore, it is  
I would say sufficient to say prima facie the evidence is inadmissible for it to come within 

the Regulation 50, power for you to admit it, then invite the Committee to exercise its 
 
discretion under Regulation 50.  I appreciate there might be an argument that that might 
 
persuade a criminal court to do it, but I would be doing so under a narrower power than 
 
Section 23, with narrow requirements, rather than the broad requirements of Regulation 
 
50.   
 
 
THE CHAIRMAN: Could I just make an intervention.  Would it be fair to say that 

looking at heads of charge 9 and 11 that the witness statements would really be 
 
addressing matters under 9d(i) and (ii) and 11d(i) and (ii) and these basically are matters 
 
for the panel rather than for witnesses? 
 
 
 
MR PEARCE: It is a good point and it is another way of putting the point that I made 
earlier; that the charges do not stand or fall on the admission of the evidence.  I accept 

there is some force in that point.  Of course, you have to determine, or you may have to 
 
determine not only the factual basis but also whether it amounts to serious professional 
 
misconduct to have made comments of this nature.  In that context what the doctor has  
 
to say about their involvement with the patient may be relevant.  So it is not a position in 
 
which their evidence goes only to matters which lie purely within your domain.  You are 
 
quite right to say that, it will be my submission in due course, that d(i) and (ii) are matters 
of influence for this Committee from the available background evidence, almost all of 

which is admitted in any event on behalf of the Doctor.  But it does, in our submission, at 
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least potentially go to those issues you may need to consider of whether this amounts to 
 
serious professional misconduct. 
 
 
 
THE LEGAL ASSESSOR: Just come back to the Rule 50 point.  It seem to me that the 
 
proviso to Rule 50(1) applies to evidence which is not admissible in a criminal trial and  
 
I really want to ask: are you conceding that these statements could not be admissible in a 
criminal trial under section 23 of the Criminal Justice Act? 

 
 
MR PEARCE: No, I am not.   
 
 
 
THE LEGAL ASSESSOR: So if the evidence is relevant, and I must say that as far as I 
 
can see it is evidence which might bear on one of the issues in relation to one or other of 
 
the charges, if it is admissible under section 23 then you probably have a right to put it in 
evidence, hence my question whether or not these witnesses were overseas, which opens 

the door to the application of section 23.  Do you follow my reasoning? 
 
 
 
MR PEARCE: I do.  If I may say so, I think it is perhaps a little bit more rigorous than the 
 
reasoning that I brought to bear in making the application.  In principle I would argue that 
 
the status came within section 23(1) and I was simply approaching it from other way 
 
saying regular 50 is broader so we need do not need to consider Regulation 23(1). 
 

THE LEGAL ASSESSOR: Could we have a look at section 23, because I think if section 
 
23 renders these statements admissible then this Committee does not need to consider 
 
whether it exercises its discretion on the proviso. 
 
 
 
MR PEARCE: Yes.  Paragraph 9-127.  
 
 
THE LEGAL ASSESSOR: Written in remarkably opaque statutory language: 

 
 
“The Criminal Justice Act 1998, ss 23, 24,  
 
 
 
(1) Subject –  
 
(a) to subsection (4) below; and 
 
 
  
 
(b to paragraph 1A of Schedule 2”, 

 
 
 of another statute,  
 
 
 
“a statement made by a person in a document shall be admissible in 
 
criminal proceedings as evidence of any fact of which direct oral evidence 
by him would be admissible if - 

 
 
(i) the requirements of one of the paragraphs of subsection (2) below are 
 
satisfied; or, 
 
 (ii) The requirements of subsection (3) below are satisfied.” 
 
 
 
Going to subsection 2, that says:  
 

“The requirements mentioned is subsection (1)(i) above are - 
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(a) that the person who made the statement is dead or by reason of his 
 
bodily or mental condition is unfit to attend as a witness; 
 
  
 
(b) that – 
 
 
(i) the person who made the statement is outside the United Kingdom; and 

 
 
(i) it is not reasonably practicable to secure his attendance; or.”   
 
 
 
So I think on the question of whether this statement is admissible, if the witness is outside 
 
the United Kingdom, that is the first test, second, it is not reasonably practicable to secure 
 
his attendance.  The question which has to be answered there is: is it reasonably 
practicable to secure his attendance now and presumably the answer to that must be no? 

 
 
MR PEARCE: Clearly we would say no, sir, out of the very fact the person is abroad on 
 
holiday. 
 
 
 
THE LEGAL ASSESSOR: My advice is that prima facie section 23 applies.  If that is the 
 
case the statement is admissible, there is no need to go to the proviso of Rule 50.  The 
only thing I ought to do is ask Mr Morris what he has to say about the admissibility of 

that statement under section 23? 
 
 
 
MR MORRIS: Sir, these dates were fixed back in January and no doubt witnesses would 
 
have been, or should have been told about the dates and, in my submission, the issue of 
 
practicability, therefore, has to be seen not merely from the point of view of looking now 
 
when they are present in France, but from an earlier perspective.   
 

If, however, it is thought that it impracticable for them to attend, then certainly the 
 
provisions of section 23 are met.  One then has to proceed to apply the principles set out 
 
in section 25 which state that: 
 
 
 
“If, having regard to all the circumstances – 
 
 
(a) the Crown Court  - 

 
 
(i) on a trial on indictment; 
 
 
 
is of the opinion that in the interests of justice a statement which is 
 
admissible by virtue of section 23  or 24 above nevertheless ought not to 
be admitted, it may direct that the statement shall not be admitted.”   

 
 
So admission of the evidence is not automatic following on satisfying Section 23 and the 
 
various considerations that have to be borne in mind by the Committee are then set out in 
 
25(2): 
 
 
 
“Without prejudice to the generality of subsection (1) above, it shall be the 
duty of the court to have regard – 

 
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(a) to the nature and source of the document containing the statement”, 
 
 
 
 and its authenticity. I do not seek to dispute that, 
 
 
 
“(b) to the extent to which the statement appears to supply evidence which 
 
would otherwise not be readily available.”   
 

My learned friend has conceded in relation to both these witnesses that other evidence is 
 
available in relation to the issue which they address: 
 
 
 
“(c) to the relevance of the evidence that it appears to supply to any issue 
 
which is likely to have to be determined in the proceedings”,   
 
 
That clearly is relevant: 

 
 
“and, 
 
 
 
(d) to any risk, having regard in particular to whether it is likely to be 
 
possible to controvert the statement if the person making it does not attend 
 
to give oral evidence in the proceedings, that its omission or exclusion will 
result in unfairness to the accused or, if there is more than one, to any of 

them.” 
 
 
 
So that perhaps is a reference to the point the Chairman made about to what issue and 
 
whether their evidence is of any assistance on the unproved allegations made in 9d(i) and 
 
(ii) and 11d(i) and (ii).   
 
 
In my submission, their evidence may go to those issues because, for example, if they 

were to concede that, for example, if one looks at Dr Dover at 11c(ii), if he were to 
 
concede in evidence that he should have studied Patient H’s school reports, then to make 
 
that comment, or that evidence would go to the question or whether or not that was a 
 
sustainable comment. 
 
 
So the matter does not end with the satisfaction of section 23, one has to consider the 
 
matters in section 25.   

 
 
THE LEGAL ASSESSOR: Thank you.  Just come back to you, Mr Pearce, section 23, the 
 
requirement that it is not reasonably practicable to secure his attendance.  Do you know 
 
of any authority at which point you have to consider whether it is reasonable practicable 
 
to secure his attendance?  Whilst I said originally it was not clearly reasonably 
practicable to secure his attendance now, it would certainly be, would it not, reasonably 

practicable to have secured his attendance by a subpoena in the the weeks proceedings. 
 
 
 
MR PEARCE: It would have been practicable, whether it was reasonably practicable 
 
might be where we take issue.  I am not seeking to argue that you have to make the 
 
decision now, we can wait until the moment of calling and the person say there is nothing 
 
we can do about this because they are effectively -- one might say if they were ten miles 
away I would not be reasonably practicable.  I do not seek to argument argue it that way.  

What I do seek to argue is in the context of this case as an adjourned hearing it was not 
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reasonably practicable to secure their attendance once we knew, as we did, when we 
 
approcahed them to attend this hearing that they were not available.  Just to flesh out.  
 
Yes, this hearing was fixed in January of this year, we know the circumstances in which 
 
the date were canvassed.  We certainly did not seek to check availability of witnesses 
 
then because, frankly, the view we took was the case had to be fixed for a hearing when 
 
this Committee and these lawyers could attend.  That was the priority and fitting 
witnesses in,  

I am afraid, in the context of the case, case was somewhat secondary to that and was not 
 
going to determine whether any particular (Inaudible).  So I defend, if I put it that way, 
 
the approach to fixing the case, then seeing whether the witnesses were available, in 
 
terms of reasonably practicability, as I indicate, that arises we would say from the fact of 
 
the context of an adjourned hearing where the witnesses have been asked to attend before, 
 
it was not then reasonably practicable to cancel all arranged holiday in order to be here. 
 

THE LEGAL ASSESSOR: Is it a question of law, the reasonableness, or a question of 
 
fact? 
 
 
 
MR PEARCE: Question of fact, I would say. 
 
 
 
THE LEGAL ASSESSOR: Mr Morris, do you agree? 
 

MR MORRIS: I do. 
 
 
 
THE LEGAL ASSESSOR: Thank you very much.  I am helped by that.  I think I can take 
 
this quite quickly.  My advice to you is that the evidence of Dr Chubb and Dr Dover is 
 
potentially relevant to the question to be decided in the charges to which, shall we say, 
 
their evidence relates.  Their reaction to certain letters that were written by Dr Cosgrove 
is, in my opinion, relevant and on that basis I advise you.   

 
 
The next question to be addressed is: is their evidence admissible within the meaning of 
 
the Criminal Justice Act 1988, section 23? The decision that has to be made there, 
 
because  
 
I think it is not disputed they are outside the United Kingdom, is whether or not it is 
reasonably practicable to secure his attendance.  The way we approach that, I advise you, 
 
is not to restrict yourself to is it reasonably practicable now to get him, but whether it has 

been reasonably practicable to secure his attendance in the normal course of the 
 
preparation of this case.  If you decide – and I think that is properly a question of fact for 
 
you to decide on what you have heard from both counsel - if you decide that it has not 
 
been reasonably practicable to secure his attendance, then section 23 of the Criminal 
 
Justice Act 1988 will apply, the statements will then be admissible per the basic principle, 
and in which case then you can receive them, provided you then go on to consider the 

matters which Mr Morris has referred to in section 25 of the Criminal Justice Act which 
 
directs you to take into account certain matters in deciding whether you exercise your 
 
discretion to so admit the documents. 
 
 
 
If, on the other hand, you decide that it has been reasonably practicable to secure the 
 
attendance of the witness my advice to you is that the statements are inadmissible from 
the point of view of a criminal court, in which case then the proviso applies to Rule 50(1), 

which reads as follows: 
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“Provided that any factual matter is tendered as evidence which would not 
 
be admissible if such proceedings were criminal proceedings”, 
 
 
 
I pause there to say that you have to make an antecedent decision admissible in criminal 
 
proceedings in England.  Carrying on with the quotation: 
 

“..the Committee shall not receive it unless, after consultation with 
 
the legal assessor” 
 
 
 
(which it has done) 
 
 
 
“they are satisfied that their duty of making due inquiry into the case 
before them makes its reception desirable.” 

 
 
So if you reach the point that the evidence is inadmissible as per the rules of evidence 
 
which I have described to you, you then have to consider if you are going to make a due 
 
inquiry into this case is the reception of that evidence desirable.  That is very close to the 
 
question, in many ways, of whether or not the evidence is in itself relevant to the charges. 
 
 It will then be a question of fact whether or not you consider that evidence is such that it 
crosses the line from being relevant to being desirable; its reception being desirable.   

 
 
I do not think I can elaborate on the words “desirable” or “relevant”.  They are the 
 
English words used in the relevant rule and it is a question of fact for you to decide that. 
 
 
 
Do either counsel have any observations on the way in which I have set out the reasoning 
 
that I think the Committee should follow? 
 

MR PEARCE:  No. 
 
 
 
MR MORRIS:  No. 
 
 
 
THE CHAIRMAN:  May I just ask, is there any information as to when these witnesses 
were notified as to the dates of the current hearing? 
 
 

MR PEARCE:  I thin the answer to that is yes, but I will just check.  (Pause)  The answer 
 
is we may be able to obtain the information but we will have to go and search it out. 
 
 
 
THE CHAIRMAN:  What is the date of the witness statements? 
 
 
MR PEARCE:  Dr Chubb is 11 July 2003, Dr Dover 29 September 2003.  Of course, they 

were both prepared for the previous hearing. 
 
 
 
THE CHAIRMAN:  Fine.  We will now go into private session to consider this question. 
 
 
 
PARTIES THEN, BY DIRECTION FROM THE CHAIR, WITHDREW 
 
AND THE COMMITTEE DELIBERATED IN CAMERA 
 

PARTIES HAVING BEEN READMITTED
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THE CHAIRMAN:  Mr Pearce, the Committee has carefully considered your 
 
application for the Committee to receive the witness statements made by Dr Chubb 
 
and Dr Dover.  You have indicated to the Committee that those statements are relevant 
 
to Heads 9 and 11 respectively. 
 
 
The Committee has considered the submissions made by Mr Morris acting on behalf 

of Dr Cosgrove.  Mr Morris has submitted that it is preferable for the witnesses to give 
 
evidence before Committee to allow for cross-examination.  Mr Morris has indicated 
 
that there is a potential disadvantage in not having the opportunity to cross-examine 
 
this evidence. 
 
 
 
The Committee has had regard to Rule 50(1) of the Committee Procedure Rules and 
sections 23 and 25 of the Criminal Justice Act 1988 in respect of the receipt of this 

evidence and has been guided by the advice of the Legal Assessor. 
 
 
 
The Committee finds that the requirements of section 23(2)(b) of the Criminal Justice 
 
Act 1988, that it is not reasonably practicable to secure the witnesses attendance, have 
 
not been met.  Nonetheless the Committee considers that the information contained 
 
within the statements may be relevant to their inquiry.  It has therefore decided under 
the proviso to Rule 50(1) of the Committee's Procedure Rules that it is desirable and in 

the interests of justice, bearing in mind the question of fairness to both the parties 
 
involved and Dr Cosgrove, that the statements should be received. 
 
 
 
The Committee will be able to afford appropriate weight to the documents' relevance 
 
and validity in due course. 
 
 
MR PEARCE:  I am obliged, sir.  Then if it is a convenient point to read those two 

statements, I do so, sir. 
 
 
 
The first statement is of Helen Chubb MB BCh MRCPsych MRCGP: 
 
 
 
“I am employed as a Consultant Psychiatrist by Cardiff and Vale 
NHS Trust at the Link Centre, Langcross Street, Cardiff.  
 
 

Between August 2000 and February 2001 Dr Miranda Thomas was 
 
my S.H.O.  On 24 November 2000 Dr Thomas received a letter 
 
from Dr P V F Cosgrove which was addressed to Dr Dolbern 
 
dealing with a patient whose identity I know and will refer to as F. 
 
 I have been shown a copy of this letter, Exhibit RD1, and I 
identify this as the letter. 

 
 
The letter contained references to Dr Thomas and myself and in 
 
particular to Dr Thomas' dealings with the patient F.  I found the 
 
letter extremely offensive and felt it could be even libellous 
 
towards Dr Thomas and myself.  The content was grossly 
 
inaccurate and where Dr Cosgrove had put phrases in quotes that 
he claimed Dr Thomas made these were most definitely inaccurate. 

 
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Dr Cosgrove alleged Dr Thomas has seen F on two occasions 
 
which was untrue and that she and I had come to the conclusion 
 
that the patient had a personality disorder and there was no 
 
medication to treat it. 
 
 
 
Dr Thomas only saw F on one occasion and after this consultation 
her diagnosis of him was unclear and no conclusion had been 

made. 
 
 
 
The letter alleged that Dr Thomas had told F that ‘the consultant 
 
thinks that you have got a personality disorder which is not 
 
treatable’.  Whilst I was not present when Dr Thomas is alleged to 
 
have stated this to F I cannot believe that it was said and I certainly 
did not say it to Dr Thomas during the discussion I had with her 

about this patient. 
 
 
 
It is possible to suffer from ADHD and a personality disorder and 
 
Dr Cosgrove's statement in the last paragraph of page 2 of his letter 
 
that ‘if F responds to treatment for adult type ADHD, it will show 
 
that he has got a treatable disorder.  Since personality disorder is 
untreatable, according to Dr Thomas and Chubb, it will mean that 

F does not have a personality disorder and that these two 
 
psychiatrists were wrong’.  I felt this statement was made to bring 
 
Dr Thomas and my professional into disrepute and was extremely 
 
disturbed that Dr Cosgrove went on to suggest that the patient 
 
make a formal complaint about us to the General Medical Council. 
 
 
I understand that my statement may be used in evidence for the 

purposes of a hearing before the General Medical Council's 
 
Professional Conduct Committee.  I confirm that I am willing to 
 
attend the hearing to give evidence if asked to do so. 
 
 
 
I believe that the facts stated in this witness statement are true.” 
 
 
Sir, the other statement is that of Stephen Dover: 

 
 
“I, Stephen Dover, will say as follows: 
 
 
 
I am a Consultant in Child and Adolescent Psychiatry employed by 
 
North Staffordshire Combined Healthcare NHS Trust at the Mental 
Health Directorate, Child and Adolescent Mental Health Service, 

Ripon Road, Blurton, Stoke on Trent. 
 
 
 
On 16 July 2003 Dr Cosgrove carried out a private assessment of a 
 
patient whose identity I know and will refer to as H, who was 
 
previously under my care.  Dr Cosgrove diagnosed H. as suffering 
 
from Attention Deficit Hyperactivity Disorder (ADHD). On the 
19 July 2003 Dr Cosgrove wrote a letter to H's General Practitioner 

a copy of which was also sent to H's parents and myself.  I produce 
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a copy of this letter. 
 
 
 
I was very concerned about this letter as a large part of the content 
 
was highly critical of my practice with Dr Cosgrove's conclusions 
 
being based on information provided to him by H's parents that 
 
actually had no basis in fact. 
 

In particular my team has had ongoing involvement with H over a 
 
number of years and have liaised extensively with various 
 
educational professionals about his progress.  In addition at no 
 
time has his General Practitioner actually asked me to arrange a 
 
second opinion. 
 
 
Dr Cosgrove's comments in this letter about my revalidation with 

the General Medical Council are in my opinion particularly 
 
unacceptable.  Unfortunately he made no effort to contact me prior 
 
to writing this letter to ascertain whether what he was writing was 
 
actually true. 
 
 
 
I am concerned that unfounded criticism of my practice has been 
shared with a local General Practitioner with whom I will have to 

continue to work around other cases.  More seriously, Dr Cosgrove 
 
has also copied his letter directly to H's parents and I have since 
 
been contacted by the father of H who has informed me that 
 
following Dr Cosgrove's comments about my practice he was 
 
considering contacting a solicitor. 
 
 
Overall I am extremely concerned about Dr Cosgrove actions 

which in my opinion would seem quite inappropriate.  
 
 
 
I understand that my statement may be used in evidence for the 
 
purposes of a hearing before the General Medical Council's 
 
Professional Conduct Committee.  I confirm that I am willing to 
attend the hearing to give evidence if asked to do so. 
 
 

The contents of this statement are true to the best of my knowledge 
 
and belief.” 
 
 
 
That concludes the second of those two statements. 
 
 
THE CHAIRMAN:  That concludes the business for the week and we will reconvene at 

9.30 on Tuesday.  Thank you. 
 
 
 
(The Committee adjourned until Tuesday, 15 June 2004) 
 
 
 
 
 
 
 

 
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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
 
Tuesday 15 June 2004 
 
Held at: 
St James’ Buildings 
79 Oxford Street 
Manchester M1 6FQ 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Eight) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was not present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of Transcribe UK 
Tel No:  0208 614 5799) 
 
-------------------------------------- 
 
 
 
 

 
 
 
 
INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
MRS D, Sworn 
 Examined 
by 
MR 
PEARCE 
      

 Cross-examined 
by 
MR 
MORRIS 
     

 Re-examined 
by 
MR 
PEARCE 
    29 
 Questioned 
by 
THE 
COMMITTEE 
    30 
 Further 
questioned 
by 
MR 
MORRIS 
    31 
 
MRS C, Sworn 
 Examined 
by 
MR 
MORRIS 
 
     33 
  Cross-examined 
by 
MR 
PEARCE 
    39 
  Questioned 
by 
THE 
COMMITTEE 
    51 
 
 
MRS E, Sworn 
 
  Examined 
by 
MR 
MORRIS 
 
 
     52 
  Cross-examined 
by 
MR 
PEARCE 
    56 
  Questioned 
by 
THE 
COMMITTEE 
    64 
 
 
 
 
 
____________________

 
 
 
 
 
 

THE CHAIRMAN:  Good morning, Mr Pearce.   
 
 
 
MR PEARCE:  Thank you.  I call my next witness, Mrs D. 
 
 
 
MRS D, sworn 
 
Examined by MR PEARCE 
 


You will recall from when you gave evidence before that we are calling you Mrs 
 
D and your son D for the purposes of this hearing. 
 
A Yes. 
 
 
 

Mrs D, could I ask you, first of all, to write on that blank piece of paper before  
 
you your name, your address and your son’s name, please. (Pause.)  (Same handed.)  Sir, 
I do not know whether that needs to be given a formal exhibit number.  It probably ought 

to be. 
 
 
 
THE CHAIRMAN:  C14. 
 
 
 
MR PEARCE:  I am much obliged.  (To the witness):  Mrs D, when was your son born?  
 
What was his date of birth? 

12 February 1986. 

 
 

When he was a baby did you have any difficulties with his behaviour? 
 

As a baby D never slept and was very difficult to feed.  This went on for quite a 
 
number of years and when he reached the toddler years I had been to see a GP beforehand 
 
but it was just the new baby syndrome and “This is your first child”, you know, “it will 
 
come to you”.  When he reached the twos it was not getting any better and it was then 
again the terrible twos.  He was not eating, he was not sleeping but it just continued and 

continued along those lines. 
 
 
 

Did he start at a nursery school eventually? 
 

Yes, he went to nursery school when he was about four years old. 
 
 

Was any referral made in respect of his behaviour? 
 

Yes, the nursery nurses approached myself and said that D was very active to the 

point that he was annoying the other children in the nursery and had words to me that he 
 
had ants in his pants and could not sit in peace and possibly I would be best to go and see 
 
a child psychologist because D’s Dad and I had separated at that point and they felt that 
 
his behaviour could have been part of the disruption in his life. 
 
 

So what was the view taken by the psychologist as to what you ought to do about 

D’s behaviour? 
 

Be firm with him, just say no, you know, tell him what to do and do not back 
 
down against it, but it did not matter what I tried to tell him to do, he just constantly 
 
fought against it. 
 
 
 

Did this problem continue when he was at school? 
A Yes. 

 
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How did the school manage his behaviour? 
 

Well, they did not to such an extent that D was removed from class rooms.  He 
 
was stopped from playing at play time and at lunch time I had to take him home.  He was 
 
just put outside the classroom to sit at a table on his own with a school auxiliary to be 
 
taught on his own. 
 
 

I think there came a point when you found about ADHD, Attention Deficit 

Hyperactivity Disorder.  How did you find out about that condition? 
 

It was through a television programme. 
 
 
 

As a result of watching the television programme did you send off for a fact 
 
sheet? 
 
A Yes. 
 


Did you read a book on the subject? 
 
A Yes. 
 
 
 

Is it right that you spoke to somebody in a family support group? 
 
A Yes. 
 
 

Did she suggest that you contact Dr Cosgrove? 


Yes, that is right. 
 
 
 

Did you then arrange an appointment to see Dr Cosgrove? 
 

Yes, I did. 
 
 
 

When did you go to see the doctor? 

D was about 10 ½ when we went to see Dr Cosgrove, so it would be 1996. 

 
 

Yes, that would put it in the middle of 1996. 
 
A Yes. 
 
 
 

I think we know you live in Scotland. 
A Yes. 
 
 


Where did you travel to to see the doctor? 
 

The Bristol Priority Clinic. 
 
 
 

When you attended on Dr Cosgrove was it there and back in a day? 
 

Yes.  I was like in and out seeing Dr Cosgrove within half an hour. 
 


During your consultation with Dr Cosgrove what enquiries/investigations did he 
 
make? 
 

What I took down with me were school reports about D’s behaviour and what the 
 
school were trying to do to contain his behaviour within class. I gave that to Dr Cosgrove. 
 
Dr Cosgrove in turn gave me a tick questionnaire type where there was about 20 
 
questions in a box and you need to tick each box that was relevant to D’s behaviour and 
once I had completed that I handed it back over to Dr Cosgrove and Dr Cosgrove  

concluded that D had ADHD, hyperactivity. 
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Did Dr Cosgrove suggest that anything could be done to assist with your son’s 
 
condition? 
 

Yes. Dr Cosgrove suggested that D be put on Ritalin and said to me that that 
 
would more or less take away all of D’s problems relating to his hyperactivity and not 
 
being able to sit and focus in school. 
 


During the course of the consultation did Dr Cosgrove ask you any questions? 
 

Yes, he asked me some short questions like when D was born, how was he when 
 
he was a baby, did he sleep, did he eat, not much more questions than that. 
 
 
 

Did he ask your son any questions? 
 

No, he did not even acknowledge that D was there. 
 


What was your son’s behaviour during this consultation? 
 

It was quite a small room we were in and Dr Cosgrove had a desk.  I sat in the 
 
chair next to the desk and there was a couch and another chair directly behind and D was 
 
jumping over the furniture and all Dr Cosgrove said to him was, “Could you please stop 
 
jumping on the furniture, it does not belong to me”. 
 
 

Did Dr Cosgrove examine your son in any way? 


No, he did not. 
 
 
 

How much did you pay for the consultation? 
 
A £160. 
 
 
 

What, if any, arrangement was there about contact between Dr Cosgrove and you 
after the consultation? 


Dr Cosgrove arranged telephone contact two weeks after the initial appointment at 
 
the cost of £25 a telephone consultation. 
 
 
 

Did you understand that that would be the only telephone consultation or did you 
 
know whether Dr Cosgrove wished there to be further consultations after that? 

It was not clarified.  I really was not too sure how often or how long these 
 
telephone consultations would need to go on. 

 
 

Was any arrangement made about you returning to see Dr Cosgrove? 
 

No.  When I made the initial appointment I took it to be his secretary but I do not 
 
know who the female was that I spoke to over the phone had said should I require to 
 
attend a second time it would be a reduced fee of like £80.  That was all I was told. 
 


Were you in fact required to attend a second time? 
 

No, I did not go back a second time. 
 
 
 

Did you ever see Dr Cosgrove again for a consultation? 
 

No, I did not. 
 
 

Let me ask you about telephone consultations, if I may.  After that consultation at 

the clinic did your son then start to take Ritalin as prescribed? 
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Yes, he did. 
 
 
 

Did Dr Cosgrove have contact with you by telephone? 
 

Two weeks after the initial consultation he did. 
 
 
 

What did you say in the course of that conversation about your son’s behaviour? 

I was concerned.  I did see a slight change in D’s behaviour when he took the 

medication, but the more concerning bit about it was that D was tending not to eat and not 
 
to sleep, he was going all day without having any food and come bed time he was not 
 
able to relax and go to sleep. 
 
 
 

Just so we understand, so you did see some change in his behaviour. 
 
A Yes. 
 


For the better or for the worse? 
 

He did calm down, yes. 
 
 
 

He did calm down? 
 
A Yes. 
 
 

Calm down completely? 

A No. 
 
 
 

Was it to a level you would call normal? 
 

No, it was not normal, but it was containable as to the fact that it was not before. 
 
 
 

After you had told Dr Cosgrove this what, if any, arrangements were made about 
continuing medication? 


Dr Cosgrove, because I was concerned about D’s weight loss and not being able 
 
to sleep, suggested a second line drug and in his own words it would solve all the 
 
problems that Ritalin was giving D and more or less it would help him to eat, it would 
 
help him to sleep, it would take away all the side effects and his words to me over the 
 
phone were that I would not need to see another doctor regarding D’s behaviour, because 
the next set of tablets would stop that from happening. 
 
 


So there was a sleeping tablet.  Did your son start to take a sleeping tablet? 
 

It was a drug called Risperidone. 
 
 
 

What about the Ritalin, did that continue? 
 
A That 
continued. 
 


At the same dose? 
 
A Yes. 
 
 
 

The same dose? 
 

The same dose and then it would go up after the first three days.  It started off at 
 
half a tablet, then it would go up to one until D was on a maximum dose of six a day. 
 


Those tablets, was it obvious to you from the medication bottle or from what Dr 
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Cosgrove said as to what the dosage was of those tablets? 
 

The dosage that Dr Cosgrove had written down and noted on a piece of paper 
 
initially for me to take home. He had given me the prescription for Ritalin there and then, 
 
the dosage was marked on a piece of paper and after the telephone conversation he told 
 
me to increase the dose to whatever it was.  With the second drug Dr Cosgrove just sent 
 
me out a private prescription through the post and I had to go to the chemist to get it. 
 


So that was the first telephone consultation with Dr Cosgrove. 
 
A Yes. 
 
 
 

Was there a further ----- 
 

There was two, a second one, there was two telephone consultations. 
 
 

Two telephone consultations. 

A Yes. 
 
 
 

When was that? 
 

Two weeks after the first one.   
 
 
 

So about a month after the original attendance at the clinic. 
A Yes. 

 
 

What did you have to say to Dr Cosgrove then about your son’s progress? 
 

What I said to him was that I was pleased that D was starting to eat and he was 
 
starting to sleep and so far things were all right, kind of thing. 
 
 
 

What was done about dosage or drugs then? 

Dr Cosgrove had just told me to take what he had written down on the piece of 

paper and the letter that he had sent out along with the prescription, to continue to take 
 
the same dose. 
 
 
 

I think you have indicated that there was a relatively low dose at the start and it 
 
had increased to six tablets. 
A Yes. 
 
 


And six tablets was the maximum dose that he was prescribed. 
 
A Yes. 
 
 
 

How long after starting on Ritalin did your son reach that dosage? 
 

It could possibly have been about six to eight months that he could have gone up 
to 60 milligrams of Ritalin. 

 
 

So I am clear, how many times did you speak to Dr Cosgrove on the telephone? 
 

Two telephone conversations. 
 
 
 

Did there come a time when it is obvious from what you are saying, that the 
 
prescriptions for Ritalin carried on?  Who then was prescribing the Ritalin? 

It was my own GP. 

 
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Did there come a time when you changed your GP? 
 

I had initially when I stayed at my first address when I went to see Dr Cosgrove 
 
the first time, I had a different GP at that point, and then my partner and I split up and I 
 
moved home so I then got another GP who originally was my own GP from when I was a 
 
girl and I moved back into that catchment area. 
 
 

So you had returned to that area. 

A Yes. 
 
 
 

What was that GP’s name?       
 

Dr Spence.  Dr John Spence. 
 
 
 

Did Dr Spence continue the prescriptions of Ritalin? 

Yes, he did. 

 
 

And Risperidone or not? 
 
A Yes. 
 
 
 

For how long did your son take those drugs? 
 

Roughly about three-and-a-half years. 
 


How did it come about that he stopped taking them? 
 

I was getting a bit concerned about D’s behaviour.  The drug did not seem to be 
 
working as well as I thought it should have worked and he was in his last year of primary 
 
when the school contacted me again to say that D was being disruptive and could not 
 
continue in class and they were really quite concerned for him going to secondary school, 
 
so that is when I contacted my GP again and my GP just did not know what to do because 
he was not an expert of any of the medication that was given out.  He did not now much 

about ADHD, so he decided to refer me to Dr Sarah Hukin, who was an adolescent child 
 
psychologist. 
 
 
 

Let us get that name again.  Sarah Hukin.  Is that right? 
 

Yes, Sarah Hukin.  
 
 

Is ‘Hukin’ H-U-K-I-N? 

A Yes. 
 
 
 

And a child and adolescent psychologist, did you say? 
 

Yes.  Psychiatrist, sorry. 
 
 

What treatment did Dr Hukin prescribe? 


Dr Hukin decided to take D off Risperidone and introduced another drug similar 
 
to Risperidone called clonidine.  She started off with a low dose of clonidine for D and 
 
eventually that was to work up to whatever level she decided and she said to me it was a 
 
very dangerous drug, it should not be stopped immediately because it can cause seizure, 
 
heart attack, as far as I know.  D’s behaviour was still as erratic as it was before and I did 
 
not see any benefit from being on the clonidine and I wanted him taken off the clonidine.  
 


You wanted him to come off the clonidine.  Was he still on the Ritalin at this 
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stage? 
 
A Yes. 
 
 
 

How did it come about that he ceased taking drugs? 
 

I had read an article in the newspaper, in one of the local papers and it was about a 
 
support group in Edinburgh called Overload and Janice Hill, the woman that had written 
the article, had gone through an awful lot with her own daughter, behavioural problems 

and she was writing about Ritalin and how freely available it was on the streets.  
 
 
 
I then contacted Janice Hill and had spoken to her and she had raised some fears that I 
 
already had about the drug and I made an appointment to go and see Janice Hill in 
 
Edinburgh and had spoken through a lot of things with Janice.  I decided then at that point 
 
that Ritalin was not doing D any good - none of the drugs were because his behaviour 
was just going back to the way it was. 

 
 

So you, having investigated this matter, you felt that it was inappropriate for your 
 
son to continue taking these drugs? 
 
A Yes. 
 
 
 
 

Then did you speak to doctors about that? 

Yes.  I spoke to Sarah Hukin about it and she more or less said, “Well, Mrs D, it is 

your choice if you wish to take your son off these drugs and want to go down another 
 
avenue.”  I was going to go down the avenue of vitamin tablets and stuff like that, with 
 
the Overload network.  I was going to see a Professor Steve Baldwin.  My son saw Steve 
 
Baldwin once before he was killed in a train crash. 
 
 
 

That is to say Dr Baldwin, not your son, was killed in a train crash? 
A Yes. 

 
 

Sorry, just so we are clear. 
 

My son saw him once and he was unfortunately killed in a train crash, so after that 
 
I was kind of left to my own devices to try and work things out because there were no 
 
other services available.  
 
 

In any event, your son came off those drugs? 

A Yes. 
 
 
 
 

Could I ask you to look at one document that I think you may have been asked to 
 
look at before when you gave evidence which is not in the bundle.  It is one of the 
 
exhibits, D1, which is one of the exhibits produced on the last occasion. 
 

MR MORRIS:  If it is of any assistance I have had copied D1 in case the Committee did 
 
not retain it. 
 
 
 
THE CHAIRMAN:  That would be helpful because the Secretariat has retained only one 
 
copy.  The Panel members will be without.  (Copies produced
 
 
MR PEARCE: Mrs D, is this a letter you wrote to Dr Cosgrove dated 23 September 

1996? 
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A Yes. 
 
 
 
 

I will just read it through quickly so that we can refamiliarise ourselves with it: 
 
 
 
“I am writing to you to apologise for the delay in sending 
 
your fee of £54.00.  I have recently moved house and 
changed my doctor so things are a bit hectic at the 

moment.  D is doing very well with both drugs, Ritalin 
 
and Risperdal (sic).  My new doctor, who’s name is Dr 
 
Spence, Gilbertfield Street, Ruchazie, Glasgow, is very 
 
helpful and has no objections to prescribing the drugs.  I 
 
am not on the telephone yet but hope to be in the near 
 
future.  I wish again to thank you so very much for your 
help.  If it had not been for you I think D would probably 

be in care.  I do not want to break contact with you and I 
 
will send your money as soon as possible.” 
 
 
 
Old and new addresses are given. 
 
 
 
“Thank you again so very much and I hope to be able to 
speak to you soon.  Kind regards.” 

 
 
It is apparent from the tone of that letter that at that stage you were appreciative of Dr 
 
Cosgrove’s efforts to assist your son? 
 

Yes, that is right.  
 
 
 
MR PEARCE: Thank you.  I have no further questions at the moment.  Mr Morris may 
have some. 

 
 
Cross-examined by MR MORRIS: 
 
 
 
 
 

Mrs D, 1996 was a long time ago.  Would you accept that your recollection now 
of events then perhaps is not entirely perfect? 
 

It depends on what you are putting forward to me.  I could not possibly answer 

that question.  
 
 
 

For example, you suggested that you had two telephone conversations with Dr 
 
Cosgrove.  I suggest it was three? 
 

No, it was two.  
 


Are you sure about that? 
 
A Yes. 
 
 
 
 

You talked about a maximum dosage of six tablets? 
 
A Yes. 
 
 
 

Of Ritalin a day.  Who prescribed that dosage? 


Dr Spence.  
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Do you recall the dosage that Dr Cosgrove recommended for your son? 
 

Initially it started off at half a tablet to one tablet to possibly three tablets a day.  
 
 
 

I would like to see what you have to say about some of the documents that were 
 
created at the time in 1996 and whether or not you accept what was put in them.  I 
wonder if you could have with you a copy of C8, which you may have.  You 

will need to turn up tab 6.  You have got D1.  I would like you to have before you a 
 
bundle of records from D’s, your son’s, general practice records, together with one 
 
document from the psychiatric records.   
 
 
 
THE CHAIRMAN:  This will be D30. 
 
 
MR MORRIS:  The final document is a chronology headed, “Patient D Chronology”. 

 
 
THE CHAIRMAN:  This will be D31. 
 
 
 
MR MORRIS:  Mrs D, can I explain that that chronology is not an original document.  It 
 
has been created by me collating notes taken from your son’s records and if I have got it 
 
wrong, no doubt you will correct me as we work our way through it.  Could I just assist 
you and members of the Committee with the bundle D30.  There is pagination, although 

there is an omission on the second page.  It is the second page of a letter from Dr Steer, 
 
consultant paediatrician, to Dr Spence.  That did not appear in the copy document that I 
 
had, so perhaps it could be called 140A.  Apart from that hiatus, the pagination continues 
 
in order until we get to the penultimate three pages, when you will see the pagination 
 
reverts backwards to 119 to 121, that is notes of an external case conference. 
 
 
The explanation for that is that they are taken from a bundle of psychiatric notes, whereas 

the remainder of the notes are taken from the GP records. 
 
 
 
Mrs D, can I take you back in time, then, to before you heard about Dr Cosgrove, back to 
 
early 1996 and to the notes of a case conference that was held and conducted or chaired 
 
by Dr Joanne Barton.  You will see that at pages 119 to 121, at the very back of that 
bundle D30.  Do you see that?  Headed, “Not to be circulated without the consent of the 
 
author”? 


Sorry, what page was that? 
 
 
 

119 to 121.  Right at the very back.  
 
 
 
THE CHAIRMAN:  The witness is confused.  It is the bundle that starts with the heading, 
“Paediatric Department, Kirkcaldy Acute Hospitals” and it is the last three sheets in the 

bundle.  Have you got it? 
 

I have got it, thank you.  
 
 
 
MR MORRIS:  Is this right, Mrs D, that your son had been seen by another consultant 
 
psychiatrist, Dr Robinson, and she had diagnosed a conduct disorder? 
 
A Yes. 

Q       You were not happy about that diagnosis and asked for a second opinion? 
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A       That is right. 
 
  
 
Q       And you received that second opinion from Dr Barton? 
 
A       Yes, that is correct. 
 
  
 
Q       And before that second opinion was given, Dr Barton recommended that your son 
come in for some inpatient assessment? 

A       Yes. 
 
  
 
Q       I think what we have there is the Case Conference that was conducted after that 
 
inpatient assessment and I believe you specifically asked to see these notes, do you recall 
 
that? 
 
A       No, I have never seen these notes.  This is the first time I have seen them. 
  

Q       Right.  Can I just take you to the second page of that document under the heading 
 
"Family Work", do you see that? 
 
A       Yes. 
 
  
 
Q       Now, in the third line the author says: 
 
  
"It is very clear from the discussions with Mrs D that the major 

issue for the family concerning D is the nature of the diagnosis". 
 
  
 
I am sorry, perhaps I ought to give the date of this which is 3 April 1996: 
 
  
 
"... the major issue is the nature of the diagnosis and, therefore, 
 
the nature of the treatment that the diagnosis will elicit.  Mrs D 
does not accept that the diagnosis provided by Dr Robinson and 

Dr Barton of mixed disorder of emotion and conduct is correct 
 
and feels very strongly that the diagnosis fits the description of 
 
Attention Deficit Disorder, as described by Dr Chris Green.  Mrs 
 
D has also been involved in discussions with the local ADHD 
 
Support Group.  Therefore, mother is very keen for D to be tried 
on a course of Ritalin to see whether this alleviates some of the 
 
difficulties she is clearly experiencing at home.  It is clear that 

Mrs D feels she is not getting the help she needs from the 
 
Department of Child and Family Psychiatry and what has been 
 
offered so far is not seen as appropriate". 
 
  
 
Is that an accurate account of what you were thinking at the time? 
A       Yes. 

  
 
Q       I think it goes on to say: 
 
  
 
"Mrs D did indicate that she would be willing to work with a joint 
 
package of help for the management of D if it did include the use 
 
of Methylphenidate", 
  

 which as you probably know is Ritalin? 
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A       Yes. 
 
  
 
Q       It is right, is it not, that I think Dr Barton was not prepared to go down that route 
 
and agreed effectively with Dr Robinson's diagnosis? 
 
A       Yes, that is correct. 
 
  
Q       And she says over the page on 121: 

  
 
"It is difficult to see how the present situation can be moved on 
 
with respect to the family's contact with the Department until 
 
there is agreement or consensus on the diagnosis and treatment 
 
thereof.  It is clear that, if the Department do not provide 
 
something acceptable to Mrs D, she will continue to be active in 
seeking out other agencies who may provide a diagnosis and 

treatment that is more acceptable to her". 
 
  
 
And they go on to say, the authors, that the diagnosis is confirmed, namely that of mixed 
 
disorder of conduct and emotion, and: 
 
  
 
"It was felt that the treatment model should again be carried out 
on an out patient basis by the local community psychiatric team.  

The In Patient Team will urge Mrs D to reconsider the help 
 
offered by Dr Jean Robinson, particularly on an individual basis 
 
for D, as he is clearly very confused and unhappy, which is very 
 
much affecting his relationship with his family ...", 
 
  
 
and they effectively discharged your son on 4 April, with a recommendation to continue 
involvement with the local team, and I think you said that you had a meeting with the 

Ward Manager to let you know what they were thinking? 
 
A       Yes. 
 
  
 
Q       And just as confirmation of Dr Barton's view, if we look at the GP records, 174 to 
 
175, a letter from Dr Barton to your GP Practice I think, Dr McColl, dated 7 May 1996.  I 
do not know whether you have found that? 
 
A       Yes. 

  
 
Q       When I think she confirms her view that she agreed with Dr Robinson in relation to 
 
the diagnosis and says in the third paragraph: 
 
  
 
"It is my feeling that Mr and Mrs D continue to have difficulty 
accepting this diagnosis, feeling that D's primary problem is one 

of Attention Deficit Disorder and that he requires treatment with 
 
Ritalin ... Mr and Mrs D, however, are, I understand, intent on 
 
pursuing a referral to Dr Cosgrove in Bristol who I understand 
 
offers private consultations regarding diagnosis of ADD or 
 
ADHD". 
 
  
So, that was May - the beginning of May.  I think a little  earlier, is it right, if we look at 

D1, you had written to Dr Cosgrove on 26 April - it is the back page of D1 - confirming 
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the appointment you had made for 21 May? 
 
A       Yes, that is right. 
 
  
 
Q       And then you travelled down to see Dr Cosgrove on 21 May, and if you look in C8 
 
- and I am sorry to flit backward and forward between documents - at Divider 6, Dr 
 
Cosgrove has written a letter to your GP, Dr Taylor, on that same day.  Now you have 
told us that your recollection of this consultation is that you were in and out within 

half-an-hour, he asked you some short questions about the date of birth, how D was 
 
sleeping and eating and got you to complete a questionnaire and then gave you a 
 
diagnosis of Attention Deficit Hyperactive Disorder? 
 
A       Yes. 
 
  
 
Q       He asked you a lot of detailed questions, did he not, and you gave a very full 
history of your son's condition? 

A       It was not detailed questions.  It was questions in general about D's behaviour. 
 
  
 
Q       Well, let us look at some of the detail he sets out in the letter to your GP and see 
 
whether or not you agree with the detail and seek to identify where that detail would have 
 
come from.  It starts off, "Mrs D heard about ADHD from a parent of an ADHD child and 
 
made contact with me via the ... support group.  I was able to see D with his mother this 
afternoon".  Now, did you tell him about how you had come to make contact through the 

support group? 
 
A       Dr Cosgrove? 
 
  
 
Q       Yes? 
 
A       I probably did, yes. 
 
  
Q       "Mrs D told me that D has poor concentration, a short attention span, is very 

distractible and frequently bored".  Is that an accurate summary of what you were telling 
 
him? 
 
A       These were all tick questionnaires that were written in a box that I ticked off.  
 
When you see Dr Cosgrove's questionnaire typed, there was about 20 questions written 
 
down and it is "Easily bored?", "Loses concentration?", and you tick them as you go 
along as to what affects your son - your child. 
 
  

Q       "He concentrates [very] poorly at school where he hardly puts pen to paper"? 
 
A       That was also given in a school report. 
 
  
 
Q       "He is hardly learning anything", school report? 
 
A       Yes.  I had taken down school reports and behaviour reports that I had received 
from the school.  I took them down to Dr Cosgrove. 

  
 
Q       "He is impulsive not only when in a temper.  He has jumped out of windows, lit 
 
fires and once climbed on to the roof  with roller skates on".  Where did that information 
 
come from? 
 
A       That has probably come from myself. 
 
  
Q       Right.  "He has daily tempers and will smash up furniture in the house such as two 

coffee tables, two pot plants, ripped mother's briefcase and poured hot tea on the floor - 
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all in one temper"? 
 
A       Yes, that is correct. 
 
  
 
Q       All from you? 
 
A       Yes. 
 
  
Q       "He is aggressive to his two siblings, and is frequently fighting in the playground at 

school".  Well, the report of aggression to his two siblings --- 
 
A       No, it was not his two siblings. 
 
  
 
Q       ... that was his brother and sister? 
 
A       Yes, but his sister was a baby at the time.  He never went near her.  She was only 
 
months old.  But my older -- my other child who is now twelve, yes, he could be pretty 
rough with him. 

  
 
Q       Right.  I think at the time he was four, was he not? 
 
A       Yes.  When my second son was born, yes. 
 
  
 
Q       "... frequently fighting in the playground at school", would that have come from the 
 
school reports? 
A       Yes.  Well these things were all written down on school reports and, because D was 

so disruptive in class, he was constantly on what they call a behaviour programme where 
 
it was written in detailed boxes every day of his behaviour at playground, at lunchtime, in 
 
the classroom and how the teachers dealt with it and did he get a happy or a sad face that 
 
day.  And so it was all very detailed, and that is the reason I took them down to Dr 
 
Cosgrove because they were so detailed to let him see exactly what was happening in D's 
 
life at school. 
  

Q       Right.  "He has no friends as a result of acting immaturely, and annoying, shouting 
 
and swearing at them".  Has that come from you? 
 
A       Yes, probably. 
 
  
 
Q       I am sorry? 
A       Probably, yes. 
 
  

Q       "He has low self-esteem and does not like himself thinking that he is stupid".  
 
Again, your assessment? 
 
A       Well I could possibly have said that, but these are also questions that were in Dr 
 
Cosgrove's questionnaire. 
 
  
Q       "He has no motivation to do what needs to be done or what he is asked to do", your 

source again? 
 
A       Again, that could be the questions written down in the  box. 
 
  
 
Q       "He is always on the go, never sitting still and runs when he could walk"? 
 
A       That could probably be mine. 
 
  
Q       "He is clumsy and constantly trips and falls", you? 

A       It could be me, or it could be the questions that were in the box.  There were so 
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many questions and they were all similar to what you are explaining. 
 
  
 
Q       "His mother said that for the six hour trip to Bristol his bottom was on the seat for 
 
just 15 minutes!"? 
 
A       That is right, because Dr Cosgrove made a comment to another member who was 
 
passing by in the corridor and he said, "This little chap's been travelling down from 
Glasgow for six hours and hasn't sat down once", and they both laughed. 

  
 
Q       And did you tell him about what the nursery school staff thought, and indeed you 
 
thought, that you considered him to be hyperactive as a preschooler? 
 
A       Yes. 
 
  
 
Q       And I think it was in that context that did you report the comment by the nursery 
school member of staff that he had "ants his pants"? 

A       That is correct. 
 
  
 
Q      "And she still ...", that is a reference to you, "... considers he is hyperactive", and he 
 
says that he would certainly agree with that observation of him today.  Again, did you tell 
 
him that you considered him to be hyperactive? 
 
A       I would be lying if I said "Yes" or "No". 
  

Q       You cannot remember? 
 
A       I can't really remember, no. 
 
  
 
Q       "He has been suspended twice so far in his school career", is that an accurate report 
 
from Dr Cosgrove? 
 
A       Yes. 
  

Q       And that would have come from you, would it not? 
 
A       Yes.                        
 
 
 

Then Dr Cosgrove gives his  considered diagnosis and then he describes him 
 
being like his biological father.  He then goes on to give a description of father: 
 
 
 
“Poor concentration and poor motivation at school and left unable to read, write or 

spell.  He is currently an alcoholic”. 
 
 
 
Did that information come from you? 
 
A Yes. 
 
 

Then he sets out the recommendation of Ritalin and what he is recommending by 

way of dosage.  I think you said that it was to start off with at half a tablet a day, is that 
 
your recollection? 
 

Yes, from what I can remember. 
 
 
 

I think what he says here is to start off 5 milligrams, I think that should be a.m., 
 
not o.m., and 5 milligrams at 4 p.m.  5 milligrams is half a tablet, so that is a total of one 
tablet a day for two days, followed by 5 a.m., 5 lunchtime, 5 4 p.m., 5 7 p.m. so that is 

doubling the dose to two tablets a day for four days.  Do you recall that? 
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A Yes. 
 
 
 

Followed by 10 a.m., 5 lunchtime, 10 4 p.m., 5 7 p.m. which would take it up to 
 
30 milligrams (in other words, three tablets a day) until the first telephone appointment.  
 
Do you accept that those were the recommendations he gave? 
 
A Yes. 
 


He goes on to say:  
 
 
 
 
“I will have a series of telephone appointments with his parents in order to 
 
monitor his progress and to find the optimum dosage and frequency through the 
 
day.  I have told his mother that I am raising the dosage faster than I normally do 
 
because of the seriousness of the current situation.  Hopefully, the 7 p.m. dose will 
improve his sleep pattern since he does not get to bed nor to sleep until after 

midnight.” 
 
 
 
I think you mentioned that he asked you about his sleeping patterns.   
 
A Yes. 
 
 
 

Was that right, that at the time he was not going to bed nor getting to sleep until 
after midnight? 


Yes, it has always been the case with D since he was a small child. 
 
 
 

Then he goes on to talk about Ritalin in the next paragraph four lines down: 
 
 
 
“It does tend to cause a fall in appetite and D’s is poor because of his 
 
hyperactivity and poor concentration so treatment may well improve his food 
intake”. 

 
 
Did you tell him about your son’s poor appetite? 
 

It was all in  the case scenario when D was born that he did not eat and did not 
 
sleep so that was well documented from when he was a baby. 
 
 

But beyond the school reports did you take any other records down with you to Dr 
 
Cosgrove? 


Not that I can recall, no.  I think I may have taken down one, but I am not too 
 
sure, from Dr Robinson who was the first doctor that I saw before I saw Joanne Barton, 
 
because I remember Dr Cosgrove saying that Conduct Disorder was ADHD. 
 
 
 

He comments on the inpatient assessment of Yorkhill, I think, in the third 
paragraph on that page.   

 
 
 
“He was admitted to Yorkhill for four weeks in March 1996 under the care of Dr 
 
Joanne Barton.  His mother told me that a diagnosis of Conduct Disorder was 
 
made and that she was informed that D needs cognitive therapy.  He was also seen 
 
by Dr Jean Robinson for three appointments and, once again, Conduct Disorder 
 
was diagnosed and cognitive therapy recommended.  This cognitive therapy has 
not yet started.  His mother told the child psychiatrists that her son would not be 

able to concentrate well enough to benefit from counselling, and I am in full 
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agreement with her on this”. 
 
 
 
Again, is that an accurate record of what you were telling him at the time? 
 

Yes, it would have been. 
 
 
 

Then there is a discussion about Ritalin and the final paragraph on that page: 
 

 
“I have made out a private prescription for Ritalin but I know that his parents 
 
would very much appreciate it if you would copy it down on to an NSH scrip.  On 
 
each occasion that I alter the dosage, I will send them a fresh private prescription 
 
to bring to you.  You may care to keep them in his file”. 
 
 
 
Just on that subject of prescriptions, can you look back, please, to page 1 of that tab 6.  
We have here a document setting out a dose of Ritalin on a piece of headed notepaper 

from the Bristol Priority Clinic, clearly, a subsequent letter/prescription from 21 May 
 
dated 5 June and you will see written “Specimen.  This is not a prescription” underlying it 
 
all.  Do you recall receiving his recommended doses on paper like that? 
 

I cannot remember. 
 
 
 

We will come back to that. That is later on in the history so I do not want to get 
out of tune.  Mrs D, all this information that you gave, whether by way of written 

questionnaire or in questioning by Dr Cosgrove, would have taken considerably longer 
 
than half an hour, would it not? 
 

No, it did not. 
 
 
 

But in any event did you think he was listening to you and taking in what you 
 
were saying? 

Yes, of course. 

 
 

Then on 27 May (it is not on the chronology but if we look to the bundle D1) I 
 
think you write again to Dr Cosgrove, this is the second letter, advising Dr Cosgrove that 
 
D had started his medication on Friday 24 May: 
 
 
 
“So far so good. The only side effect I can see at the moment is his appetite which 
 
you told us about.  The other thing I need to mention is that my own doctor will 

not prescribe Ritalin for D. What they have said to me is that I have gone outwith 
 
the NHS and gone against Yorkhill Hospital, Glasgow and I will have to get my 
 
prescriptions from you privately.  I would be most grateful if you could advise me 
 
what to do as I do not want D to run out”. 
 
 
So you were not getting much help from, I think, was it Dr Taylor, your GP at that time? 


Yes, that is right. 
 
 
 

Would it be fair to say that she effectively washed her hands of you and the 
 
treatment of your son? 
 

In the treatment of Ritalin, yes. 
 
 

If we look, please, at the GP records, D30, at page 213, again, Mrs D, I appreciate 

these are records you may not have seen before, I do not know, can you help?  These are 
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handwritten records by your son’s GP.  Have you seen these before? 
 

No, I have not. 
 
 
 

There is an entry there for 4 June 1996 which if I have got the writing correctly 
 
says:   
 
 
 
“Spoke to Dr Barton re Ritalin.  She transferred me to Dr Robinson. She agreed 

that Ritalin could be prescribed and so I will agree to do that” or “do this”.   
 
 
 
You presumably on 4 June would not have attended with D to speak to Dr Taylor or 
 
would you?  Can you help us with that? 
 

I cannot remember. 
 
 

What I suggest is that on 3 June you made your first phone call to Dr Cosgrove 

and told him that your son had been on Ritalin for 11 days, was very well, but was better 
 
on 10 milligram tablets and when confined to the five milligram tablet his aggression 
 
would increase. 
 

I have never telephoned Dr Cosgrove to speak to him over the phone.  I have only 
 
ever spoken to a female to make an appointment, met with him when I went down to the 
 
initial consultation, two telephone calls.  Everything else has been done by letter.  I would 
not know how to telephone the doctor and suggest that he give D a higher dose of Ritalin. 

 
 

Have you never spoken to Dr Cosgrove since ---- 
 

Twice on the phone when he called me in his consultation. 
 
 
 

He called you? 
 
A Yes. 
 


Did he call you on 3 June? 
 

He may  have done. Does that tie in with two weeks after when I initially saw 
 
him?  If it does then it will be.  I said he called me two weeks after the initial 
 
consultation. 
 
 

Your initial consultation, we know, was on 21 May, approximately two weeks.  
 
(The witness nodded).  Just help me with the conversation.  You have written saying that 

your son started Ritalin on 24 May, so by 3 June, if my arithmetic is right, he would have 
 
been on Ritalin for 11 days or thereabouts. 
 
A Yes. 
 
 
 

You were, I suggest, commenting then he was very well, but better on 10 
milligrams three times a day. 


Where does it say that? 
 
 
 

You will not see it in the letter.  I am just suggesting that that is the gist of your 
 
telephone conversation. 
 

No. I do not know anything about medication.  It was up to Dr Cosgrove to advise 
 
me.   I was telling him how I felt D was on the dose that he had given him.  It was then up 
to Dr Cosgrove to decide if he increased the dose.  It was not up to me.  I did not know 

enough about the drug or anything about the drug. 
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All I am suggesting is that you were telling him that on the larger dose he was 
 
better than on the smaller half tablet dose where his aggression was not reducing. 
 

That is possibly true, yes. 
 
 
 

And that his appetite had fallen.  Do you recall telling him that? 

Over the phone, yes. 

 
 

Did he ask you about your son’s weight? 
 

No, not that I can recall, but obviously if you are not eating you are going to lose 
 
weight. 
 
 
 

I suggest he asked you about your son’s weight and that at that stage it did not 
concern you. 


I do not believe that to be true, because I was concerned that D was not eating 
 
properly because of the drug and I said this over the telephone to Dr Cosgrove.  That was 
 
why Resperidone was introduced, not because Ritalin was not working.  Ritalin was 
 
doing what Dr Cosgrove said it would do.  It would calm D down and help him 
 
concentrate in class.  He did tell me that D’s appetite could go and it may stop him from 
 
sleeping and that is exactly what it did do and when Dr Cosgrove phoned me I explained 
this to him.  That is when he suggested he introduce a second line drug. 

 
 

We will come to that.  I suggest that was not suggested at this telephone 
 
consultation.  You told him that as far as sleeping was concerned, he was still awake up 
 
until 1 or 2 a.m. 
 

That has always been the case with my son.  He has never slept since he was a 
 
baby. 
 


You confirm what you said in your letter of 27 May that your GP was at that stage 
 
(and I am suggesting this is 3 June) refusing to prescribe, but as far as you getting on with 
 
your son was concerned, at that stage it was fantastic. 
 

Yes. There was a marked difference in his behaviour, as Dr Cosgrove said the 
 
drug would do. 
 
 

Dr Cosgrove agreed to call you again when the situation as to whether or not you 

were going to get a prescription from your GP was sorted out.  Do you recall that? 
 

I had two telephone calls with Dr Cosgrove.  When I had gone to see my GP after 
 
initially seeing Dr Cosgrove they were not going to prescribe Ritalin and then changed 
 
their mind and decided to prescribe Ritalin.  The second telephone call I believe ---- 
 
 

Can I just stop you there, Mrs D, and just help you on that? 

A Yes. 
 
 
 

The change of mind, I think, occurred, did it not, on 4 June, if we look at Dr 
 
Taylor’s notes at 213, where she says she spoke to Dr  Barton about Ritalin and then she 
 
was put on to Dr Robinson who agreed that Ritalin could be prescribed, “so I will agree 
 
to do that”?  So as from 4 June is it right that Dr Taylor was agreeing to prescribe Ritalin 
for your son? 

A Yes. 
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Indeed, we see another entry on that page also dated 4 June where the Ritalin dose 
 
that Dr Taylor was agreeing to prescribe is set out there - 10 milligrams twice a day plus 
 
5 milligrams twice a day, so that is two full tablets and two half tablets, taking it to 30 
 
milligrams a day. 
 
A Yes. 
 


And the times are set out there. She has noted above that:  
 
 
 
 
“Ht and wt 3 monthly” then an arrow to “P/N” 
 
 
 
which I suggest probably means practice nurse.  Were you there on 4 June to pick up the 
 
prescription, can you recall that? 

Of course, yes. 

 
 

Do you recall being told that your son’s height and weight would be checked on a 
 
three month basis. 
 
A Yes. 
 
 
 

Can I suggest that on 5 June two things happened.  First of all if we look at page 
212 in that bundle, we see, I think it is an entry for 5 June, we see Dr Taylor again when 

she notes, “Has been on Ritalin, ‘I feel good’, no problems.  Then underneath, I think that 
 
may be the words, “Mum, slightly reduced appetite” and your son’s height and weight 
 
were noted. 
 
Does that ring any bells at all? 
 

Yes, if it is written down there I was there with the doctor.  
 
 

On the same day I suggest Dr Cosgrove telephoned you again and you reported to 

him that Dr Taylor had agreed to prescribe and you told him the dose that was being 
 
given, namely 10mg, 5mg, 10mg, 5mg during the day and that things were going well.  
 
Can you recall that? 
 

I recall speaking to Dr Cosgrove, yes, but I do not recall on what actual date it 
 
was. 
 
 

I can understand that? 


It was not Dr Taylor who set out the prescription, it was Dr Cosgrove.  She was 
 
acting on his. 
 
 
 

He had given a recommendation in a letter to Dr Taylor? 
 
A Yes. 
 


Did  you, during the conversation, tell him what the response from the school was, 
 
namely that the teacher cannot believe the change? 
 

I do not recall saying that.  
 
 
 

Just to help you on that, Mrs D, can I take you to the second letter that we have in 
 
the bundle from Dr Cosgrove in C8 at divider 6?  It is dated 17 July, 1996.  It is page 5 of 
that divider, pages 5, 6 and 7.  It is dated 17 July.  Writing to your GP: 

 
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“Since I wrote to you last, I have had three telephone 
 
appointments with Mrs D regarding D.  I have taken the 
 
Ritalin dosage up from 5mg twice a day to 10mg om; 5mg 
 
lunchtime, 10mg 4pm; 10mg 7pm” 
 
 
 
- so that is 30 mg a day -  
 

“Initially D’s aggression ceased on a 10mg dose and his 
 
mother was very pleased with 30mg per day.  On this 
 
dose, his teacher could not believe the change in him.” 
 
 
 
Do you recall telling Dr Cosgrove that? 
 

I do not recall but I am not saying that that is not true.  It could possibly have been 
said over the telephone.  I do not know.  

 
 

That, I suggest, was said at that second telephone consultation on 5 June.  Just 
 
carrying on, what I suggest you were telling him at that stage, at home he got angry when 
 
the tablets wore off and that the 5mg tablet was not as good as the 10mg tablet.  Would 
 
that sound right? 
 

Well obviously yes, because if the half a tablet was not as strong as the 10mg 
tablet then I would probably say that was correct, I did say that. 

 
 

Were you telling him at that stage that your son’s appetite had gone down, 
 
certainly at breakfast and lunch and that he would only really eat at supper time? 
 

Yes.  He would only eat later on at night, once the tablets had worn off, which 
 
could be about nine o’clock at night. 
 
 

Were you asked about his weight and did you tell Dr Cosgrove that it was five-

and-a-half stone? 
 

I must have done.  
 
 
 

And commented, “He always looked thin, never been a great eater”? 
 

He has not been a great eater.  That is something I have always said. 
 
 

You were asked, I suggest, about his sleeping patterns and you mentioned that he 

would get to sleep about 11.30 pm, that the half a tablet of Ritalin at 7pm would last for 
 
about one-and-three-quarter hours? 
 
A Yes. 
 
 
 

That is right? 
A Yes. 
 

 
 

You expressed an intention of going to see Dr Barton to tell her what had 
 
happened to your son on this course of treatment? 
 
A Yes. 
 
 
 

Did you, in fact, go and see her or did you subsequently write? 

No, I wrote a letter to her.  

 
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What I suggest happened also on that date was that Dr Cosgrove suggested 
 
increasing the Ritalin dosage up to 35mg.  That is to say, converting the half tablet at 7pm 
 
to a full tablet at 7pm. 
 
A Yes. 
 
 
 
 

Do you recall that? 
A Yes. 

 
 

That, I suggest, was 5 June.  Then if I can take you to a letter your GP wrote, Dr 
 
Robinson, on 21 June.  We will find that in the other bundle, D30 at page 168: 
 
 
 
“This young boy came out of Yorkhill in March of this 
 
year and I understand you will be offering the family 
further input. You will have seen the letter describing his 

visit to the clinic in Bristol and he is now on 
 
Methylphenidate Hydrochloride 35mg a day.  His mother 
 
and D himself both report a marked improvement.  
 
However, it is agreed that it would be welcome to have 
 
input in your department as well.” 
 
 
Then on 11 July, if you could go in that same bundle to 212, it is not very easy to read, 

Mrs D, but what I am suggesting there is a note of a prescription being given to you for 
 
your son for 112 tablets of Ritalin and the dosage being set out there as 1 qd - four times a 
 
day, which would suggest a total not of 35mg a day but one of 40mg a day.  The 
 
comment underneath that, “Long talk with Mum about prescribing.”  Is that Dr Taylor’s 
 
consultation or was it another doctor? 
 

Excuse me, which part are you reading? 
 


I am sorry? 
 

What part are you reading here? 
 
 
 

I am sorry.   Page 212.  If you look down from the top there is an entry which says 
 
11/7/96.  Do you see that? 
A Yes. 
 
 
 


It appears to say, prescribing treatment - it looks like an ‘R’ with a cross at the 
 
bottom, “Methylphenidate, 10mg x 112” and then “1 qd”.  What I am suggesting is you 
 
were being told by your GP that the dose was to be one tablet four times a day 
 

Yes, possibly, yes. 
 
 

Were you only seeing Dr Taylor at that particular surgery, or were there other 

practitioners at that surgery 
 

Dr Taylor was a partner of the surgery.  It was Dr McCall.  
 
 
 

I do not know whose writing that is, but one of the doctors? 
 

It was mainly Dr McCall that I saw.  Dr Taylor was a female doctor.  
 
 

Mainly Dr McCall that you saw? 


Yes.  He was not too happy about putting D on Ritalin. 
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He seemed to be increasing the dose, therefore, from 35mg a day to 40mg a day? 
 

I do not know if that was Dr McCall or that was Dr Spence, because I had moved 
 
home and it may have been Dr Spence.  I am not sure. 
 
 
 

I think if we follow the chronology we may find that you did not change doctors 
until the end of July, but let us see where we go on that.  You then have, I suggest, a third 

and what transpired to be a final telephone conversation with Dr Cosgrove on the 17 July, 
 
after which he writes the letter that we see at divider 6, page 5.  Perhaps if you could go 
 
back to that letter, please.  What I am suggesting is that between the month that had 
 
transpired between 5 June and 17 July, things had deteriorated somewhat inasmuch as his 
 
aggression had returned and that his temper had increased and he was being violent again. 
 
 If we look at the letter in the first paragraph about six lines down where Dr Cosgrove 
says: 

 
 
“His aggression has returned and he is hitting his mother 
 
now on a daily basis.  Yesterday he would not take his 
 
morning dose of Ritalin and then came down to set fire to 
 
the living room carpet.  He smashed the telephone at the 
 
same time, together with kicking and spitting.” 
 

Do you recall telling Dr Cosgrove about that on the telephone? 
 

I must have told Dr Cosgrove otherwise he would not have known.  I do not 
 
believe it was on the telephone.  I can only remember speaking to him twice. 
 
 
 

Dr Cosgrove commenting:   
 
 
“Clearly he needs the Ritalin but I cannot increase the 

dose at present because his appetite has fallen 
 
considerably and he is awake until after midnight.  I have 
 
therefore decided to add low dose Risperidone to the 
 
Ritalin and have asked his mother to give him” 
 
 
and then sets out a schedule, 0.5mg twice a day for two days, then 0.5mg three times a 
 
day for the next three days and then 0.5mg four times a day thereafter until a further 

telephone appointment in about ten days after starting the Risperidone.  As you say, he 
 
said to you that the Risperidone would deal with the aggression and help his thinking and 
 
help him sleep and increase the appetite? 
 
A Yes. 
 
 
 

Did he invite you to write to him telling him when the Risperidone was started? 


Not that I recall, no. 
 
 
 

Going back to your son’s GP records, again to page 212, if you would, please.  
 
We have got an entry there, I think probably Dr Taylor’s entry, mentioning that she had 
 
received a letter addressed to her, she had received a letter from Dr Cosgrove 
 
recommending additional Risperidone.  Dr Taylor discussing that with a prescribing 
advisor, advised against prescribing.  I cannot read the next word, something like,   

 
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“You were advised of that” - something - “above to Mrs 
 
D.  In addition the product is unlicensed for this use and 
 
none of us has any expertise” - something - “for this.  
 
Therefore, would be unwise to prescribe.  Accepting of 
 
reasons.   Mrs D will speak to Dr Cosgrove.”  
 
 
Do you recall speaking with Dr Cosgrove the following day, 25 July and telling Dr 

Cosgrove that your GP was refusing to prescribe Risperidone? 
 

No, because I had written Dr Cosgrove a letter.  I was in the process of - I had got 
 
a private prescription sent through the post by Dr Cosgrove for Risperidone and there 
 
was, I cannot recall how many tablets, there may have been about 20 or 30 tablets on a 
 
private prescription.  I had gone to Boots the Chemist and bought about ten tablets and 
 
had gone to see my GP.  The GP had advised me no, they were not prepared to prescribe 
the other drug and also advised me because I had gone privately, this was me suffering 

the consequences of going privately because they did not have enough knowledge of the 
 
drugs and were not prepared to prescribe them for me.  Between that space of time, about 
 
three weeks, I was moving home and I had moved back over to where I originally came 
 
from and I wrote to Dr Cosgrove to say that they were not prepared to prescribe 
 
Risperidone. 
 
 
Q Right. 
 


Then I registered with my new GP and I spoke to him about it he was prepared to 
 
prescribe both drugs for D. 
 
 
 
Q       Right.  Do you recall when you wrote to Dr Cosgrove?  I am looking at D1, and the 
 
only letters that we have got is your initial one of April which we have looked at, 27 May 
 
which was in relation to Ritalin at that stage and the only other one we have is 23 
September which is considerably later than this.  Do you think you wrote this at around 

--- 
 
1.  A       I think it is the 20 September one, because from when Dr Cosgrove gave me 
 
the private prescription for Risperidone I am going to my old GP who would 
 
not prescribe it, I had enough Risperidone at that point to do me and, when I 
 
moved home, my new doctor prescribed it and that is in the letter as far as I 
 
remember. 

  
 
Q       Right.  You see, you do not say in your letter of 23 September that your GP had 
 
refused to prescribe Risperidone.  You are just confirming that Dr Spence has no 
 
objection to prescribing both the drugs - Risperidone and Ritalin.  So, you do not recall 
talking to Dr Cosgrove and telling him about the refusal to prescribe Risperidone by Dr 
 
Taylor? 

A       No, I cannot remember the first conversation that I had with Dr Cosgrove regarding 
 
Ritalin.  What he had said to me at that point was that, if the doctor would not prescribe 
 
me the Methylphenidate, he would then be able to prescribe me a cheaper drug called - 
 
and correct me if I am wrong - dexamphetamine, it may have been, which is a cheaper 
 
form of Ritalin. 
  
 
Q       Right. 

A       Risperidone was not brought up at that point.  He more or less said that, if the 
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doctors were not prepared to prescribe for me, he would give me a cheaper drug to buy to 
 
save me money, from what I can remember. 
 
  
 
Q       Well, let us move on.  I suggest that at about 30 July was when you changed over 
 
GPs.  If we look at the GP records, just before we get to 30 July if we look at 26 July Dr 
 
Taylor, four lines or five lines down, has asked for an urgent referral of D to Dr 
Robinson.  There is a note then on 30 July: 

  
 
"Spoke to Dr Robinson.  She will see them in two weeks", 
 
  
 
although she goes on to say: 
 
  
 
"She doesn't feel her input very appropriate and no ..." 
(something) "... referral to counsellors or social work". 

  
 
And just if we go over the page to 211 this is when I suggest you transferred to Dr 
 
Spence, and somebody has written at the top:  
 
 
 
"Dr Cosgrove, Bristol, diagnosed ADHD.  On Ritalin 10 mg QD 
 
..." (four times a day) "... Risperidone half a tablet BD" (which I 
think is twice a day).  Noted for registration", 

  
 
and then on 2 August I suggest Dr Spence issues a prescription for Risperidone, 30 
 
tablets, with the direction to take half a tablet twice a day? 
 
A       Yes, that is right. 
 
  
 
Q       Right.  And we note also further down on 22 August your son's height and weight 
being recorded.  And then on 23 September is when you write to Dr Cosgrove, the letter 

that we have seen at D1, where you tell him that you had recently moved house and 
 
changed doctor: 
 
  
 
"D is doing very well with both drugs.  Ritalin Risperdal", 
 
  
as you call it there.  You tell him about your new doctor: 
 
  

"... is very helpful and has no objections to prescribing the drugs. 
 
 I am not on the telephone yet but hope to be in the near future.  I 
 
wish again to thank you so very much for your help. If it had not 
 
been for you I think D would probably be in care. I do not want to 
 
break contact with you and I will send your money as soon as 
possible". 

  
 
Now, in fact I think that was the last time you wrote to the doctor? 
 
A      Uh-huh. 
 
  
 
Q       And, indeed, I think the last time you spoke to him was back at the end of July? 
 
A       Uh-huh. 
  

Q       Now at that stage he would have had your new address, but would not have had 
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your telephone number? 
 
A       No, he did not.  I never contacted Dr Cosgrove.  That was the letter.  That was the 
 
first letter that I had written to Dr Cosgrove since I spoke to him. 
 
  
 
Q       Right. 
 
A       As you can see, I have written in the fees and not having contact with him because I 
did not pay for the two telephone consultations with him.  I moved home without 

contacting Dr Cosgrove.  I received round about August or September a survey from Dr 
 
Cosgrove and Dr Bramble from Nottingham University, to see how my son was doing on 
 
Risperidone and to say that Dr Cosgrove had over 200 patients that he had been treating, 
 
and that prompted me to write a letter to Dr Cosgrove.  And it was strange because I do 
 
not know how they got my new address because I never informed him that I was moving 
 
and I did not inform him of my new address.  Everything happened so quickly.  I was in 
and out my new house within a month. 

  
 
Q       So, your letter of 23 September with the address there --- 
 
A       Uh-huh. 
 
  
 
Q      --- how long did you stay there for? 
 
A       I was there for two years. 
  

Q       Right.  And you said, "I am not on the telephone yet but hope to be in the near 
 
future"? 
 
A       That is right. 
 
  
 
Q       Right.  And so Dr Cosgrove would have had your new address, but not any 
 
telephone number? 
A       Once I had written this letter after 23 September, yes. 

  
 
Q       Right.  And thereafter you did not have any input from Dr Cosgrove on appropriate 
 
treatment of your son? 
 
A       No. 
 
  
Q       It came from Dr Spence? 
 
A       That is right. 

  
 
Q       And specialists he referred you or your son to? 
 
A       Yes. 
 
  
 
Q       And, as far as you know, did either or any doctor treating your son make any 
contact with Dr Cosgrove --- 

A       I am not aware. 
 
  
 
Q       --- about future treatment? 
 
A       I do not know. 
 
  
 
Q       And if I can take this quite quickly, if we look at the chronology, Mrs D, D31, I 
think on the same day that you wrote to Dr Cosgrove you wrote also to Dr Barton and Dr 

Robinson.  The letter you wrote to Dr Robinson I think we find that in C8, Divider 6, at 
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Page 10, where you tell her about -- I do not know if you have got that?  You tell her 
 
about your trip to Bristol, being put on Ritalin: 
 
  
 
"D is such a different person now and so much happier within 
 
himself.  As I am a patient of Dr Cosgrove I feel I should 
 
continue to keep D with him, rather than see you, because you do 
not believe he has this condition.  If you wish to write to me I 

have moved house and my new address is at the top of the page". 
 
  
 
Well, in fact - in fact - you did not keep your son with Dr Cosgrove because thereafter he 
 
was with Dr Spence? 
 
A       That is right, because I could not afford Dr Cosgrove's fees. 
 
  
Q       Right.  And I think you also wrote to Dr Barton and it is C2, but I am not sure 

whether the Committee have C2?  I am afraid I have not had it copied. 
 
  
 
THE CHAIRMAN:   There is only one copy available from the Secretary.  Do we need to 
 
run off some copies? 
 
  
 
MR MORRIS:   Sir, I do not think it matters at this stage: 
  

Q       (To the Witness)  Do you recall writing to Dr Barton as  well as Dr Robinson? 
 
2.  A       Yes. 
 
 

  
 
Q       And, if I just read from it, I hope you will take it from me as correct.  Again you 
tell her about Dr Cosgrove and the diagnosis he made and then you comment: 
 
  

"D is a changed boy now while not perfect, but then what 
 
children are?  My old GP prescribed Ritalin, as does my new one. 
 
Such a pity D had to go through so much and your team were 
 
unable to help him.  For the sake of all the other children who 
 
come to see you, it would be really helpful if you would listen to 
what mother says and try to help". 
 
  

Did you take the view that Dr Barton had not really listened to you? 
 
A       Yes. 
 
  
 
Q       Then going to back to the chronology, Mrs D, if we may, at D31, this is really 
extracts from your son's GP records.  In 1997 your GP, Dr Spence, was talking about 
 
there being problems over lunchtime, he notes his height and weight and took the 

decision to increase the Ritalin to 50 mgs a day for 28 days and the Risperidone to 
 
increase that to 2 mgs a day.  That is to double the dose, do you remember that? 
 
A       Yes. 
 
  
 
Q       And then it came back down again I suggest in March of that year and back up 
again to 50 in April of the same year, and then on 19 May - and we can follow this in the 
 
actual record at 211 - your doctor, or your son's doctor, is reporting that Risperidone is 

not helping, that your son is aggressive and therefore took the decision to try stopping it 
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and to prescribe clonidine in its place.  Do you remember that? 
 
A       Uh-huh. 
 
  
 
Q       That did not appear to work and on 28, shortly after, at Page 210, the note was that 
 
your son had been in trouble again, aggressive at school and the scouts.  Query what to 
 
do, and decides to increase the Risperidone to one tablet four times a day and so to double 
it again.  Do you remember that? 

A       Yes. 
 
  
 
Q       And that appeared to work to some extent because on 5 June he records, "Better 
 
therefore continue", and height and weight are recorded, and then in January 1998 the 
 
Ritalin he records as not helping and he substitutes or suggests dexamphetamine instead.  
 
Do you remember that? 
A       Yes. 

  
 
Q       On 20 January he refers your son to Dr Steer, a Consultant Paediatrician, or 
 
expresses his intention of referring him to Dr Steer, and comments that the 
 
dexamphetamine was no use and therefore back to Ritalin, and the dose being given I 
 
suggest  was 60 mgs a day? 
 
A       Could I ask you why it is written down here 75? 
  

Q       Where is it written 75?  You may well be right. 
 
A      "Advises increasing Ritalin to 75 mg" on 30 January. 
 
  
 
THE CHAIRMAN:   It is in the chronology at D31, the final entry. 
 
  
 
THE WITNESS:   D was never on 75 mgs. 
  

MR MORRIS:   (To the Witness)  Yes.  Well, what I suggest is on the -- we may have got 
 
this wrong.  Well, I think it will become clear.  If we look at the 23 January letter to Dr 
 
Steer at 141, where Dr Spence sets out how he has dealt with your son, the first 
 
paragraph: 
 
  
"After he saw Dr Cosgrove, he was started on Ritalin with a great 
 
deal of success.  His most recent problem is that he is now 

reaching maximum doses of Ritalin and still finding that at 
 
certain times of the day his behaviour is quite difficult.  His 
 
mother has recently been asked to take him away from the scouts 
 
as they can't control his behaviour.  His present regime is of 
 
Ritalin, up to 60 mg per day, with Risperidone 1 mg four times a 
day.  Just after new year, his mother and I ask discussed this and 

thought we would try him on Dexamphetamine 5 mg twice a day, 
 
but his behaviour became extremely aggressive and she couldn't 
 
cope with this after 2 or 3 days without Ritalin and therefore the 
 
dose of Ritalin was re-started to reach the maximum of 60 mg per 
 
day". 
 
  
I think that is where I got the 60 mgs a day from. 

A       Yes, but it has got 75 marked down somewhere. 
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Q       Well, we will come to that: 
 
  
 
"I wonder if some of the problems they are having, is that he is 
 
now reached a considerable size and despite Ritalin having a 
 
detrimental effect on growth, he seems to have put on 4 kg and 2 
inches in about the last 4 months ...  I thus wonder if you have 

any suggestions as how to go about dealing with his medication 
 
problems, and do you feel that the change in height and weight 
 
are anything to be worried about". 
 
  
 
And then we get Dr Steer's response, at Page 140 and 140A, to Dr Spence: 
 
  
"I think your first response in attempting a switch to 

Dexamphetamine was really quite appropriate, but you don't seem 
 
to have got as far as being able to put him on an equal dose ... I 
 
don't think there is any evidence (and this was reviewed fairly 
 
thoroughly recently) indicates that final stature is significantly 
 
affected by long-term neurostimulant usage and I think there is 
 
every expectation that these drugs will continue to be useful even 
into adulthood in ADHD ... I would be more than  happy to see D 

if you wish.  Again I wouldn't be too worried about growth and 
 
would be happily reassuring to parents.  Regular checks of blood 
 
pressure are prudent, say 2-3 monthly to make sure hypertension 
 
doesn't develop but I haven't seen any child with this so far". 
 
  
 
And then he goes on to say: 
  

"In D's case if he is in the severe category of ADHD, i.e. with 
 
complicating Conduct Disorder and potential Oppositional 
 
Defiant Disorder then one could be excused I think for increasing 
 
the Ritalin even further and it is usually tolerated even in doses 
 
that you would think would start to cause side effects.  In the first 
instance then I would suggest increasing the Ritalin to 
 
two-and-a-half tablets ... TDS ...", 

  
 
and TDS is three times a day.  Now, that is a total of 75 mgs? 
 
A       Right, well D never received that. 
 
  
 

  

"... making sure that it is given as nearly at 4 hourly intervals as is 
 
feasible. 
 
  
 
I don't have a huge amount of personal experience with 
 
Risperidone but those cases I have seen that have been assessed 
 
in the past by Dr Cosgrove do seem to have done well on this 
drug particularly from the point of view of ameliorating appetite 

suppressing effects of Methylphenidate, and also helping to 
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minimise sleep problems ..."                                                  
 
 
 
Was D’s Ritalin increased to 75? 
 

No, it stayed at 60. 
 
 
 

But all that was done, of course, without reference to Dr Cosgrove. 
A Yes. 

 
 
Re-examined by MR PEARCE 
 
 
 

Just one or two matters.  You have been taken, Mrs D, through that period from 
 
late 1996 and through 1997 when it is apparent that Dr Steer in particular was a 
 
consultant who was referred to by Dr Spence the GP.  

I have never spoken to Dr Steer.  Dr Spence must have taken it upon himself to go 

to him. 
 
 
 

So it was Dr Spence who was, as far as you were aware, in charge of the dosage 
 
and taking responsibility for that. 
 

Yes.  Well, Dr Spence did not have much idea about the dosage of Ritalin or 
 
Risperidone. 
 


I understand.  Mr Morris has referred you to a number of the records.  I do not 
 
think we need to go back through them, but he has referred to a number of records when 
 
either dosages have changed or actually the drug that was being prescribed was changed 
 
by Dr Spence.  You recall there were a number of such occasions. 
 
A Yes. 
 
 

On the occasions when the medication was changed did Dr Spence see your son? 

A Yes. 
 
 
 
Q Always? 
 

Not all the time, no.  There were times when I did go over and see him myself to 
 
speak about D’s behaviour and he would suggest, “Why don’t we try it this way?” 
 
 

We see I think from the records a reference to height and weight being measured. 

A Yes. 
 
 
 

One other matter.  If you can just look back again to the bundle that is called C8, 
 
the one with the tabs in it, and tab 6, of course, the letter at page 10, it is a letter to Dr 
 
Robinson.  I hope I summarise the tone of it correctly.  You were saying to Dr Robinson 
that things were much more satisfactory now Dr Cosgrove had become involved in 

assisting, is that right? 
 

Yes, that is right. 
 
 
 

If you would just turn over the page to page 11 of that tab, this is a letter written 
 
by Dr Robinson on 25 September 1996.  Do you recall receiving this letter? 
 

Yes, I do. 
 


“Dear Mrs D,   
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Thank you for keeping me updated about D and his progress.  I concur with your 
 
view that the diagnosis made by Dr Cosgrove is appropriately treated by him.” 
 
A Yes. 
 
 
 

So that was the response you received from Dr Robinson. 
A Yes. 

 
 
Questioned by THE COMMITTEE 
 
 
 

Just for clarification, the time when you visited Dr Cosgrove at the Bristol clinic, 
 
when did you actually receive the questionnaire?  Was it posted to you or given to you 
 
while you were in the consultation? 

For the Risperidone? 

 
 

No, the questionnaire that you completed. 
 

The questionnaire was given to me when we went to see him at the consultation. 
 
 
 

And you completed this and then, what, took it into ---- 
 

No, I completed it as I sat beside Dr Cosgrove. 
 


Again, just to confirm, did Dr Cosgrove undertaken any type of physical 
 
examination on your son? 
 

No, he did not. 
 
 
 

And no weight was taken at the time? 
 

No weight, no height. He did not even acknowledge D was there.  The questions 
were mainly addressed to myself. 

 
 

Was your son’s blood pressure checked? 
 
A No. 
 
 
 

Not even maybe by a practice nurse? 

Not when I saw Dr Cosgrove, no. 
 
 

THE CHAIRMAN: Could I seek clarification, Mrs D, about the letter of 23 September in 
 
D1?  It has been suggested that there were three telephone calls but you indicate that 
 
there were two telephone calls.  In that letter you indicate that there is a fee of £54. 
 
A Yes. 
 
 

I am just checking my arithmetic. 


I know.  I was looking at that figure myself.  The telephone calls may have been 
 
£27.  I was thinking of the £25 consultation fee. 
 
 
 

So you think it might be £27 and that would explain two telephone calls in your 
 
mind. 
 

Yes, that is right. 
 


In the final telephone call/conversation with Dr Cosgrove was it indicated to him 
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that you were not going to continue to receive calls from him because you could not 
 
afford them? 
 

No, I was too embarrassed to say anything to Dr Cosgrove. 
 
 
 

Were the bills for the telephone calls raised after the telephone call or was it 
 
anticipated that you would pay in advance of the telephone call? 

It would be anticipated that Dr Cosgrove would phone me and then he would bill 

me for the consultation over the phone and I would pay them by cheque. 
 
 
 

So what you are saying is that you did not indicate in this letter that you did not 
 
want any more telephone consultations. 
 

No, I did not, no. 
 
 

And you did not indicate on the telephone. 


No, I did not.  I thought I could afford the telephone calls and was going to pay  
 
Dr Cosgrove but my circumstances changed. 
 
 
 

So no further telephone calls came from Dr Cosgrove. 
 
A No. 
 
 
THE CHAIRMAN:  I think these are all the questions from the panel.  Mr Pearce, do you 

want to come back on any of these points?  I can see Mr Morris getting set to come back. 
 
 
 
Further questioned by MR MORRIS 
 
 
 

Mrs D, just in relation to the charges, I have suggested there were three telephone 
 
calls.  Two took place within two days of each other, 3 June and 5 June.  What I would 
suggest is that there was only one charge in relation to those two calls. 


No.  There was only ever two calls that I spoke and that was in relation to how D 
 
was with the Ritalin and then the second line drug that was being introduced which was 
 
risperidone. 
 
 
 

Then in relation to the anticipation that he would call you to consult with you, you 
were too embarrassed to tell him that you were not going to be able to afford any future 
 
consultations. 


That is right. 
 
 
 

He did not have and never did have your new telephone number at your new 
 
address, did he? 
 

No, that is right. 
 

THE CHAIRMAN:  Mr Pearce?  That concludes the evidence.  All that remains for me, 
 
Mrs D, is to thank you very much for coming to assist us and you may now stand down. 
 

Thank you very much. 
 
 
 
(The witness withdrew.) 
 
 
MR PEARCE:  Sir, if I may then explain the situation in respect of the outstanding 

evidence which I seek to adduce, we are, of course, to hear again from Professor Taylor 
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in the morning.  We had left the position last week, you will recall, that Dr Thomas who 
 
gave evidence in respect of Patient F was not cross-examined and my learned friend had 
 
asked for the medical records relating to Patient F. I had said to the Committee that there 
 
had, it seemed to me, been an oversight in respect of those patient records.  I have now 
 
seen the full correspondence file and the position appears quite clear, in my submission, 
 
(I do not think I need to refer you to the letters) that we had indicated in January that we 
could not get those records because we could not get consent. 

 
 
In any event, what has happened since last Thursday is that we have contacted the 
 
appropriate Trust and the appropriate unit.  They have confirmed essentially that there 
 
ought to be records relating to Patient F but that they cannot find them.  So I am afraid 
 
that we have drawn a blank.  They can give us no further information about where the 
 
records might be and, reading between the lines of the communications we have had, they 
(that is, the people with whom we have been communicating) have probably lost them, 

because they clearly anticipated they ought to have them and then told us they could not 
 
find them. 
 
 
 
My learned friend tells me in that situation that the records of Patient F cannot be 
 
produced that he has no questions for Dr Thomas, so I will not need to recall her. 
 
 
You will recall also, I think, in the course of the same conversation that I mentioned the 

question of the records of Patient H to whose evidence Dr Dover referred.  Those records 
 
have been obtained and have been made available to my learned friend.  So the only 
 
remaining evidence that I seek to call now is that of the remainder of Professor Taylor’s 
 
evidence and any cross-examination of him and he will be available in the morning. 
 
 
 
MR MORRIS:  Sir, I think it was indicated that I would seek to interpose before the close 
of the Council’s case two of my own witnesses.  I have alerted my learned friend to that 

fact.  He does not take objection.  I hope to be in a position to call them at 2 o’clock. 
 
 
 
THE CHAIRMAN:  Thank you very much.   In that case, we will now adjourn and 
 
reconvene at 2 p.m. 
 
 
(The Committee adjourned for lunch.) 
 
  

 
 
THE CHAIRMAN:  Mr Morris, are you ready? 
 
 
 
MR MORRIS:  I was proposing to start but I think Mr Pearce may want to say something.  
 
 
MR PEARCE: Sir, may I raise another issue about medical records.  This relates to 

Patient A and the position is as follows.  It has been correctly identified that Professor 
 
Taylor, the witness whom I called, has fairly recently seen that patient following a 
 
referral to him.  My learned friend has asked to see the records relating to that 
 
consultation.   
 
 
 
The position appears to be as follows, from what we have discovered this morning.  The 
records are physically available.  We cannot be necessarily sure that they are readily 

found until we have them in our hands but in principle the records are physically 
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available.  I think, as we understand it, the Trust policy would be not to disclose those 
 
records unless consent were available.   
 
 
 
As in the cases of F and H, to whom I referred last week, we will do our part to try to 
 
facilitate the disclosure of the records without consent, because consent will not be 
 
forthcoming in the available time, but we will do so really on two indications, essentially, 
sir. 

 
 
The first one, I have already asked my learned friend this, which is the indication from 
 
him that he really does want to see the records.  He indicates that he does, so that part is, 
 
as it were, dealt with.   
 
 
 
The second, sir, is your position in that if you as a Committee see it as being desirable 
that those records ought to be received in evidence, or at the very least ought to be 

available to my learned friend to consider whether they ought to be put in evidence.  I 
 
therefore seek that indication from you.  If you do, indeed, give that indication then we 
 
will continue to use our best endeavours this afternoon to have those records available 
 
tomorrow morning. 
 
 
 
THE CHAIRMAN:  The Legal Assessor indicates he wants to say something.  
 

THE LEGAL ASSESSOR:  Not really.  It is the same rule… 
 
 
 
MR PEARCE: Regulation 15, indeed so. 
 
 
 
THE LEGAL ASSESSOR:  It is exactly the same set of criteria as applied in the last case. 
 
 I do not have any advice. 
 

THE CHAIRMAN:  I will check with the Panel members.  I think I am getting the signal 
 
that we would wish these records to be made available.  
 
 
 
MR PEARCE: I am much obliged.  The representatives of those instructing me - I am 
 
lucky enough to have two before the Committee at the moment in the hearing - will 
communicate that and we will continue making those endeavours in the hope that we will 
 
have those records available for you tomorrow morning.  I am obliged, sir.  

 
 
MR MORRIS:  I will call Mrs C, the other of Patient C. 
 
 
 
MRS C Sworn 
 
Examined by MR MORRIS: 
 


I am going to call you Mrs C in order to safeguard your son’s anonymity.  Before 
 
we progress any further, though, could you on a piece of paper write down your full name 
 
and your son’s full name, please? (Pause. Same handed to Committee)  
 
 
 
THE CHAIRMAN:  We will call this D32. 
 
 
MR MORRIS:  I am going to call you Mrs C and I am going to call your son C.  I know it 

will be difficult for you to call your son ‘C’ but if you can try.  It is in his own interests.  
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Mrs C, I want to start by showing you a letter that was written by Dr Cosgrove about your 
 
son.  There is a bundle there, it should be marked C8 in the top right-hand corner.  If you 
 
look at divider 4 in that bundle, you will see a letter dated 29 May 1999 addressed to Dr 
 
Rackham, with a heading, although it is blanked out, which is your son’s name and it is 
 
signed by Dr Cosgrove.  
 
 
First of all, can you help us with this.  Was Dr Rackham at the time yours and your son’s 

general practitioner? 
 
A Yes. 
 
 
 

If we look at the first line of the letter to Dr Rackham it says: 
 
 
 
“Thank you for asking me to see C, whom I was able to 
meet with his mother and stepfather on 27 May.” 

 
 
Are we right, therefore, I thinking that Dr Rackham referred your son to Dr Cosgrove? 
 

Yes, that is correct. 
 
 
 

Did you have any input into that referral by Dr Rackham? 
 
A Yes. 
 
 


How did you come to hear about Dr Cosgrove and speak to your GP about him? 
 

I was experiencing a lot of problems with my son at the time and somebody came 
 
with a magazine article about children with ADHD.  I had never heard of it before.  I rang 
 
the helpline and on speaking to several people over… 
 
 
 

You say a helpline - was that the ADHD helpline? 

Yes.  Over the course of a weekend, I was given several doctors’ names in which 

to get a second opinion, I suppose with my son and I chose to take my son and asked my 
 
GP if he would refer him to Dr Cosgrove who, through the helpline I had very good 
 
feedback so I decided that I asked my GP if he would refer him and that is what he done.  
 
 
 

I come back to the substance of the letter and the subsequent letter you also wrote, 
not on that occasion to Dr Rackham but to Dr Moses, which was then copied to you and 
 
Dr Rackham.  Can you just help us.  As a result of that consultation with Dr Cosgrove, 

did he prescribe for your son Ritalin and Risperidone? 
 

Yes, he did. 
 
 
 

Following that prescription, was that a prescription he himself issued to you, Dr 
 
Cosgrove? 
A Yes. 
 

 
 

Were there subsequent prescriptions for those drugs? 
 
A Yes. 
 
 
 

Who issued those? 
 

My GP.  My GP carried the prescriptions and still does. 
 


Did anyone conduct any monitoring of your son’s condition following his 
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commencement on Ritalin and Risperidone? 
 

Yes.  I had obviously Dr Cosgrove and my son’s GP would do his height, blood 
 
pressure, his weight.  
 
 
 

How often would your GP monitor height, blood pressure, weight? 
 

Between eight and twelve weeks.  Normally about twelve weeks, depending on 
how the prescriptions run. 

 
 

You mentioned Dr Cosgrove being part of the monitoring.  What was his part of 
 
the monitoring process? 
 

I had a lot of telephone appointments with Dr Cosgrove. However, saying that, 
 
there were occasions when maybe things were not quite right with C.  I never had any 
 
problems with Dr Cosgrove.  If I rang today and it is a bit late in the day, I could 
guarantee a phone call back tomorrow.  On several occasions it was his recommendation 

that I would take C over to Bristol to see him, which happened a few times.  
 
 
 

So apart from telephone monitoring, you took your son C to see him again in 
 
Bristol? 
 
A Yes. 
 
 
 

I want you now to look, please, a little more closely at the contents of first of all 

the letter Dr Cosgrove wrote to Dr Rackham, which we have got in divider 4 and then, 
 
secondly, a letter he wrote to Dr Moses.  Just dealing with the first letter, please, I want 
 
you to help us as to its accuracy as a report of what you were telling Dr Cosgrove about 
 
your son.  It starts off by saying: 
 
 
 
“His mother told me about his poor concentration, short 
attention span and his distractibility.  He flits from one 

focus of attention to the next.  He is very forgetful of 
 
instructions and messages, for example.  A summary 
 
report of his school years…” 
 
 
 
but just pausing there, is that an accurate account of what you were telling him about your 
son? 
 
A Yes. 
 

 
 

Did you take school reports with you to the consultation 
 

Yes, I did, both from the previous school C had attended and the school that he 
 
was attending at that time. 
 
 

If I could take you to the bottom of the page, the last paragraph on that page: 

 
 
“I am also concerned about C’s aggression and the quality 
 
of his thinking.  His mother says that he does not always 
 
make sense to her and he is quite illogical at times.  She 
 
describes him as a compulsive liar, usually in order to get 
 
out of trouble.  However, his lies can become widened and 
convoluted and detailed.  He has made accusations that 

teachers at the Pollards Unit hit him and dragged him by 
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the arm.  His stepfather says that C thinks that people are 
 
constantly against him and I suspect that C is mildly 
 
paranoid.” 
 
 
 
Again, are those details given both by you and by the stepfather? 
 
A Yes. 
 


Then he sets out the Ritalin and Risperidone doses that he is going to start your 
 
son on.  He then goes on to say this: 
 
 
 
“Mrs C told me that C was seen by Dr Moses, consultant 
 
child psychiatrist, when he was five years old but she was 
 
given no diagnosis.  At this time she was being called into 
school” 

 
 
- I think that is a reference to you? 
 
A Yes. 
 
 
 
 
Q  
 
 
“…being called into school every week and she considers 

that her son was hyperactive at that age.  Dr Moses saw C 
 
again when he was six and had a half-an-hour talk with 
 
the mother and told her that she should see C again in one 
 
year’s time.  Mother said that Dr Moses had seen C three 
 
times in four years.” 
 
 
Then he expresses his surprise that not more has been done for the child by the local 

specialists? 
 
A Yes. 
 
 
 
 

Is that an accurate account of what you were telling Dr Cosgrove at the 
 
consultation about Dr Moses’ involvement with your child? 
A Yes. 
 
 


Can I go on, then, to the next letter which we see at the next divider, divider 5.  It 
 
begins at page 2 and it is addressed to Dr Moses, dated 7 July 1999.  If you look at the 
 
back page of that letter on page 4, Mrs C, you will see that a copy of it was apparently 
 
sent both to you and to Dr Rackham, your GP.  Do you remember receiving a copy of that 
 
letter? 

Yes, I do.  

 
 

Again, I just want to take you through it, please, and get your comments on it.  In 
 
the third paragraph down, the paragraph beginning, “When I met Mr and Mrs C, C’s 
 
parents…”  Do you have that? 
 

I think there are some notes mixed up on this one.  I think I might have somebody 
 
else’s here.  
 


Divider 5, page 2.  Just to help you with that, again, can you turn to the end of that 
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letter, two pages on? 
 
A Yes. 
 
 
 

Do you see at the bottom, “c.c. Mr and Mrs C, Dr Rackham? 
 

Yes, that is right.  
 
 

Going back to the front of that letter, please, it is addressed to Dr Moses.  Going 

down the page to about two-thirds of the way down, do you see the paragraph beginning, 
 
“When I met Mr and Mrs C”? 
 
A Yes. 
 
 
 
 

Dr Cosgrove says this: 
 
 
“I was told that C had been attending St Cadoc’s Hospital 

five days per week since November 1998.  I was also told 
 
that in that time, some six months you” 
 
 
 
- that is Dr Moses -  
 
 
 
“had seen C only once and that, furthermore, you told his 
parents that you were going to prescribe a sleeping tablet 

at night for C.  This never happened!  You neither 
 
prescribed this medication you had promised, nor did you 
 
explain to Mr and Mrs C why you had changed your mind 
 
and were no longer going to prescribe it.” 
 
 
 
Accurate or not as a report? 
A Yes. 

 
 
Q       And then can we go over the page to Page 3 and about nearly halfway down to a 
 
paragraph beginning, "Why are you unhappy?", do you see that? 
 
A       Yes. 
 
  
Q       And Dr Cosgrove says: 
 
  

"I feel sure that your unhappiness will turn to sheer joy and 
 
happiness when I tell you that within ten days C was very much 
 
better", 
 
  
 
and this is after the prescription of Ritalin and Risperidone? 
A       Yes. 

  
 

 
  
 
"He has ceased being aggressive and abusive, and his maternal 
 
grandmother has had him visit her three times over one weekend 
 
since starting the medication compared with no visits at all during 
the last eight months - six of which he was in your Children's 

Psychiatric Unit attending for five days per week!" 
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Is that an accurate account of what you were telling him? 
 
A       Yes, it is.  Yes. 
 
  
 

 
  
"As a result of my intervention ..." (he goes on) "... Durands 

School have now changed their minds and are going to have him 
 
back - following a visit from a member of their staff.  His mother 
 
says that her son is 'a lot better' and that there has been 'a great 
 
improvement'". 
 
  
 
Again, is that accurate? 
A       Yes, it is. 

  
 
Q       And what was the position with Durands School?  Why had they decided not to 
 
have him? 
 
A       Because I was basically advised to keep him home or he would be excluded.  They 
 
could not cope with his behaviour, with his aggression, and it actually got that bad that C 
 
had actually injured a male member of staff.  They had Health and Safety watching C's 
behaviour with apparatus.  He would be told, "You can go two bars", and he would go 

eight, you know?  There was just no -- and I had to keep him home. 
 
  
 
Q       Right.  Going down to the bottom paragraph on that page, three lines in, and "You" 
 
is a reference to Dr Moses: 
 
  
 
"You first saw C when he was 5 years old when he was not 
eating, was thin, was having frequent tempers and when the 

parents were being called into school on a weekly basis". 
 
  
 
Now, is that an accurate account of what the position was when he  was five years old? 
 
A       Yes, it is.  Yes. 
 
  

 
  

"You made no diagnosis ..." (he goes on) "... and did nothing that 
 
actually resulted in alleviation of this child's malfunctioning". 
 
  
 
Is that a correct account of what you were telling him? 
 
A       That is right, yes. 
  


 
  
 
"You saw him again when he was 6 years old and had one 
 
half-hour's talk with C's mother.  There was a similar meeting 
 
when he was 7 years of age so that you had seen C and his mother 
 
three times in four years". 
  

Again, is that what you were telling Dr Cosgrove? 
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A       That is right, yes. 
 
  
 
Q       And then over the page on Page 4: 
 
  
 
"In 1998, he was not allowed to return to Caldicot St Mary's 
 
School because of his behaviour there during the previous 
academic year.  In September 1998, he was expelled from 

Durand's Primary School after but one month there because of his 
 
violence to children and because he completely refused to do any 
 
of the work the teachers set.  In November 1998, he was admitted 
 
under you to St Cadoc's". 
 
  
 
Again, is that an accurate account of C's scholastic history? 
A       Yes, it is.  Yes. 

  
 
Q       Mrs C, can you just summarise for us the changes, if any, that occurred to your son, 
 
C, following his seeing and being prescribed medication by Dr Cosgrove? 
 
A       Yes.  Virtually straightaway, as soon as my son started taking the Risperidone and 
 
the Ritalin, on the day we returned from our very first appointment was the first night that 
 
my son had ever slept through the night - and, I mean, I am talking he was nearly seven - 
and I actually had to wake him in the morning which I had never, ever done before.  I 

mean, he was always running wild after just a few hours sleep. 
 
  
 
Following that he maintained for some seven years in mainstream school, but only as 
 
long as he had his medication.  There was an incident where the medication for some 
 
reason was not at the school and, within two hours of him not having it, I was requested 
 
to go and fetch my son home from school. 
  

To this day, C is still on medication via other specialists.  He is now out of the area.  He is 
 
still on medication, but he has  maintained a very, very good seven years of a mainstream 
 
schooling which I think is a great achievement for C. 
 
  
 
Q       Prior to him going on to the medication, what were the prospects for him as far as 
his schooling was concerned? 
 
A       The advice the other doctor had given me was - and this was in the April time - that 

come July when the children would break up from school that C would be far better off 
 
being in a Children's Home.  That devastated me.  My child was six-and-a-half and they 
 
wanted to push him off into care.  There was nothing wrong with my care for my son.  He 
 
just needed help and thankfully I got him that help. 
 
  
MR MORRIS:   Thank you, Mrs C.  Wait there.  There may be some more questions. 

  
 
THE WITNESS:   Okay. 
 
  
 
Cross-examined by MR PEARCE: 
 
  
 
Q       Mrs C, could I make sure that I am understanding the sequence of this right? 
A       Yes. 

  
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Q       I am going to put to you what I understand to have been the sequence of the care 
 
and treatment that has been involved, relevant to your son's condition, and you tell me if I 
 
am right, if I am wrong or if you are not sure, if you will do? 
 
A       Uh-huh. 
 
  
 
Q       I want to start from this.  That I suggest that Dr Moses first saw your son when he 
was five, nearly six? 

A       No. 
 
  
 
Q       Is that correct? 
 
A       No, definitely not. 
 
  
 
Q       When was it? 
A       He was, I would say, between the age of three-and-a-half  -- he had an eating 

disorder.  My son would eat nothing.  He would scream and scream.  You show him food 
 
and he would scream. That is when she very, very first seen C.  Three-and-a-half/four. 
 
  
 
Q       Three-and-a-half? 
 
A       Uh-huh. 
 
  
Q       Could I ask you to look at Division 5 of that -- well, you are probably on Division 5 

already? 
 
A       Yes. 
 
  
 
Q       A letter there from Dr Cosgrove to Dr Moses? 
 
A       Right, yes. 
 
  
Q       Do you see on the page that is numbered "3", typed number  "3" at the bottom? 

A       Yes. 
 
  
 
Q       The bottom paragraph, second sentence: 
 
  
 
"You first saw C when he was 5 years old when he was not 
eating"? 
 
  

A       No, no. He was about four. 
 
  
 
Q       About four? 
 
A       Three-and-a-half/four. 
 
  
Q       Right.  Well, just so you are clear, I suggest that you are wrong about that and that 

he was five/nearly six when Dr Moses first saw him? 
 
A       No, definitely not, and I will tell you for why because I had actually separated with 
 
C's father that year and it was obviously a concern to me.  It was quite a traumatic split 
 
for my son and he was definitely three-and-a-half to four.  I would say four. 
 
  
 
Q       Right.  Dealing with that split with C's father, it is right to say, is it not, that at least 
at that time contact between C and his father was problematic in that a lot of C's bad 

behaviour appeared to be linked with him seeing his father? 
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A       Well, no, because C's behaviour was like it from the day he was born.  It is just that, 
 
you know, I thought -- C is one of three children, the youngest of three.  I had two boys a 
 
lot older. 
 
  
 
Q       Yes. 
 
A       A lot older. 
  

Q       Yes. 
 
A       And I just thought, "I have got myself a naughty baby", as a parent would. 
 
  
 
Q       Yes.  So, let me just read you these comments and ask you to comment on them? 
 
A       Uh-huh. 
 
  


  
 
"When he was nearly six when his mother ..." 
 
  
 
I am sorry, this is what Dr Moses said in evidence, you see, and I want to see what you 
 
say about it: 
 
  
"I had initially seen him when he was nearly six when his mother 

brought him with a variety of complaints that seemed to focus 
 
mostly around his behaviour when he had contact with his father 
 
from whom he was separated"? 
 
  
 
 A       No. 
 
  
Q       You would not agree with that? 

A       No, I would not agree.  No. 
 
  
 

 
  
 
"The gist of that meeting was that this was a younger ..." (and 
there is no word here.  It is from a transcript, but I think it means 
 
child I think) "... who was not too bad on the whole, but when he 

had met his natural father his behaviour was more difficult to 
 
manage"? 
 
  
 
A       My son was difficult to manage from day one.  I would not blame anything.  
 
Having the contact with his father definitely was nothing to do with C's behaviour. 
  

Q       Had his father been in the habit of putting his hands round your son's neck if he 
 
would not eat? 
 
A       Do you mind me asking where you got that information from? 
 
  
 
Q       Well, it has come from the medical records.  Is that correct? 
 
A       Yes, it is correct.  It happened on one occasion and access was stopped. 
  

Q       And is it right to say that you thought that your son's reluctance to eat might relate 
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to that? 
 
A       His reluctance, yes.  Yes, I did. 
 
  
 
Q       Yes.  Now at that point on that first visit, whenever it was, Dr Moses - and I think 
 
we are agreed about this - made no psychiatric diagnosis? 
 
A       No. 
  

Q       And, indeed, she said that she did not think that your son needed psychiatric follow 
 
up? 
 
A       No, she said she would see him in twelve months' time. 
 
  
 
Q       Was not the second time when Dr Moses -- or, sorry, the second time that your son 
 
was referred to Dr Moses’ unit was on a re-referral from the General Practitioner about a 
year later? 

A       Yes, because I had not had another appointment.  She told me she would see him or 
 
send for him again in twelve months' time and it was then referred back to her. 
 
  
 
Q       And on that occasion in fact you did not see Dr Moses, did you?  You saw a more 
 
Junior Doctor? 
 
A       I do not think so. 
  

Q       Well, does this in any way assist your recollection? That the Junior Doctor 
 
eventually had a period of time off sick and was not able to see C, your son? 
 
A       I thought that was Dr Moses? 
 
  
 
Q       There was a doctor who was ill and who could not see you in any event, is that 
 
right? 
A       Yes, there was. 

  
 
Q       And that Dr Moses herself saw your son again in August of 1998? 
 
A       Probably. 
 
  
 
Q       For the second time, I suggest.  And that what she was saying then was that she 
wanted to know how he was getting on at school?  That it was the end of the summer 
 
holidays and that she wanted to see how he was at the beginning of the next school term 

and so she said, "I will see you again in a month's time in September - late September"? 
 
A       I am not sure. 
 
  
 
Q       And that the third time you saw Dr Moses, I suggest, was late September 1998? 
 
A       I am not really sure. 
  

Q       Might be? 
 
A       Probably.  I am not really sure. 
 
  
 
Q       Right.  And that having seen school reports Dr Moses felt that it was appropriate 
 
that your son be admitted as a day patient attending the school at St Cadoc's Hospital? 
 
A       The school had told me not to send C to school any more. She had to do something, 
yes. 

  
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Q       Well, that was her --- 
 
A       The school were advising me that my son was not to return to school.  He had 
 
injured a male member of staff by one of his violent outbursts, when he threw the table 
 
and obviously hurt the teacher quite badly.  They had done risk assessments at the school 
 
and it was felt that -- and I think you will find that -- so much has happened with my son 
 
that it is hard for me to put dates in and things to it. 
  

Q       I understand.  I understand. 
 
A       But I am pretty sure that, if you check back in the records, it was via a telephone 
 
call made by myself that Dr Moses actually seen(sic) my son again and recommended 
 
that he would go into Pollards Well for a while. 
 
  
 
Q       Yes.  She had asked, I suggest, that she had wanted to see those school records 
before she made a judgment in the autumn of 1998? 

A       You just stood there and said I went with reports and that she had seen the reports.  
 
I went armed with the reports. Of course she had seen the reports. 
 
  
 
Q       I have not said anything about reports other than to say  that, when you attended in 
 
August 1998, she said she wanted to see the reports and wanted to see you again a month 
 
later? 
A       Uh-huh. 

  
 
Q       Does that --- 
 
A       She would have seen the reports of my son. 
 
  
 
Q       Yes.  That sounds as though that would be right, does it? 
 
A       Well, not really, because my son was basically excluded from school and it was 
recommended that he would start Pollards Well School in the September. 

  
 
Q       Yes, and that was Dr Moses' recommendation? 
 
A       That he would start Pollards Well School. 
 
  
 
Q       Yes.  She would have no choice, of course, in whether he was excluded from any 
other school? 
 
A       No, and she actually had no choice whether he would be excluded from Pollards 

Well as well but that happened too. 
 
  
 
Q       Yes.  Well it was her decision to admit him to Pollards Well, was it not? 
 
A       Yes. 
 
  
Q       Now, then, there came a time - and I think it was about May 1999 - that you saw Dr 

Cosgrove? 
 
A       Uh-huh.  Yes, it was. 
 
  
 
Q       And you have indicated how that came about? 
 
A       Yes. 
 
  
Q       How you came across his name.  Now, did you go and see Dr Cosgrove in Bristol? 

A       I did, yes. 
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Q       Yes.  And when you went to see Dr Cosgrove, did the consultation with him take 
 
the form of him producing a questionnaire and asking you to complete it?  A written 
 
document with tick boxes, do you recall that? 
 
A       No, I do not recall that.  No. 
 
  
Q       Right.  Do you think it did not happen, that there was no written questionnaire, or 

that there might have been and you have forgotten? 
 
A       There may well could have been.  There could have been. I honestly cannot 
 
remember. 
 
  
 
Q       And he would have asked you questions, no doubt, about what was going on? 
 
A       He asked me lots of questions. 
  

Q       Approximately how long do you think that consultation lasted, Mrs C? 
 
A       Quite a few hours, because myself, my son's stepfather  and C were all seen 
 
together; then myself and my husband were seen; and then he seen(sic) my son on his 
 
own and then he seen(sic) -- and I was quite amazed by this, because then he seen(sic) my 
 
son how he would react when I would not respond like this, you know?  (Snaps her 
 
fingers)  I was talking and I was getting the kicks and the thumps and the pulling on my 
hair and he was in the windows pulling the blinds down, you know, all the time.  And Dr 

Cosgrove was being very patient, carrying on and, you know, talking to me and going 
 
through different things even though all this was going on, and C most definitely showed 
 
exactly what the problems were. 
 
  
 
Q       And you have indicated that subsequently the monitoring, the weight and the height 
 
measurement --- 
A       That is right. 

  
 
Q       --- and the blood pressure was done by a General Practitioner? 
 
A       Yes, that is right. 
 
  
 
Q       Did Dr Cosgrove carry out any physical examination on that visit in May 1999? 
A        Yes, yes. 
 
  

Q       What did he do? 
 
A       Weight, blood pressure, height, yes. 
 
  
 
Q       Right. 
 
A       All that was done there. 
  

Q       And by him?  By Dr Cosgrove? 
 
A       Yes. 
 
  
 
Q       Not by a nurse? 
 
A       And there was a nurse there as well. 
 
  
Q       A nurse there as well? 

A       As well, yes. 
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Q       How many further times did you meet Dr Cosgrove face to face? 
 
A       Face to face I would not have a clue.  Quite a few times. 
 
  
 
Q       Approximately?   I mean five, ten, 20? 
 
A       Five.  Yes, probably five times. 
  

Q       Probably five? 
 
A       Yes. 
 
  
 
Q       And when was the last time you had any contact with Dr Cosgrove for clinical 
 
purposes - I do not mean anything to do with this case, but in terms of him caring for C - 
 
whether it was by letter, telephone or meeting him?  Again, approximately?  You may not 
recall precise dates. 

A       I would say approximately - oh, my mind's gone - 18 months or two years, 
 
probably. 
 
  
 
Q       18 months? 
 
A       Two years. 
 
  
Q       So, perhaps mid-2002 perhaps? 

A       Yes, I would think so. 
 
  
 
Q       Right, okay.  And then from 1999 until 2002, that period of approximately three 
 
years, did you have regular contact with Dr Cosgrove --- 
 
A       Yes, I did. 
 
  
Q       --- by one means or another? 

A       Yes, I did. 
 
  
 
Q       During that time, did the prescriptions of Ritalin and Risperidone change from time 
 
to time? 
 
A       Yes, they did.  Yes. 
  
 
Q       Right.  And was it Dr Cosgrove who was taking the initiative in saying, "Well, I 

think this dose needs to be adjusted - increased/decreased"? 
 
A       Yes, it would.  Yes. 
 
  
 
Q       And then was your General Practitioner duly issuing a prescription on the basis of 
 
what Dr Cosgrove was saying? 
A       Not necessarily just on what Dr Cosgrove was saying, but I would take the 

prescription along and say, you know?  And he would ask me what changes with my son, 
 
why did I -- you know, was I getting a problem.  And, yes, I mean I would not say it was 
 
solely, you know? 
 
  
 
Q       No, I do not want to suggest that your GP was not independently bringing any 
 
judgment to bear, do not get me wrong, but was there ever an occasion when your GP did 
not follow a recommendation from Dr Cosgrove about a change in dose? 

A       No. 
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Q       He always, in fact, followed the recommendation? 
 
A       Well, yes, because there would be a problem one way or another with my son, yes.  
 
                      
 

And I take it from what you said that throughout this period of time you had a 
 
confidence that Dr Cosgrove was, I was going to say meeting your son’s needs. That may 
be a fair way of putting it. 

A He 
did. 
 
 
 

In a way that other people such as Dr Moses had not. 
 
A Yes, 
completely. 
 
 
 

I take it from your attitude today that you still hold that view today. 

And I still hold that, very much so. 

 
 

I understand. What was the highest dosage of Ritalin per day that your son 
 
received from Dr Cosgrove? 
 

I honestly cannot remember. 
 
 
 

If we can think about it in terms of tablets, how many tablets a day do you think 
your son was on? 

A Four. 
 
 
 
Q Four? 
 
A Yes. 
 
 
 

Is that having tablets four times a day? 
A Yes. 

 
 

Was it one tablet each time or more than one tablet or, indeed, less than one tablet 
 
each time? 
 

One, yes, probably one of each. 
 
 

One of each, Ritalin and Risperidone. 
 
A Yes. 

 
 

Do you ever recall there being a time when the dosage that your son received was 
 
more than one tablet at once? 
 

No.  I do not think so.  I cannot remember. 
 
 

I appreciate it may be difficult to recall that.   May I just refer you then to one or 

two parts of the letter from Dr Cosgrove to Dr Moses  that we have been looking at.  In 
 
this letter it is suggested that in the six month period from November 1998 to I think May 
 
1999, which would be the period between your son starting at Pollards Well and Dr 
 
Cosgrove seeing him and therefore you ---- 
 
A Yes. 
 
 

That Dr Moses had only seen your son once. 


That is right. 
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In fact, Dr Moses saw your son regularly during that period. 
 

No and actually I am quite annoyed about this, because I am just a normal parent 
 
trying to do the best by her child.  I would turn up for these appointments that Dr Moses 
 
was supposed to be there and other people and I would turn up to having a nurse and a 
 
key worker giving me apologies, “Oh very sorry, she could not make it”, “Very sorry, she 
could not make it” and I used to get quite upset by it and think, “Well, I’ve got to make 

the effort.  If I didn’t make the effort I would be a bad mother”, you know, if I made 
 
excuses repeatedly. She has seen my son once and on that meeting she promised me a 
 
sleeping draft because members of staff, key workers, nurses, were talking to my son and 
 
my son would say, “I watched so and so” and they would get the paper of the day before 
 
and say, “Well, that’s on at 3 o’clock in the morning, it didn’t finish until 5, oh, oh, yes”, 
 
you know, “you have got a problem, he isn’t sleeping, we will speak to the doctor”. She 
comes, “Yes, I will prescribe a sleeping draft”.  I chased that sleeping draft for six months 

and never to this day have I ever, ever had a reason why she did not prescribe it ever 
 
given to me.  My son did have a sleep problem.  He would not sleep.  He was up and 
 
hyperactive the whole time.  I would not have got away with that. 
 
 
 

What sleeping draft did she say she would prescribe? 
 

It began with a P, I think.  I cannot remember the name. 
 


I suggest to you that at no stage did Dr Moses ----- 
 

Oh, she did! 
 
 
 

Say that she was going to prescribe any sleeping tablet. 
 

100% she did.  She told me it was brought to her attention by not only myself, the 
 
staff. 
 


Certainly she was aware, it was brought to her attention that there were sleeping 
 
problems. 
 

And she had told me at the only meeting she attended that she would prescribe a 
 
sleeping draft and that never ever came forward. 
 
 

 Dr Moses was seeing your son regularly on a weekly basis while he was at 
 
Pollards Well. 

A No, 
no. 
 
 
 

How do you know that, Mrs C? Were you present in Pollards Well all the time 
 
that your son was there? 
 

I was there a damn sight more than she was, that is for sure, and I was only a 
parent.  Because of the feedback, because I was very involved in that school.  I went up 

once a week and had lessons side by side with my son and, no, she was not that involved 
 
with my son.  One meeting I am referring to.  Out of six plus meetings she was supposed 
 
to attend she made one. Apologies. 
 
 
 

Why do you think she was not at the other five meetings?  Was it because she 
 
could not be bothered? 

I honestly do not think she could be, no, no.  The only recommendation I had from 

her was to put C into care. 
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If Dr Moses was ---- 
 

There was nothing wrong with him.  Why then, if there was nothing wrong with 
 
my child, only a naughty boy that needed to go into care, why is he now still being 
 
treated, still taking medication and he is in a specialist school?  He is not in care, he is in 
 
a specialist school.  We are seven years on.  If Dr Cosgrove had mistreated my son, why 
seven years on? Why?  Dr Moses said there was nothing wrong with him, he was a 

naughty boy, put him into care. 
 
 
 
THE CHAIRMAN:  Mrs C, I know that these are difficult circumstances for you, but it 
 
would help us all if you would just pay attention to the questions being put by Mr Pearce 
 
and perhaps subsequently by Mr Morris and confine your replies to the substance of the 
 
question.  I think it would help us. 
 

MR PEARCE:   When did Dr Moses say that your son should be put in care? 
 

April of that year where I then took my son privately.  That is what forced my 
 
decision to take my son privately. 
 
 
 

In what context did she say it? 
 

That there was nothing wrong with him, he was basically a very naughty child. 
 


So she said there is nothing wrong with him, he is a very naughty child who needs 
 
to be in care or words to that effect. 
 
A Yes. 
 
 
 

I suggest that she never said that your son needed to be in care. 
 

What was the recommendation then? 
 


Did she ever suggest that your son needed to be in care? 
 

Yes, she did, yes. 
 
 
 

She said those words? 
 
A Yes. 
 
 

Could I ask you to have a look again at a letter from Dr Cosgrove to Dr Moses.  

Did you tell Dr Cosgrove that Dr Moses had said that your son should be in care? 
 
A Yes. 
 
 
 

Dr Cosgrove does not mention that in this letter.  If you had said that to Dr 
 
Cosgrove, Dr Cosgrove would have put it in the letter, would he not? 

That is exactly and that is what resulted in me taking my child privately to see 

another doctor.  I did not want my son going into care.  I did not feel that was the right 
 
road and I still do not. 
 
 
 

Mrs C, if anybody said that, and somebody may have said it ----- 
 
A It 
was. 
 
 

But it was not Dr Moses. 


My son was due to finish school there in the July at Pollards Well and the 
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recommendation that was being forwarded in the meeting I had in the April and I only 
 
had it on a report (like I said, she did not attend any meetings anyway) and in that report 
 
it was stated that it was felt that C’s next placement should be of one in care.  She felt that 
 
I was my son’s problem, I think. 
 
 
 

I suggest that is not what she said at any point. 

Okay.  I was there. 

 
 

It is apparent from this letter of Dr Cosgrove to Dr Moses that he feels angry 
 
about the care that had been provided to your son. 
 
A Yes. 
 
 
 

Did he express that kind of anger to you when you told him the background on 
that visit to Bristol in the May? 


Not an anger, but he could not see that my son could just be dismissed and, you 
 
know, not had any treatment or nothing was tried, that it was obvious from my son’s 
 
behaviour the whole time we were there that indeed there was a problem. 
 
 
 

When you received this letter, the one to Dr Moses, a copy of it, what did you 
 
think about the letter?  Did you think, “Well, Dr Cosgrove agrees with me.  It is obvious 
that my son has not had proper care there”? 


Not so much that.  I just felt that he was obviously, you know, explaining why I 
 
had taken C from the National Health, if you like.  I brought him out from there.  I just 
 
felt that he was throwing the case over. 
 
 
 

But did you find that this letter confirmed your views that your son has been let 
 
down? 
A Yes. 

 
 

If I can pick up one or two matters, prior to that letter being sent, subsequent to 
 
you seeing Dr Cosgrove, Dr Moses indicated that it was no longer appropriate for her to 
 
treat your son, did she not? 
 
A Yes. 
 
 

Her explanation to you was that he was saying that he had ADHD and that that 

was an explanation for his behaviour and that that ran contrary to her approach. 
 

No.  My son went to school.  I had made it fully aware that I was taking my son 
 
privately to see somebody else. 
 
 
 

Yes, I understand. 

And that he was going to be off on that particular day in May.  My son went to 

school the next day and was told that was his last day there, as I had taken him privately 
 
then he was not allowed to see even the rest of the short period of time that he had left in 
 
school until the July, until they broke up for the summer.   C could not even stay in that 
 
school until July.  He was dismissed there and then.  That was his last day and they 
 
invited him back for one day for him to say goodbye to his friends which was a week and 
 
a half or whatever later. 
 


Dr Moses’ concern was that your son could not be both treated by Dr Cosgrove 
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and in her unit because it was two completely different approaches.  Dr Cosgrove was 
 
making a diagnosis with which she did not agree. 
 

Agree with, that is right. 
 
 
 

He was giving treatment with which she did not agree. 
 

Agree with, yes. 
 


And that she felt that the diagnosis and the treatment were contrary to what she 
 
was trying to achieve in Pollards Well.  She may have been right, she may have been 
 
wrong, Dr Cosgrove may have been right or may have been wrong, and I know you have 
 
your views on it, but I am just seeking to understand what the difference between them 
 
was that led to your son not going there any longer.  It was Dr Moses saying it was not 
 
appropriate for him to continue “because what Dr Cosgrove is doing is not consistent 
with what I want to do”. Am I right in that? 

A Yes. 
 
 
 

It is right to say, is it not, that in the year 2002 your son’s behaviour again 
 
deteriorated significantly? 
 

A little bit, yes. 
 
 

Sufficiently significant for your GP to refer him back to the Trust where Dr Moses 

works. 
 
A Yes. 
 
 
 

Dr Moses thought it was not appropriate that she should treat him. 
 

I would not have allowed her to treat him. 
 
 

No, but there was a referral back. 


Yes.  My son found it very hard to cope as my mother had died and he was quite 
 
upset by things and he had not been seen apart from with the GP then. 
 
 
 

At that stage I suggest that your son was having three drugs - Ritalin, Risperidone 
 
and Clonidine. 

That is right. 
 
 


The Ritalin at that stage, I suggest, was 40 milligrams a day.  Just so you 
 
understand, it appears to be the case that Ritalin will come in 10 milligram tablets, so 40 
 
milligrams a day would be four tablets, although in point of fact my understanding is that 
 
he would be having 1 ½ tablets at one time, 1 ½ tablets at another time and one tablet at 
 
another time, but anyway it was a total of four tablets daily and he was still seeing Dr 
Cosgrove at that stage. 


Not at that stage, no. 
 
 
 

There is a letter I want to ask you to look at to see whether that is right that he was 
 
not still seeing Dr Cosgrove.  I have to hand it over to you.  I have not got any copies at 
 
the moment.  We will have copies made if it is necessary in due course. Can I just ask you 
 
to have a look at this letter.  (Same handed.)  As I understand it, and we can run through 
the sequence, I think this is a letter from your general practitioner to Dr Moses’ unit in 

2002. 
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No, I had not actually been seeing Dr Cosgrove at that point. 
 
 
 

The letter says you were seeing him, does it not? 
 

I know what the letter says, but, no.  I will be honest with you, the only reason 
 
was because my Mum had died recently and she helped me fund my treatment for C.  My 
 
appointments my Mum helped me pay for and I could not afford to continue on my own.  
That was the only reason. 

 
 

Was there a deterioration in your son’s behaviour? 
 

In C because his grandmother had passed away, yes, and they were very close. My 
 
mother was very, very young. 
 
 
 

I do not want to intrude too much into the details of your private life.  These 
experiences are intrusive enough as they are, I understand that, Mrs C, but was it the case 

that your mother’s death led you to stop going to see Dr Cosgrove because you could not 
 
afford it, is that what you are saying? 
 

That is right, yes. 
 
 
 

I understand.  
 

But I knew that my son still needed to be seen as obviously there were problems 
and there are still problems now.  He is still having treatment.  He is still, you know, .....  

He has got a condition and that condition is still being treated, you know.  I cannot get 
 
away from that fact either and he is still on medication. 
 
 
 
MR MORRIS:   I have no re-examination. 
 
 
 
Questioned by THE COMMITTEE 
 


I have just the one question, Mrs C.   You indicated that on the first occasion you 
 
attended Dr Cosgrove your son’s height, weight and blood pressure were taken. 
 

That is right, yes. 
 
 
 

And that you had some five face to face consultations. 

Yes, I did. 
 
 


On the subsequent consultations were his height, weight and blood pressure 
 
taken? 
 
A Yes. 
 
 
 

They were taken? 
A Yes. 

 
 

Was any comment passed on them? 
 

No, no, he was doing fine. 
 
 
 
THE CHAIRMAN:  Thank you very much.  Mr Morris, do you want to come back? 
 
 
MR MORRIS:   No, thank you, sir. 

 
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THE CHAIRMAN:  That concludes your evidence, Mrs C.  Thank you very much for 
 
attending. 
 
 
 
(The witness withdrew.) 
 
 
 
THE CHAIRMAN:  I am trying to work out an estimate of timing.  Your witness is going 
to take another hour.  It may be we will want a break at some stage.  It may be better to 

take a break just now and then deal with the witness in one sitting. 
 
 
 
MR MORRIS:   Sir, yes. 
 
 
 
THE CHAIRMAN:  We will deal with it in one sitting? 
 
 
MR MORRIS:   Yes. 

 
 
THE CHAIRMAN:  We will take a short break just now and we will come back at 3.20. 
 
 
 
(The Committee adjourned for a short time.) 
 
 
 
MRS E Sworn 
Examined by MR MORRIS: 

 
 

I am going to call you Mrs E so as to safeguard your son’s anonymity.  I just 
 
wonder if we could start, though, by you writing down on that blank piece of paper your 
 
full name together with the full name of your son? (Pause.  Same handed to the 
 
Committee) 
 
 

Mrs E, I think your son underwent treatment by the Oxfordshire Mental Health 

Care NHS Trust at the Warneford Hospital in Oxford?  
 

That is correct. 
 
 
 

In the later part of the 1990s? 
 

That is correct. 
 
 

In April 1999, you had made - you and your husband, I think, had made - a 

complaint to the Trust centring around their diagnosis of attention deficit hyperactivity 
 
disorder in your son, the length of time it took to reach that diagnosis, the subsequent care 
 
and treatment that was offered to him and the lack of support you felt had been given to 
 
yourselves to help you cope with his behaviour and condition? 
 

That is correct. 
 


Did you have any assistance in formulating that complaint and presenting that 
 
complaint? 
 

Yes we did, with CHC, the Health Council, a lady called Val Garner. 
 
 
 

Was that complaint put in in written form? 
 

Yes, they all were.  
 


As a result of receiving that complaint, did anyone from the Trust see you? 
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We had several meetings with different people throughout the hospital, yes.  
 
Originally a Dr Oppenheimer saw us. 
 
 
 

Did there come a time when you saw a Wendy Samways? 
 
A Yes. 
 
 

Who, as we understand it, was at the time responsible for dealing with complaints 

to the Trust? 
 

That is correct, yes.  
 
 
 

What was the upshot of the meeting you had with Mrs Samways of how the 
 
complaint should be progressed? 
 

They would internally look through the paperwork to see if they could resolve the 
questions that I had raised locally within the NHS system and we still never had any 

satisfaction from that, so we were wanting to have the independent review.  
 
 
 

Was that agreed by Mrs Samways, that there should be an independent review? 
 

I do not think she ever actually agreed to it, no.  It was something that Val Garner 
 
had tried to push through.  
 
 

You talked about the fact that she was proposing that the record should be looked 

at internally? 
 
A Yes. 
 
 
 
 

Whom did you understand was going to conduct that review of records? 
 

She did not actually say who but we did have a meeting with Dr Oppenheimer, Dr 
 
McDonald, who had been E’s clinician and again from that meeting we still had other 
concerns and the original concerns had not been met at all.  

 
 

Right.  What happened next, then, as far as the complaint was concerned?  
 
 
 

We seemed to go from one to another to another, different doctor looking at them 
 
and Val Garner had actually written to the Ombudsman to see if they would get involved. 
 In between times, Wendy Samways and Maria Dineen visited our home to push for an 
 
independent report on the situation.  

 
 

What did you understand by the independent report?  How was that going to be 
 
done? 
 

We were led to believe that it would be fair and that they would look into all the 
 
concerns that we had raised and they would if necessary criticise any of the NHS dealings 
and that then that would have answered in their terms their local issues, so it was another 

step forward for us, we were led to believe. 
 
 
 

Did you know at that stage who it was proposed would conduct that review? 
 

At the meeting with Wendy Samways and Maria Dineen there were two names 
 
given and one of which was the lady who did the report.  
 
 

I think that was Dr Kenyon? 


That is right. 
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Did you agree to that review of records by Dr Kenyon? 
 

Yes, I did.  
 
 
 

At that stage what was your understanding, if any, as to what further steps you 
 
could take if you were not satisfied with what Dr Kenyon reported? 

We were not told any other procedures.  

 
 

At the time when you agreed to this procedure taking place, had you received any 
 
advice from the Community Health Council or from anyone else? 
 

Not at that point.  It was not until afterwards that we had agreed to the review that, 
 
because our Health Council lady was on holiday but when she returned she said she 
 
would not have actually suggested we go down that route. 
 


Had you at that stage met and seen Dr Cosgrove by the time this stage had been 
 
reached? 
 

Oh, yes.  Yes. 
 
 
 

Did you discuss the proposed review with him? 
 

Yes, I did. 
 


What was his view? 
 

Again, he did not think it was in our best interests to have gone down that line. 
 
 
 

I would like you, please, to look at a letter he wrote.  In front of you, you should 
 
have a bundle of documents headed C8.  Could you look, please, at divider 7 of that?  On 
 
the first page there is a letter from Mrs Samways to Dr Cosgrove asking him to provide 
her with copies of any medical records he might hold regarding your son and mentioning 

that the Trust is currently reviewing the management of your son’s care.  Over the page, 
 
there is Dr Cosgrove’s response to that request, dated 3 October 2000.  Do you have that? 
 
A Yes. 
 
 
 

If you look at the end of that letter you will notice that a copy of it was apparently 
sent to you? 
 
A Yes. 
 

 
 

And your husband.  Can you confirm having received a copy of that letter? 
 
A Yes. 
 
 
 

He says in that letter that he is unwilling to agree to the request to disclose your 
son’s records to the enquiry and he sets out his reasoning: 

 
 
“I do not believe that the independent expert will be truly 
 
independent nor sufficiently knowledgeable concerning 
 
the treatment I have given to E subsequent to my taking 
 
over his care from Dr McDonald.  I am concerned that I 
 
am being drawn into a process which in the end will 
whitewash the circumstances of E’s inadequate care given 

by an employee of your Trust.  It seems to me inevitable 
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the Trust will come to a final decision which first and 
 
foremost will ensure that the Trust cannot be sued by Mr 
 
and Mrs E with regard to the care of their son.” 
 
 
 
Did you approve or disapprove or have any views on his decision not to disclose your 
 
son’s records to that enquiry? 

I approved.  I knew that Dr Cosgrove was actually going to write and say that he 

would refuse as well. 
 
 
 

You knew that in advance? 
 

Yes.  Before the letter, yes. 
 
 
 

What were your views, please, when you received that letter on his assertions that, 
first of all, your son had been given inadequate care by the Trust, that that investigation 

might end in a whitewash of such inadequate care? 
 

I agreed.  I agreed with the statement there. 
 
 
 

That the investigation was programmed to ensure the Trust was not criticised at 
 
all or only criticised in a minor way? 
 

Certainly when we received the report back they were not. 
 


Obviously you did receive the report from Dr Kenyon.  What was your view of 
 
that report and its assessment of the care that had been given to your son by the Trust? 
 

It was a whitewash.  They were vindicated.  I do not think that they were given 
 
the full and correct information in the first place and certainly from the information they 
 
were given, they had ever reason to say that the NHS did a wonderful job.  
 
 

That review by Dr Kenyon involved her reviewing the medical records.  Is that 

correct? 
 

I am not quite sure if it was the medical records but certainly some of the 
 
communications from the Trust.  I am not quite sure whether she was given E’s full 
 
records or not. 
 
 

She did not speak to you.  Is that correct? 
 
A No. 
 

 
 

Can you help us, please, with your assessment from your perspective as E’s 
 
mother, of the treatment that your son received at the hands of Dr Cosgrove? 
 

It was a complete turn around for my son at that point.  He had declined 
 
emotionally and behaviourally very severely and when Dr Cosgrove took over, he then 
turned E around emotionally and behaviourally. 

 
 

What was his diagnosis? 
 

That he had attention deficit disorder, that he had Tourette’s and also oppositional 
 
defiant disorder. 
 
 
 

What medication did he prescribe for him? 

He had Ritalin, pimozide and Risperidone.  

 
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The pimozide was for what condition? 
 
A Tourette’s. 
 
 
 

Was there any monitoring of your son’s condition after the prescription of those 
 
drugs? 
 

Yes.  The GP has regular monitoring of my son.  
 


What form did that monitoring take? 
 

Weight, height, blood pressure. 
 
 
 
Q       Did you have any further contact with Dr Cosgrove after the initial consultation and 
 
assessment and diagnosis? 
 
A       Yes, very regular. 
  

Q       Was that by telephone, or by meeting, or...? 
 
A       Both. 
 
  
 
Q       Both. 
 
A       We have had telephones and also meetings with Dr Cosgrove. 
 
  
MR MORRIS:   Yes, if you would wait there, please. 

  
 
Cross-examined by MR PEARCE: 
 
  
 
Q       Could I ask you a little about the complaints process first, please, Mrs E.  Am I 
 
right in understanding that this is the only time that you have made a complaint in respect 
 
of medical treatment? 
A       Yes, it is. 

  
 
Q       Yes.  So, would it be fair to say that you had limited knowledge of the procedures 
 
involved? 
 
A       Very limited, yes. 
 
  
Q       Yes.  Now before you made this complaint I think your son had been treated at the 
 
Trust for some little time, is that right? 

A       About a year. 
 
  
 
Q       About a year? 
 
A       Yes. 
 
  
Q       And ultimately a diagnosis of ADHD had been made? 

A       It had been made, yes. 
 
  
 
Q       Although it had not been made you thought as early as you thought it might have 
 
been, is that right? 
 
A       I thought it could have been made a bit earlier, yes. 
 
  
Q       Yes, I understand.  Yes.  And I appreciate you had other complaints. 

A       Yes. 
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Q       I am not at the moment too concerned with the detail of the complaints, but just to 
 
understand the position. 
 
A       Yes. 
 
  
 
Q       So, you made this complaint and you had assistance from the appropriate people 
who are there to help --- 

A       Yes. 
 
  
 
Q       --- those such as yourself who have complaints about medical treatment? 
 
A       Yes. 
 
  
 
Q       And ultimately you had this meeting, or you had as you indicated a number of 
meetings, both with doctors - Dr Oppenheim and Dr McDonald? 

A       Yes. 
 
  
 
Q       But also with the administrators, if I can call them that, such as Wendy Samways? 
 
A       Yes. 
 
  
 
Q       And is it fair to say this, that initially it was being suggested from the Trust's side 
that they would carry out an Internal Review and that what you wanted was an 

Independent Review? 
 
A       I do not think at that point we were wanting an Independent Review in the early 
 
stages.  It was that all the way along we had wanted explanations of why things had 
 
happened. 
 
  
 
Q       I understand, but were they -- well, perhaps I am getting ahead of myself.  Did 
there come a time when you were not getting adequate explanations and, therefore, you 

felt there should be an Independent Review? 
 
A       Yes. 
 
  
 
Q       And that was why Mrs Samways or Miss Samways came to see you, or saw you, to 
 
discuss there being such a review? 
A       No, she came to see us in the house for the report to Dr Kenyon. 
 
  

Q       Right.  I am sorry, the report of Dr Kenyon? 
 
A       Well, for Dr Kenyon for her to do the independent report. 
 
  
 
Q       Oh, I see.  Yes.  Well, we may be at slight cross-purposes.  At that visit, when Miss 
 
Samways attended at your house, her purpose was with a view to asking you if you 
agreed to Dr Kenyon or the other named person carrying out a review of the 

documentation? 
 
A       Yes. 
 
  
 
Q       Yes.  And do I correctly understand it that from your point of view at that stage, 
 
with the advice you had received, that seemed like a good way forward because it was an 
 
independent person looking at the papers rather than somebody from within the Trust? 
A       That is what we were led to believe from the Trust, yes. 

  
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Q       Yes, yes.  And, therefore, you agreed to that review going ahead and to Dr Kenyon 
 
being the person carrying out the review? 
 
A       Yes. 
 
  
 
Q       Is it not the case that Miss Samways made clear to you that, whatever the outcome 
 
of that review, it was open to you to proceed thereafter through the NHS complaints 
procedure? 

A       No. 
 
  
 
Q       Did she talk about trying to resolve the matter locally before other procedures were 
 
followed? 
 
A       Not that I can recall, no. 
 
  
Q       Right.  But you would only have a fairly vague sense of what the procedures were? 

A       Definitely, yes. 
 
  
 
Q       Yes, I understand that.  Now Dr Cosgrove's letter that we have looked at came, as I 
 
understand it, after that visit from Miss Samways? 
 
A       Yes. 
 
  
Q       But before you received Dr Kenyon's report? 

A       Yes. 
 
  
 
Q       But in the meantime, between the Miss Samways visit and Dr Cosgrove's letter, 
 
you had spoken to Dr Cosgrove? 
 
A       Yes. 
 
  
Q       And told him about the Independent Review? 

A       Yes. 
 
  
 
Q       Did what Dr Cosgrove have to say to you about that reflect the kind of things that 
 
he has said in this letter as to why you should not agree to it? 
 
A       Well, I had already spoken to Val Garner --- 
  
 
Q       Yes? 

A       --- before I spoke to Dr Cosgrove. 
 
  
 
Q       Yes? 
 
A       And so I had already formed the opinion that it was not going to be to our best 
 
advantage to have gone for the report. 
  

Q       And what was Dr Cosgrove's view?  Why did he think you should not go for that? 
 
A       Again, because he thought it would be in the Trust's favour and that it would not do 
 
us and our case any particular use at all. 
 
  
 
Q       Right.  Why was he saying it would be in the Trust's favour? 
 
A       Well he did not really go into an awful depth about why, but certainly that, you 
know, from what we were led to believe from the Health Council that they would use the 

time to vindicate themselves, and Dr Cosgrove did agree with that point. 
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Q       So, Dr Cosgrove was saying that he thought that the report would, what, result in 
 
Dr Kenyon vindicating the Trust? 
 
A       Yes. 
 
   
 
Q       Right.  And how?  How was that going to come about, as you understood what Dr 
Cosgrove was saying?  Was Dr Kenyon not going to be shown relevant documents, or 

was she going to express a biased opinion in favour of the Trust?  What was your 
 
understanding about? 
 
A       Possibly that, you know, it would be certain parts of information given and not the 
 
full side of the things that we were asking for. 
 
  
 
Q       Right. 
A       So, they would pick and choose their paperwork. 

  
 
Q       Right.  So, that the Trust might not disclose everything that was relevant? 
 
A       Yes. 
 
  
 
Q       Right.  You see, in this letter he says, "The expert will not be sufficiently 
 
independent to do justice to the case"? 
A       Yes. 

  
 
Q       Was that a view he expressed to you, that Dr Kenyon would not be sufficiently 
 
independent? 
 
A       He did not personally, no, but I did actually speak to the ADHD Helpline who was 
 
quite surprised that this particular lady had been picked for being a specialist in this area. 
 
  
Q       Well there is more than one point there, is there not? One is whether she is 

sufficiently specialised in the area which is another point that Dr Cosgrove makes, but 
 
one is whether she is sufficiently independent.  Now, Dr Cosgrove is expressing the view 
 
in the letter that she is not sufficiently independent.  Did he express that view to you? 
 
A       No, no.  Not in that sense, no. 
 
  
Q       Right. 
 
A       But, you know, we have spoken about that and obviously no-one is going to 

criticise another psychiatrist if there is ever a chance that they are going to meet.  So, in 
 
that sense, you know, I had already ascertained the fact myself that she possibly would 
 
not be as independent as we would have liked. 
 
  
 
Q       How would you get a more independent psychiatrist, just in point of fact? 
A       I do not know. 

  
 
Q       No.  How had you ascertained that she was not as independent as you might have 
 
liked? 
 
A       Through the Helpline that they have a wide knowledge -- well they are not actually 
 
functioning now, but they had a wide knowledge of different doctors on who they had 
 
dealings with who are not on a bad list, but certainly they would know whether they were 
a good choice to go and see or not. 

  
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Q       Well, can I explore that a little bit further and see what you have to comment on 
 
this.  We have heard evidence in this case that amongst psychiatrists there is a range of 
 
opinions, firstly as to making the diagnosis of ADHD and secondly as to prescribing 
 
drugs for it, and those opinions are as I understand it essentially these.  Some people 
 
would - some psychiatrists would - only diagnose ADHD in a very small number of cases 
 
and would have very tight definitions, and some other psychiatrists would have a rather 
wider definition of what amounted to ADHD. So, that is the diagnosis.  And in terms of 

treatment some psychiatrists would be very reluctant indeed to prescribe drugs and would 
 
look to behavioural psychological type therapies, if you like, and other psychiatrists 
 
would believe that medication was a primary choice - one of the first things you should 
 
look to  - in those ranges of opinion? 
 
A       Right. 
 
  
Q       Were you aware, through speaking to the ADHD Helpline or speaking to Dr 

Cosgrove, that there were differences of opinions --- 
 
A       Yes. 
 
  
 
Q       --- along those lines? 
 
A       Yes. 
 
  
Q       And what you were being told, did it amount to this? That Dr Kenyon's views were 

not at the same part of that range or that spectrum of opinion as Dr Cosgrove's, for 
 
example? 
 
A       Well, no, because I mean when I had spoken to the Helpline they had basically said 
 
that she had been in and out of practice for the last five years when she had been having 
 
children. 
 
  
Q       Right. 

A       And so her actual knowledge at that particular time, with all the new drugs or 
 
whatever, she would not have been as up-to-date as maybe some other doctor. 
 
  
 
Q       So, she might be less expert? 
 
A       Yes, yes. 
  
 
Q       Yes.  But, in terms of independence, what were you told that led you to believe that 

she might not be as independent as you would like? 
 
A       In that sense, nothing.  Just the sheer fact that, because again she is an NHS doctor, 
 
they would generally watch each other's back if you like. 
 
  
 
Q       Right.  So, that is the point that essentially any NHS doctor would be a problem 
because they might be meeting in NHS circles and might show less independence than...? 

A       Yes.  In that sense, yes. 
 
  
 
Q       When you spoke to Dr Cosgrove about this, did he have  anything to say about his 
 
experience of these matters in comparison to, for example, Dr Kenyon?  His experience 
 
of dealing with treating children with ADHD? 
 
A       No, he did not say that she was a bad doctor in any sense and, you know, that he 
was a better doctor. 

  
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Q       Right. 
 
A       Not in that sense, no. 
 
  
 
Q       I am not suggesting he said she was a bad doctor actually, but I am suggesting to 
 
you or asking you whether he said that he was a better doctor? 
 
A       No. 
  

Q       No, okay.  Or a more experienced doctor in this field? 
 
A       No. 
 
  
 
Q       Now you had, I think as we see from Page 1 of this division of that bundle, signed 
 
an authorisation for Dr Cosgrove to release records for the purpose of this investigation, 
 
is that correct? 
A       That is right.  The day that they came to our house. 

  
 
Q       Yes.  And you had not told Miss Samways that you no longer authorised that 
 
release, is that correct? 
 
A       That is correct, yes. 
 
  
 
Q       And, indeed, you never said to her, "I have changed my mind"? 
A       No. 

  
 
Q       "I do not want you to have the records from Dr Cosgrove"? 
 
A       No. 
 
  
 
Q       And you never said to her, "I have changed my mind.  I do not want this review to 
 
proceed"? 
A       No. 

  
 
Q       No. 
 
A       As far as I was led to believe it was all systems go. 
 
  
 
Q       Yes.  When you received this letter from Dr Cosgrove, then, were you surprised by 
what he had to say in terms of his unwillingness to agree to the release of his records? 
 
A       No, because I had already known beforehand that he was reluctant to. 

  
 
Q       Right.  Did you say to him, "Well I think you ought to, Dr Cosgrove, because we 
 
want to see how this review goes"? 
 
A       No. 
 
  
Q       "I would like you to co-operate with it"? 

A       No. 
 
  
 
Q       Were you keen for him to co-operate with the review? 
 
A       No. 
 
  
 
Q       Was it going to help your cause if he did not co-operate? 
A       If he what, sorry? 

  
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Q       Was it going to help your cause if he did not co-operate? 
 
A       I do not think it had any impact at all, to be quite honest. 
 
  
 
Q       Were you surprised what Dr Cosgrove was saying about the expert being not 
 
sufficiently independent to do justice to the case? 
 
A       No, I was not surprised.  No. 
  

Q       Or that she was not sufficiently knowledgeable or experienced? 
 
A       No. 
 
  
 
Q       Were you surprised when he said that he is probably the most experienced 
 
specialist in the United Kingdom in the use of Risperidone? 
 
A       No, I am not surprised.  No. 
  

Q       Were you surprised when he said that you will not find an expert who will be able 
 
to do justice to your son's case? 
 
A       No, I was not surprised at that either.  No. 
 
  
 
Q       Were you surprised when he said that he believed that this would be a cover-up of 
 
the care that your son had received? 
A       Again, no, I was not surprised. 

  
 
Q       They are fairly strong words though, are they not? 
 
A       I think he feels very deeply about his patients. 
 
  
 
Q       Oh, I appreciate that, but this goes rather beyond his feelings about his patients.  
 
This is his feelings about how other medics and those involved in the medical sphere 
respond to criticisms about them and investigate those criticisms? 

A       I mean that is really not for me to say on what he believes, but I do not get that 
 
impression that he thinks he is above anybody else. 
 
  
 
Q       And when Dr Cosgrove says in his letter, and no doubt you recall this passage, 
 
"You should be asking me for my expert opinion on the matter and not just for the notes", 
did it strike you that it might be a good idea to get Dr Cosgrove's expert opinion? 
 
A       I think it possibly would have been in the Trust's best interests to have done that 

but, again, that would have criticised their handling of E and so they were I do not think 
 
particularly interested. 
 
  
 
Q       Now, you received this report subsequently from  Dr Kenyon? 
 
A       Yes. 
  

Q       And it did not uphold your complaints, as I understand it? 
 
A       No. 
 
  
 
Q       Did you make any further complaints or take matters any further thereafter? 
 
A       Yes, we had to go back to then the Health Council and through them we then went 
 
to a solicitor. 
  

Q       Right.  And did that matter proceed?  I do not particularly want to know the details 
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of it, but did that matter proceed - you going to see a solicitor? 
 
A       Yes, it did. 
 
  
 
Q       To an action? 
 
A       Not to being sued, no. 
 
  
Q       I see.  Did you obtain an adequate resolution of your dispute with the Trust? 

A       Yes, we did. 
 
  
 
Q       I am glad to hear that.  If I can ask you about Dr Cosgrove's treatment of your son, 
 
was it around this time that he had first seen him?  Around -- well, this letter is dated 3 
 
October 2000.  When had Dr Cosgrove first seen your son? 
 
A       He saw him in the June. 
  

Q       June of 2000? 
 
A       Yes. 
 
  
 
Q       And has he seen him, or when did he last see him? Actually see him? 
 
A       A face to face visit? 
 
  
Q       Yes? 

A       That would have been 2002, I think. 
 
  
 
Q       Right, right. 
 
A       The late part of 2002. 
 
  
 
Q       I am sorry, which part of 2002? 
A       The late part of 2002 I would have said, yes. 

  
 
Q       The late part of 2002.  So, he would have seen him over a period of two years or 
 
slightly longer? 
 
A       Yes. 
 
  
Q       When was the last time you had telephone contact for the purpose of your son's 
 
treatment? 

A       That was before - just before - Christmas. 
 
  
 
Q       Just before Christmas of last year? 
 
A       Yes. 
 
  
Q       Of last year, yes? 

A       Yes.  2003, yes. 
 
  
 
Q       Right.  During the period then from when Dr Cosgrove first saw your son to the last 
 
time that he actually saw him face to face, on approximately how many occasions did he 
 
see your son? 
 
A       Only about three or four, I think, over the whole period. 
  

Q       I see.  And approximately how many telephone consultations did you have in the 
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period between first seeing Dr Cosgrove and December 2003? 
 
A       That was quite a lot. 
 
  
 
Q       Approximately?  I mean are we talking once a month, once in three months, once in 
 
six months, or...? 
 
A       In the early days it was once every month to six weeks. 
  

Q       Right. 
 
A       And the most we ever felt confident being without was about three months. 
 
  
 
Q       I understand.  And during that period you have indicated that your General 
 
Practitioner, I think, was involved in monitoring? 
 
A       Yes.  Oh, yes. 
  

Q       By measurements and such like? 
 
A       Yes. 
 
  
 
Q       I understand.  Can I ask you about prescriptions of medication during that period.  
 
You have mentioned those three drugs.  I am concerned first of all, or primarily I think, 
 
with Ritalin. Has the prescription varied during that period from Dr Cosgrove first seeing 
your son until December of last year when he last had a telephone conversation? 

A       Do you mean has it been increased? 
 
  
 
Q       Well, up or down? 
 
A       Yes. 
 
  
 
Q       It has changed? 
A       Yes. 

  
 
Q       Has it changed a number of times? 
 
A       Yes. 
 
  
 
Q       Both up and down? 
A       Yes. 
 
  

Q       What is the maximum dosage that your son has received during that period? 
 
A       On the Ritalin? 
 
  
 
Q       On Ritalin, yes? 
 
A       He takes five of those a day. 
  

Q       Five single tablets a day? 
 
A       Yes.                                                                                                
 
 
 

Is that the highest he has had?  He has never had higher than that. 
 
A Yes. 
 
 

Risperidone, what about that?  What is the maximum dosage of Risperidone? 


He is on seven of those a day. 
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MR MORRIS:  I have no re-examination, sir. 
 
 
 
Questioned by THE COMMITTEE 
 
 
 
THE CHAIRMAN:   I have just got one question and it is to clarify a point raised by Mr 
Pearce.  You authorised the release of the records held by Dr Cosgrove and you gave 

Wendy Samways that authorisation.   
 
A Yes. 
 
 
 

As I understand it from the question that Mr Pearce put, that authorisation was 
 
never formally withdrawn.  There is no letter which indicates that you cancelled that 
 
authorisation. 
A No. 

 
 

When Dr Cosgrove decided not to release the records, was that his decision or a 
 
shared decision? 
 

It was shared. 
 
 
 

But you never intimated in writing to anyone that you were formally withdrawing 
your authorisation to release these records. 


No, I thought that Dr Cosgrove’s letter would actually end the question about 
 
them having his records. 
 
 
 

The letter that has been referred to, the October 2000 letter where Dr Cosgrove is 
 
indicating he is not releasing the records, was that letter stimulated by a telephone 
 
consultation or a face to face consultation? 

No, it was the telephone. 

 
 

Who initiated the telephone call? 
 

It just happened to fall in with another appointment, a previous appointment 
 
arranged, so I did not need to get hold of him for that purpose. 
 
 

So it was Dr Cosgrove who telephoned you. 
 

Yes, further obviously for my son. 

 
 

Can you recall whether the issue of the release of records during that telephone 
 
call was first raised by you or by Dr Cosgrove? 
 

I believe it was from me, that I had actually said that we had had a visit from the 
 
Trust and that they were going to do an independent report and that they had asked Dr 
Cosgrove for his records. 

 
 

And that you were having second thoughts about his records being made 
 
available. 
 

Not so much the records being available, but certainly going up, you know.  We 
 
had already spoken to the health council that suggested that that the review was a bad 
 
idea and Dr Cosgrove then supported the idea and said that he would refuse to send the 
records. 

 
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You did not provide Dr Cosgrove with a written statement saying that he was not 
 
to release these records? 
 
A No. 
 
 
 
THE CHAIRMAN:  Thank you very much. I do not think there are any further questions 
 
from  this end of the table.  Mr Morris, do you want to come back? 
 

MR MORRIS:   No, thank you, sir. 
 
 
 
THE CHAIRMAN:  That concludes your evidence.  All that remains is for me to thank 
 
you for coming to assist us. 
 
A Thank 
you. 
 
 
(The witness withdrew.) 

 
 
THE CHAIRMAN:  Does that conclude the business for today? 
 
 
 
MR PEARCE:   I think it does. 
 
 
 
THE CHAIRMAN:   Are there any housekeeping issues that need to be raised? 
 

MR PEARCE:   Not from my point of view, sir, no. 
 
 
 
THE CHAIRMAN:  Is 9.30 tomorrow a suitable housekeeping arrangement? 
 
 
 
MR PEARCE:   Yes. 
 
 
THE CHAIRMAN:  Agreed. 

 
 
(The Committee adjourned until 9.30 on Wednesday 16 June 2004.) 
 
 
 
- - - - - - 
 
 
 
 
 

 
 

 
 

 
 
 
 
 


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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
 
Wednesday 16 June 2004 
 
Held at: 
St James’ Buildings 
79 Oxford Street 
Manchester M1 6FQ 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Nine) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was not present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of Transcribe UK 
Tel No:  0208 614 5799) 
 
-------------------------------------- 
 
 
 
 

 
 
 
 
INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
PROFESSOR ERIC TAYLOR, Recalled 
 
Examined by MR PEARCE (continued) 
 
 
 
 1 
 Cross-examined 
by 
MR 
MORRIS 
    19 
 Re-examined 
by 
MR 
PEARCE 
    36 
 
 
Submission re the introduction of Dr Cosgrove’s  
witness statement  by MR MORRIS   
 
 
 
 
41 
 
 Reply 
by 
MR 
PEARCE 
      42 
 
 Advice 
by 
the 
LEGAL 
ASSESSOR 
     43 
 
 DETERMINATION 
       44 
 
 
 
 
____________________

 
 
 
 
 
 

 
THE CHAIRMAN:  Good morning.  Mr Pearce, is it over to you now? 
 
  
 
MR PEARCE:   It is, sir.  I recall Professor Taylor, please. 
 
  
ERIC TAYLOR Recalled 
 
  

THE CHAIRMAN:   I will just remind Professor Taylor for the record that he continues 
 
to be under oath. 
 
  
 
THE WITNESS:   Indeed. 
  
 
MR PEARCE:   I am obliged for that indication, sir. 
 
  

Examined by MR PEARCE (continued)
 
  
 
Q       Professor Taylor, we had I think reached a point at which you had dealt with the 
 
generality, if I can put it that way, in terms of background in respect of the condition of 
ADHD, in respect of prescribing medication such as Ritalin, in respect of the debate 
 
between such a prescription on the one hand and other forms of therapy on the other 
 
hand, and as to what you had to say in general terms in respect of monitoring of 

medication and appropriate examination before medication was commenced. 
 
  
 
Could I ask you then if we could start to turn to the particularity of the cases and, if we 
 
could deal with the patients in order, Patient A.  Now just to deal with a matter in respect 
of Patient A, is it in fact correct that since the matters with which we are concerned with 
 
in the charges in this case Patient A has been referred to you? 
 
A       Yes, that is correct.  He was not referred for treatment. He was referred to the care 

of Dr Margaret Thompson, who is a specialist in Southampton, and she asked for another 
 
opinion from me because of the unusual doses that he was on. 
 
  
 
Q       Right. 
A       So, I saw him for a second opinion. 
 
  
 
Q       Yes.  And you are aware that on behalf of Dr Cosgrove a request was made for the 

records from you? 
 
A       Yes. 
 
  
 
Q       Some records have been provided and I think copies are with the Doctor.  Just so 
that we understand those records, I think you have looked through them this morning and 
 
confirm that they comprise part of but not the entirety of what will be within your files? 

A       Yes, that is correct.  I was not in the hospital yesterday and so I could not supervise 
 
the actual files.  What they have sent I think is the essence of the files; that is to say that 
 
when the referral comes we make a detailed report and that is what you have got.  There 
 
would also be that there would be a lot of documentation that has been sent to us, from a 
lot of other sources, which I think you will probably already have --- 
 
   
 
Q       Yes. 

A       --- through other routes, and then there would be the correspondence that we sent 
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out but that would be the essential part of the correspondence. 
 
  
 
Q       I understand.  I understand.  Well, I will not ask you any more about that now. 
 
A       Yes. 
 
  
 
Q       It is just so that we understand the position. 
A       Yes. 

  
 
Q       Now, in respect of Patient A, the case that we bring - this is not admitted, but the 
 
case that we bring - is that from May 1996 Dr Cosgrove was prescribing to this patient 
 
Ritalin and that the dosage increased so that by May of 1998 it was 100 mgs of Ritalin a 
 
day and by May of 1999 it was 130 mgs of Ritalin a day.  In addition, that from July 1996 
 
Dr Cosgrove prescribed Risperidone and that from November 1998 he prescribed 
clonidine. 

  
 
Now, what I want to ask you in the light of those prescriptions is in respect of what 
 
monitoring of this patient was appropriate. In the first place, if Dr Cosgrove did not see 
 
the patient between May 1996 and May 1999, is that in your view appropriate? 
 
A       It would only be appropriate if there were adequate shared care arrangements in 
 
place. 
  

Q       Right.  And what would be an adequate shared care arrangement here? 
 
A       Well, there are several monitoring considerations that would come in with this.  
 
First of all there would be the ordinary level of monitoring that you always do, or try to 
 
do, if the children were taking stimulant medication - that is to say the regular checks on 
 
growth and the regular checks on blood pressure - all of which can be done in primary 
 
care, or by a paediatrician. 
  

Q       Yes. 
 
A       Then, especially because he is on high doses, you need the subtler problems - the 
 
more psychological problems - that can appear, and I think I mentioned when I was 
 
giving evidence before the possibility of hallucinations and the possibility that attention 
 
can become too constricted - too perseverative - and the child can give the impression of 
concentrating but in fact be frozen on the task. 
 
  

Q       Yes? 
 
A       And the appearance, or the possible appearance, of depression and mood changes 
 
as well. 
 
  
 
Q       Yes? 
A       And all those things I think are such reasons that you need really either a 

psychiatrist or a very specially trained  paediatrician to be the person who is assessing 
 
that kind of change. 
 
  
 
And then there are the issues of monitoring that come from the combination of 
 
medications, and I think that particularly I would be putting the cardiovascular issues 
 
here. 
  

Q       Yes? 
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A       Because he is on a combination of drugs that do have an effect on the heart.  The 
 
clonidine lowers the blood pressure, the Risperidone lowers the blood pressure, the 
 
Risperidone can alter intracardiac conduction and the Ritalin can increase the heart rate.  
 
And so those things together mean that I would have seen a need for cardiac monitoring 
 
as well, which I think a paediatrician would probably be able to do though they might not 
 
be aware of the issues of the interactions between these drugs. 
  

Q       Now we are and I think you are aware that a paediatrician, Dr Holme, was involved 
 
in seeing this patient during this period in the late 1990s? 
 
A       Yes, that is right. 
 
  
 
Q       And I think, so that we know, you have read Witness Statements that were prepared 
 
in this action? 
A       Yes. 

  
 
Q       And so you know something of what people have said in the background? 
 
A       Yes, yes. 
 
  
 
Q       Could I refer you please to Exhibit C12, which I hope is to your right, and Page 93 
 
of that exhibit?  You will see typed numbers at the bottom.  This apparently is a letter 
from Dr Holme to Patient A's General Practitioner, and it follows I think a referral or an 

issue being raised by Dr Vereker, a child psychiatrist, about provision of Ritalin therapy 
 
and also about the referral of Patient A to Dr Cosgrove.  In the fourth paragraph of that 
 
letter do you see this: 
 
  
 
"Margaret Vereker joined me for a major part of the consultation 
 
and at the end we agreed that the management of the Ritalin 
dosage would be left to Dr Cosgrove at The Bristol Priority 

Clinic.  Input on behavioural and cognitive training would remain 
 
with Mrs Corrigan, the Child Care Specialist"? 
 
  
 
A       Yes. 
 
  
Q       And I think we see at the bottom that this letter was copied to amongst other people 
 
Dr Cosgrove? 

A       Yes. 
 
  
 
Q       In that situation, the situation of Dr Holme having said that, what if any monitoring 
 
should Dr Cosgrove have undertaken in your view? 
 
 A       Well, this I think is a point where the child is fairly stable on medication and so the 
-- I mean in the early stages of medication, of course, you need to be checking more 

often, like monthly, on blood pressure and weight. 
 
  
 
Q       Right? 
 
A       But I think what I would have expected then would be, I think, a three-monthly 
 
check on all those main issues that I was indicating before in monitoring. 
 
  
Q       Yes? 

A       That is to say ECG, blood pressure, pulse rate and growth and mental status. 
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Q       Right.  And who should have been doing that? 
 
A       Well, under those circumstances Dr Cosgrove should have been doing it --- 
 
  
 
Q       Yes. 
 
A       --- or else renegotiating the arrangement about what the shared care practice is. 
  

Q       Yes.  Now if I refer you, please, to slightly further on in that bundle, let me take by 
 
way of example Page 125.  Now I think you will see at the bottom of Page 125, do you 
 
see the date of 13 November 1996? 
 
A       Yes. 
 
  
 
Q       This I think Dr Holme indicated in his evidence was a clinical note that he prepared 
following a clinic on that day? 

A       Yes. 
 
  
 
Q       You will see there is reference to weight and height, there is reference to the levels 
 
of Ritalin and Risperidone that are being prescribed: 
 
  
 
"Functioning well.  Attention at a level at which he can function.  
Can control impulsivity within limits.  Concentrates unaided ten 

minutes.  Had a good holiday", 
 
  
 
and then the top of the next page: 
 
  
 
"BP..." (blood pressure presumably) "... 100/70.  Growth  ...", 
 
  
with a tick, presumably meaning okay, and then "6/12" I think indicating that he should 

be seen again in six months. 
 
  
 
If I can then refer you to Page 88, and I am sorry to take you around the documents like 
 
this Professor Taylor, this is a letter typed on 19 November following that clinic: 
 
  
"Dear Christopher ..." (that is the GP) "... A is making good 
 
progress and his attention is at a level at which he can  function.  

He is able to control his impulsivity within certain limits and can 
 
concentrate unaided for about up to 10 minutes. His blood 
 
pressure today was 100/70 and his growth satisfactory with his 
 
weight at 23.7 kgs being on the 9th centile and his height at 124 
 
cms between the 2nd and the 9th.  His drug treatment at the 
moment consists of a total of 60 mgs of Ritalin a day plus, 1/2 

tablet bd of Risperidone. 
 
  
 
The Maudsley Hospital Guidelines suggest that we should check 
 
a full blood count at least annually on children who take Ritalin 
 
and I will arrange this the next time we meet in six months.  A's 
 
Fragile X screen was negative by the way", 
  

and we see at the bottom that that letter was copied to Cosgrove. Was it sufficient 
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monitoring, for the purposes that you indicate, that Dr Cosgrove should rely upon  
 
Dr Holme seeing this patient in a clinic and providing information along the lines of this 
 
letter? 
 
A       Only for some purposes, I think.  I think from the point of view of the physical 
 
effects I think that is perfectly reasonable.  At that point the drug treatment is within the 
 
ordinary range of medication doses.  I do not think it would have been necessary to do an 
ECG at that point.  He is not on the clonidine at that point.  And so from the point of view 

of the physical monitoring I think that is fine, but of course that does not tell the 
 
prescriber anything about the mental state of the child. 
 
  
 
Q       No. 
 
A       And of course it is the mental state of the child against which you are wanting to 
 
titrate the effects of the medication, and in particular knowing how things are happening 
at school and reports from the school are pretty crucial. 

  
 
Q       Yes, right.  And does adequate monitoring of this kind require Professor (sic
 
Cosgrove then to see the patient from time to time? 
 
A       It requires him to get information about the child.  It requires him to get the reports 
 
from the school, for instance --- 
 
  
Q       Yes. 

A       --- and knowledge of that.  But if it were the case that the situation had changed and 
 
that Dr Holme was then providing the physical monitoring, as he is doing, then at that 
 
dose level I think that is reasonable. 
 
  
 
Q       Right.  What about at higher dose levels when we get to 100 and 100 plus? 
 
A       Then I think personal contact would be absolutely essential. 
  

Q       Right.  Now, you mention clonidine.  After the prescription of clonidine, then, what 
 
further was required by way of monitoring? 
 
A       Well clonidine, because it is a blood pressure lowering drug among other things - it 
 
is a sedative drug - you need to be clear that the introduction of it is not sedating the 
 
patient and you also need to be quite clear that it is being taken in a regular fashion 
because, if you miss doses, then you can get a rebound hypertension.  The blood pressure 
 
which is usually kept low by the drug --- 

  
 
Q       Yes? 
 
A       --- can rebound and become quite worryingly high.  So, it is essential that you 
 
ensure and maintain that the drug is being given in an absolutely regular fashion. 
 
  
Q       Yes. 

A       And so the combination of that and the clonidine, I would have thought that that 
 
called for monthly monitoring by a person who knows what they are looking for. 
 
  
 
Q       Yes. Now in a patient who is prescribed Clonidine what, if any, warning should be 
 
given to the patient, or in the case of a child, patient’s parents about any dangers 
 
associated with Clonidine? 

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The main one is the need to take it regularly, that is to say do not miss doses.  If 
 
you cannot take it regularly then really it is better not to embark upon the treatment 
 
because the hazards of it are, I think, essentially the hazards of blood pressure rebound. 
 
 
 
Q Of 
hypertension? 
 

Of hypertension.  Some people would say that you need almost to have ECG 
monitoring if you were doing the combination of Clonidine with Ritalin.  This comes 

from a paper that reported four sudden deaths in children who were taking the 
 
combination of Clonidine and Ritalin.  However, it would not be consensus on that.  Not 
 
everybody would do ECGs with children on the combination.  I think it would represent 
 
cautious practice. 
 
 
 

Does the prescription of Risperidone have any bearing on what is appropriate in 
terms of monitoring here? 


Risperidone brings in a new class of problems.  It can reduce the blood pressure, 
 
though in these doses it is not very likely, but, nevertheless, you need blood pressure 
 
monitoring during the early stages of introducing Risperidone.  Our biggest concerns 
 
about it are probably metabolic, that is to say that  it can induce greater obesity and we 
 
have started to see cases of type 2 diabetes appearing in children who have been given 
 
Risperidone.  It can cause hyperlipidaemia, sorry, it can cause an excess of fats in the 
blood and it can cause an excessive secretion of the hormone prolactin which can make 

the breasts grow and lactate, which is an unpleasant effect, especially for young men and 
 
has other physical hazards in the long-term.  So I think there is also the potential with 
 
Risperidone of having the same kinds of adverse effect that happen if you people with 
 
psychosis start on the major tranquilisers, which, of course, this is.  Though it is 
 
uncommon you can get a sudden movement disorders, you can get sudden dystonia 
 
appearing, where the muscles go stiff.  People need to be warned about the possibility of 
that in case they needed to take the antidote for it. Then there is the remote but described 

possibility the neuroleptic malignant syndrome, which is a condition of very high fever, 
 
muscular rigidity, it is a medical emergency, it is a very serious but rare complication.  
 
People on Risperidone should be warned if they do run an unexplained fever they should 
 
go to their doctor. 
 
 

Does that have a bearing on what review is appropriate on the part of  
 
Dr Cosgrove? 


Not especially because those things are unpredictable.  It certainly means that 
 
somebody who is capable needs to be checking the neurological status to make sure there 
 
is not a syndrome developing of abnormal motor movements or motor tone.  But the big 
 
danger of the malignant syndrome is not a thing you can predict.  It is more of a question 
 
of warning people to report rapid if there is a fever sign. And I would have expected to 
take an ECG in the combination of those drugs. 

 
 

In terms of dosage increases, as and when they have occurred, and I am talking 
 
here about dosages increases to figures above 60 mgs a day, what do you say about the 
 
need for Dr Cosgrove, the treating psychiatrist, to have seen the patient when such 
 
increases of dosage took place? 
 

I think they should have been seen by a psychiatrist, preferably by the prescribing 
psychiatrist when high doses above the normal ranges have been introduced. 

 
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Why is that? 
 

Because of the possibility appearing of the hazards, especially the psychological 
 
hazards of depression, of hallucinations, of excessive attention which are things that may 
 
not be reported to you by the familiar, they may not even be reported by the teacher. 
 
 
 

Yes.  What about the relevance of alternative therapies?  One takes it that an 
adjustment of dosage upwards will reflect the fact that there is seen to be insufficient 

response to the existing dosage.  To what extent is review required to consider whether 
 
alternative therapies may be appropriate? 
 

Yes, this is the issue of whether a specialist psychological therapy and behaviour 
 
therapy in particular should be introduced.  It seems from the large and important 
 
American trial, which think I referred to last week, that if behaviour therapy is given at 
 
the same time then the necessary dose of medication is reduced.  That is in that trial the 
necessary dose without behaviour therapy was something like 35 mgs a day and with it it 

came down to something like 25 mgs a day.  So one expects medication needs to be less 
 
high if there is other therapy going on at the same time.  Especially behaviour or 
 
psychological therapy. 
 
 
 

Does that have any bearing on review of this patient during the period with which 
 
we are concerned? 

It should certainly be the case that if you are getting into non-standard doses you 

should be asking yourself whether as the prescriber whether all that should be done in 
 
non-medication avenues is being done. 
 
 
 

Does that require you to see the patient or not? 
 

If you are uncertain it requires you to see the patient.  Though a common thing to 
 
do would be to be in touch with the local mental health team if the patient was coming 
from some distance away.  There would not necessarily be the requirement of the 

prescriber to be providing that themselves.  More to refer them for it. 
 
 
 

Just dealing with this question of telephone review.  It is apparent from the 
 
evidence that Dr Cosgrove was regularly reviewing patients by telephone and that 
 
reflected - the issue was raised in your last response - that many of these patients were 
obviously travelling a consider distance to see him. 
 
A Yes. 

 
 

I think you would not criticise that, as much, the telephone review? On the 
 
contrary? 
 

No, telephone interview with the parent is a good way of determining dosage 
 
need.  Thought I would say that one would always recommend that there were reports 
obtained from the teacher as well as a report obtained from the parent because a child in 

school is somewhat different from the child at home. You can give suboptimal doses for 
 
school if you are titrating the dose against the way the child is behaving at home. 
 
 
 

But you would say in those respects you have mentioned already there are 
 
occasions when personal face to face contact with the patient and parent is appropriate? 
 
A Yes. 
 

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And necessary.  I understand.  May I move on to the case of Patient B.  The 
 
relevant documentation in relation to of Patient B actually refers in that Committee 
 
bundle at C8, division 3.  The allegations against Dr Cosgrove relate to what we allege 
 
are essentially inappropriate comments in respect of the doctor who this patient has seen. 
 
 First of all I think you have indicated last week that you consider the diagnosis of ADHD 
 
to be a valid disorder in adults; that many psychiatrists do not, but that your position in 
respect might be closer to Dr Cosgrove’s than that of many? 


Yes, yes, that is correct.  I think that probably majority of general adults that 
 
psychiatrists will be seeing that ADHD really is not an issue in adult mental health and 
 
that the problems which I would call ADHD in adult life really are those of a personality 
 
disorder or of a hypomania. 
 
 
 

The evidence last week of Dr Al Shabnder in respect of this issue was that ADHD 
was a differential diagnosis that he had in mind but that he did not have sufficient 

information to come to, as it were, fixed or final diagnosis at that stage and that he wished 
 
to investigate matters further.  If that is correct, would you criticise Dr Al Shabnder’s 
 
approach to having seen this patient? 
 

No, I would not criticise that because I think the diagnosis can be very difficult to 
 
make in adult life.  Indeed, I do not think that even the experts are agreed about just what 
 
the criteria should be for recognising it in adult knife.  It is not an easy judgment at all.  
One reason why it is difficult just relying upon what the patient is saying about his 

experience is that one of the things that research has suggested is that when you follow up 
 
people who have had ADHD into their adult life and compare them with the people who 
 
have not got ADHD, then you ask them in their adult life whether they did have ADHD 
 
as a child, or whether they have it now, then there is a big blur across the two, so that 
 
many people who say they have got ADHD did not in fact have it when they were 
 
children.  What they are describing is something rather different.  Often describing a 
sense, sometimes a sense of failing or worthlessness or something of the kind.  It is 

sometimes a matter of depression and poor image of yourself rather than necessarily it 
 
being the case that the ADHD has persisted.  So it is a difficult manner to make - the 
 
adult diagnosis.  Even experts disagree on individual cases. 
 
 
 

If then, contrary to the case that I have put, if it were the case that this Doctor had 
been saying to the patient effectively that he did not accept a diagnosis of ADHD as being 
 
correct, the patient was suggesting it was ADHD and the doctor was saying it was not, 

would you form the view that that indicated a lack of knowledge on the part of the 
 
doctor? 
 

No, I do not think that would be fair.  Of course, it is possible that it did but there 
 
is no reason to suppose that it did.  If I had seen a patient in those kind of circumstances 
 
and I thought he very definitely did have ADHD on evaluation then I would have wanted 
to feed that back to the original doctor as part of that doctor’s education and knowledge.  

But I would not have seen it as evidence of incompetence. 
 
 
 

Can I then have a look at one or two other aspects of this letter and it is what Dr 
 
Cosgrove himself says about ADHD, for your comments on that.  Can I take you to 
 
division 3, page 2, paragraph about a third of the way down the page, little over that 
 
begins: 
 

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“The four main characteristics of ADHD are poor concentration, 
 
impulsiveness, hyperactivity and poor motivation.”   
 
 
 
Do you agree with that, Professor Taylor? 
 

I would only agree with the first three on that.  The definitions of ADHD are poor 
 
concentration, impulsiveness and hyperactivity.  But poor motivation is not part of the 
diagnosis.  It can happen in it but it can happen in so many other kind of situations as 

well.  Poor motivation is a very – it is very much a feature not only of psychiatric 
 
illnesses but of personal adversity.  I think it would be wrong to be suggesting that poor 
 
motivation in itself was part of the definition of a psychiatric illness. 
 
 
 

Could I ask you to look at the previous paragraph on that same page: 
 
 
“I do consider that B is very unwell with the Attention Deficit 

Hyperactivity Disorder which is a genetically determined insufficiency of 
 
dopamine production.”   
 
 
 
May I ask you first of all on the to consider the comment that it is a genetically 
 
determined condition. Do you agree with that? 
 

No, I think that is putting it too strongly. It is a genetically influenced disorder.  
Inheritability estimates are high, in the region of 86.  But the point is those genetic 

influences work in interaction with the environment. For instance, one of the genes makes 
 
you more likely to develop ADHD if you have been exposed to cigarette smoke in 
 
pregnancy. So to say it is genetically determined, the implication there is that it is – that 
 
the determination that the creation of the disorder is by the genes, which is putting it too 
 
strongly. 
 
 
Q    
And the second part of that phrase that I have read to you, “Insufficiency of 

dopamine production”.  Do you agree that that correctly describes the causation of the 
 
condition?  
 
A     
No, I do not. I mean the evidence is quite different.  The dopamine is indeed a 
 
chemical that is involved in the brain in ADHD.  We do not know exactly what it is that 
 
is giving rise to the alteration of  it, but the strongest view, and the clear evidence about 
the way the drugs act, is that what goes wrong is that there is an excessive amount of the 
 
chemical that removes dopamine from the brain; the dopamine transporter.  

 
 
Q     
Yes?  
 
A     
What the drugs are doing is increasing the levels of dopamine, not by altering 
 
dopamine production but by blocking its removal.    
 
 
Q Yes? 
 

A     
It is an important distinction because it relates very much to the issue of how far 
 
the drugs are like the drugs of addiction (drugs like cocaine). There is a big difference 
 
between the drugs which alter the production of dopamine and the drugs which alter its 
 
(inaudible). The drugs altering it - take it away - are much quicker than - indeed cocaine 
 
will be an example of, not the drug that blocks dopamine, a transporter.  
 
 
Q     
Yes, I understand.  Thank you.  We will move on, if we may do, to Patient C and 

the letter that you see at pages 1 and 2 of division 4.  I hope I accurately summarise what 
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Dr Moses said in evidence about Patient C, it was this: that she had seen the patient when 
 
he was 5, nearly 6 years old, and at that stage she had made no psychiatric diagnosis and 
 
had not thought that psychiatric treatment was necessary but the patient had been re-
 
referred, that he had been seen by her SHO, who wanted school reports, but that the SHO 
 
had then fallen ill and had not been able to see Patient C again.  Therefore, Dr Moses had, 
 
as it were, taken up the case and had seen Patient C in the August of 1998 and had formed 
the view that it was necessary to get reports from school.  She had obtained those reports 

and seen Patient C again in September of 1998 and, thereafter, she had taken the view 
 
that it was appropriate that he be admitted as a day patient to Pollards Well (the Unit at St 
 
Cadoc’s Hospital) and that he had been so admitted in November 1998 and that, 
 
thereafter, at that Unit they had undertaken behavioural forms of therapy with the Patient. 
 
I think she had formed the view that the patient was not suffering from ADHD and, 
 
therefore, Ritalin and/or Risperidone were not appropriate treatments but that she had not 
rejected ADHD, as it were, without thinking about it; she had felt that his behaviour was, 

I think, somewhat variable and that that was a pointer against ADHD.  That is a summary, 
 
I hope a reasonably accurate one, of what Dr Moses had to say about the treatment of 
 
Patient C.  
 
 
 
I want to ask you, if I can, to comment on what Dr Cosgrove is saying in this letter. If that 
 
account is so, where we see on page 2 of the letter at division 4, approximately half-way 
down the page: 

 
 
“I am surprised that more has not been done for this poor child 
 
by the local specialist”,  
 
 
 
do you see that?  
 
A     
Yes.  
 

Q     
Is that comment justified in your view?  
 
A     
I do not think that is reasonable, no. I think the child was still quite young. I think 
 
that it could have been a reasonable judgment, for Dr Moses to make, that he was likely 
 
to respond to the rather intensive treatment of psychological treatment, which you can get 
 
in a day-patient setting.  A point comes (and if it was November when he went into the  
in-patient day) I would have expected that, sort of, if he was not responding after about 
 
three months after that, then, indeed, yes, the issue of medication should have been 

considered and reviewed actively.  Hard to say without reviewing the child at that point---  
 
 
 
Q     
Yes?  
 
A     
--whether it was a right judgment or a wrong judgment---  
 
 
Q     
I understand?  

A     
--to withhold medication. In the light of subsequent events it sounds a bit like it 
 
may have been the wrong judgment because the child did, in fact, as I understand it, 
 
respond pretty well when the ADHD medication was given.  But I think that trying that, 
 
trying to give the in-patient psychological work a chance to work first, would have been a 
 
very reasonable thing, a very reasonable venture.  
 
 
Q     
Does the diagnosis of ADHD necessarily make a difference as to whether that 

is the right approach to take?  
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A     
No, not necessarily because there is quite - there is good evidence (especially in 
 
younger children) that behavioural approaches work for ADHD just as they work for 
 
other conditions like oppositional disorders, violence and conduct disorders.  
 
 
 
Q     
Yes.  If, in fact, six months on from having gone to the Unit the diagnosis of 
 
ADHD had been made and the prescription of Ritalin and Risperidone was made, 
would you say that that indicated that Dr Moses had done nothing to alleviate this 

Patient's malfunctioning?  
 
A     
No, because plainly a lot had been done to alleviate the malfunction.  I mean, the 
 
day-patient unit treatment is doing a lot; it is doing something that has got quite sound 
 
evidence that it is a procedure that is helpful.  
 
 
 
Q     
I understand.  I use those words because if we turn to the letter that appears in  
division 5 at pages 2 to 4, that is the comment that was made by Dr Cosgrove.  Turning 

for a moment to division in the letter at pages 1 and 2 by Dr Cosgrove, that is a letter 
 
to the General Practitioner in respect of a prescription, that you see at the bottom of page 
 
2, of Ritalin and Risperidone following the history and diagnosis made by the Doctor?  
 
A     
I am sorry, I am not sure if I am in this same place.  
 
 
 
Q     
I am sorry, I am moving on. Division 4, pages 1 and 2. I apologise  
A     
Yes, I am with you now, thank you.  

 
 
Q     
The last paragraph:  
 
 
 
“I have made out private prescriptions for Ritalin and Risperidone 
 
but I know that his parents would very much appreciate it if you 
 
would copy them down on to an NHS scrip. On each occasion that I 
alter the dosage, I will send the fresh specimen prescriptions to bring 

to you, you may care to keep them in his file”.  
 
 
 
It is admitted on behalf of Dr Cosgrove that this letter makes no reference to appropriate 
 
monitoring of C while he is taking these drugs that are being recommended by  
 
Dr Cosgrove.  In your view should the Doctor have provided any such advice?  
A     
Yes, I think so. I think that I part of  making a shared care agreement would be 
 
indicating what was being done by who, otherwise it is ambiguous about who is 

monitoring which aspect of the case.  
 
 
 
Q     
Just give us an example, if you could, about what Dr Cosgrove might 
 
appropriately have had to say here, assuming that this was a patient who was a little 
 
distance from---  
A     
The kind of shared care agreement that most clinics would have would be 

recommending something like three monthly visit to the family doctor for the recording 
 
of height and weight on growth charts and the monitoring of blood pressure and pulse 
 
rate.  
 
 
 
Q     
Yes.  If I can move, please, on to Patient D. Patient D was seen by  
 
Dr Cosgrove in May of 1996. The evidence of Mrs D (Patient D's mother) is that the 
consultation on that occasion lasted about half an hour, that there was no physical 

examination of her son (the weight, height, blood pressure or anything else) and that, in 
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fact, there was no questioning of her son. If that is accepted as being correct, what do you 
 
have to say about the examination of Patient D on that occasion?  
 
A     
I think that fell short of what was necessary because you cannot judge the effects 
 
on growth unless you know you have a baseline from which to detect any changes in the 
 
future of excess due to the Risperidone or deficiency due to the Ritalin.  
 
 
Q     
Yes?  

A     
Neither would you know whether there were any contraindications, such as high 
 
blood pressure and any neurological state.  
 
 
 
Q     
Subsequently - or we know that Ritalin and Risperidone were prescribed, again 
 
what arrangement for monitoring would have been appropriate in this Patient’s case?  
 
A     
Can I just check back where we are?   
 

Q     
Please, yes?  
 
A     
I want to see what medication and doses he was on to be judging about 
 
monitoring.  
 
 
 
Q     
Right.  You have asked me a difficult question about that?  
 
A     
Sorry about that.  
 

THE CHAIRMAN:    C8  divider 6, pages 1, 2, 3. Do these help? 
 
  
 
MR PEARCE:  That is a summary of the notes, is it not, sir?   
 
  
 
THE CHAIRMAN:  I am referring to the letter from Dr Cosgrove dated 21 May 1996. 
 
  
THE WITNESS: I am sorry, I do not seem to have a division 8.  

 
 
THE CHAIRMAN:  Division 6?  
 
 
 
THE WITNESS:    Division 6.   
 
 
MR PEARCE:  Division 1 appears to be the original specimen prescription in June 1996, 
 
which I think is a total of 35 mgs of Ritalin?  

 
 
THE WITNESS: Yes.  Thank you very much.  
 
 
 
MR PEARCE: Page 3 of division 6 refers to, I think, an initial prescription of  
 
10 mgs for 2 days, increasing to 20 mgs for four days, increasing to  
30 mgs until the telephone appointment in about 10 days time?  

A     
Yes.  Yes.   
 
 
 
Q     
Slightly earlier?  
 
A     
Yes.  So in those early stages of the treatment, one would be wanting to 
 
recommend a 6 weekly monitoring of pulse rate, blood pressure, height and weight and 
 
when the dosage is established and things are stable then to go down to the three months, 
that kind of figure that I was mentioning before.   

  
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Q     
I am sorry, I was looking as you asked - as you raised that point, Professor Taylor, 
 
I was looking at what Mrs D herself said about the Ritalin. She said in evidence that after 
 
about six months the dosage that increased to 60 mgs of Ritalin.  Is that kind of 
 
monitoring appropriate to that level?  
 
A     
Yes. That would be the same kind of monitoring that was sensible.  
 
 
MR MORRIS:  I hate to interpose, but I would just like to point out that there is no 

evidence that that dosage of 60 was one recommended or prescribed by Dr Cosgrove.  
 
 
 
MR PEARCE:  I am obliged for that.  (To the witness) Could I ask you, please, about 
 
Patient E?  In respect of this matter, which relates to the investigation by the Trust and 
 
documentation at division 7 in the bundle, I think you are familiar with this 
 
documentation, you are familiar with the complaints that Dr Cosgrove makes here.  Many 
of them, I think, are matters which are for the Committee rather than for you as an expert 

to comment on.  Can I ask your comments on this: towards the bottom of page 2 of the 
 
letter in division 7 Dr Cosgrove says:   
 
 
 
“I assert that the expert will also not be knowledgeable or 
 
experienced enough with the use of Risperidone, which is I not only 
 
the medication that has dramatically changed A’s treatment, but is 
precisely the medication that Mrs E was calling upon Dr McDonald 

again and again to prescribe, which he persistently refused to do so.  
 
His constant refusal to do this so was partly because of your Trust’s 
 
policy not to prescribe this medication to children”,  
 
 
 
pausing there for a moment, did some trusts have a policy of not prescribing Risperidone 
 
to children in October 2000?  
A     
Yes, I think that is correct. I think that some trusts still would.  It is by no means 

universally approved. I do not think most trusts probably would have a policy at all and 
 
would leave it to the judgment of the individual doctor.  
 
 
 
Q     
I understand.  In your view would such a policy be criticised as being 
 
inappropriate?  
A     
I think it could now.  
 
 

Q     
Yes?  
 
A     
Because now there is some trial evidence that - not so much for ADHD but for 
 
other indications in children, especially for aggression in children - that low dose 
 
Risperidone is an effective therapy with adverse effects that need care. The trial came out 
 
last year.  Before that there was not any evidence base for prescribing the medication for 
children, though I still see it as a rather blanket policy to say "Never approved for 

children". 
 
  
 
Q       Yes. 
 
A       Because there are some indications, such as schizophrenia, in which it is very much 
 
a suitable medication for children. 
 
  
Q       Was there any evidence base, though, for Risperidone in conjunction with Ritalin 

for treating ADH? 
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A       No, and still ... 
 
  
 
Q       At that time? 
 
A       Neither then, nor now. 
 
  
 
Q       Neither then nor now, I understand.  Dr Cosgrove goes on to say: 
  

"I am probably the most experienced specialist in the UK in the 
 
use of Risperidone with children". 
 
  
 
Now I asked you to comment upon this last week, Professor Taylor, and you indicated I 
 
think that he had probably treated more people with it than anybody else? 
 
A       I think that is likely, yes. 
  

Q       Yes.  And you made a comment about his expertise as well? 
 
A       Yes, I think I was saying that experience was not the same as expertise.  You could 
 
do something wrong a lot and that does not mean that you have a lot of expertise, 
 
necessarily. 
 
  
 
Q       Do you consider that there are experts in this country who could have been 
considered as appropriate to carry out a review of the type that was being proposed by the 

Trust? 
 
A       Certainly, yes.  Yes, as I say, the use of Risperidone in general is not unusual in 
 
young people with schizophrenia.  There are plenty of people who have experience of 
 
giving Risperidone to children. 
 
  
 
Q       Yes. 
A       And in giving it for ADHD in particular, yes, the country would certainly have 

experts in that. 
 
  
 
Q       Yes.  Could we move on, please, to Patient F.  Now I think in the case of Patient F 
 
the relevant correspondence appears in Division 9 of the bundle; that being a letter from 
 
Dr Cosgrove to the General Practitioner dated 17 November of 2000.  First of all we note 
reading through it that there is reference to the history, to Dr Cosgrove's diagnosis and to 
 
the fact that he has made out a prescription.  We see, do we not, in the second paragraph 

of the second page of Division 9, which has  the handwritten number "232": 
 
  
 
"I have made out a private prescription for Ritalin for 5 mg om". 
 
  
 
Incidentally, what does "om" mean? 
A       It means every morning. 

  
 
Q       Every morning, yes: 
 
  
 
"... and 5 mg 4 p.m. for five days ..." (and so that is 10 mg a day 
 
for five days) "... followed by 5 mg qds ..." (four times a day, and 
 
so a total of 20 mg) "... for five days followed by 10 mg om; 5 mg 
lunchtime; 5 mg 4 p.m.; 5 mg 7:30 p.m. ..." (and so that is a total, 

I think, of 25 mg a day) "... until I have the first telephone 
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appointment with him in about two weeks after he starts the 
 
tablets.  I will have a series of telephone appointments with him 
 
in order to monitor his progress and to find the optimum dosage 
 
and frequency through the day". 
 
  
 
And then at the end of this letter on Page 233, a paragraph similar to one we have seen 
before: 

  
 
"I have made out a specimen prescription for Ritalin but I know 
 
that he would very much appreciate it if you would copy it down 
 
on to an NHS scrip.  On each occasion that I alter the dosage, I 
 
will send him a fresh specimen prescription to bring to you.  You 
 
may care to keep them in his file". 
  

May I, first of all, ask you about the monitoring of the dosage. If the anticipation here was 
 
that it was for the GP to carry out the monitoring, what would you say about the contents 
 
of the letter? 
 
A       Well, this is now an adult taking what for an adult is a relatively small dose of 
 
medication. 
 
  
Q       Yes? 

A       Growth is not particularly an issue in that.  I think I would just point out the need 
 
for blood pressure monitoring. 
 
  
 
Q       Yes, all right.  And the absence of a reference to that in the letter, what do you have 
 
to say to that? 
 
A       I am sorry, I did not catch that? 
  

Q       The absence of a reference to such monitoring in the letter? 
 
A       I think that should have been mentioned, yes, because you cannot expect the 
 
General Practitioner to have experience or to know what to do in the monitoring of 
 
treating ADHD in adults. 
 
  
Q       I understand.  In the letter we also see criticism of Doctors Thomas and Chubb, I 
 
think, essentially for indicating that this patient had a personality disorder which was not 

treatable and that they demonstrated negligence in not understanding about ADHD as a 
 
real condition in adults.  Well, again, the evidence from Dr Thomas is to the effect that 
 
she did not diagnose a personality disorder and that she was considering the issue of 
 
ADHD in adults, but considered that this patient should be referred to somebody who was 
 
expert in that condition. If so, was that appropriate conduct on the part of Dr Thomas? 
A       Yes, it is appropriate in the sense that it is a specialist consideration and, as I think I 

said before, the diagnosis of ADHD in adults is quite difficult.  Actually finding a 
 
specialist in ADHD in adults is a much harder thing to do, I should say, and so it might be 
 
a slightly empty prescription, but nonetheless there are such people. 
 
  
 
Q       Yes.  I have read somewhere, and tell me whether or not this is correct, that I think 
 
there are two units in the country, are there, that...? 
A       Yes, yes.  There is one more, since I started with Dr Toombe, and I believe there is 

a clinic in Cambridge as well. 
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Q       And that is dealing with ADHD in adults? 
 
A       In adults, yes. 
 
  
 
Q       As opposed to children where there are far more appropriate units? 
 
A       Yes, and also there is Dr Asherson who is another psychiatrist with an interest in 
adult ADHD. 

  
 
Q       On the other hand, on the basis of what Dr Cosgrove has to say in the letter about 
 
essentially what he understands about this consultation with Dr Thomas, was it 
 
appropriate in your view for Dr Cosgrove to say that Dr Thomas and Dr Chubb would be 
 
guilty of negligence if Mr F responded to treatment for ADHD? 
 
A       I do not see it as negligence.  I mean it may be incorrect, but I think it would be 
harsh to say that somebody was negligent if they were following the policy that the vast 

majority of psychiatrists in the country follow. 
 
  
 
Q       And I think you have indicated that, for example, a personality disorder is 
 
something which some psychiatrists - many psychiatrists - might diagnose in a situation 
 
in which you were considering ADHD? 
 
A       Yes, they might, and in a sense it is an argument about words. 
  

Q       Yes. 
 
A       Because in that sense ADHD is a form of personality disorder in the sense that it is 
 
a long lasting disposition to react in particular ways. 
 
  
 
Q       Yes.  Yes, I understand.  May I move on to Patient G, please, and in Division 10 in 
 
the bundle, Pages 3 to 5 I think in particular, is the letter to the General Practitioner in 
respect of this patient? 

A       Yes. 
 
   
 
Q       And, again, I think it follows a similar format to other letters that we have seen.  It 
 
makes reference on Page 4 of the letter, or of the bundle I should say, the first full 
 
paragraph second sentence: 
  
 
"I have made out a specimen prescription for Ritalin for 2.5 mg 

3:30 p.m. and 2.5 mg 9 p.m. ..." (and so that is 5 mg)"... for three 
 
days, followed by 2.5 mg qds ..." (10 mgs per day) "... followed 
 
by 2.5 mg om; 5 mg 3:30 p.m.; 5 mg 6:15 p.m.; 2.5 mg 9 p.m. 
 
until I have the first telephone appointment with his parents in 
 
about two weeks after he starts the tablets", 
  

and so just doing the maths there we get up to a total of 15 mg: 
 
  
 
"I will have a series of telephone appointments with his parents in 
 
order to monitor his progress and to find the optimum dosage and 
 
frequency through the day.  They always bring him back to see 
 
me at the Clinic when required". 
  

Now we note from the previous page that this patient was four, very nearly five, at the 
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date of this letter in February 2003. Can I ask you, first of all, about the prescription of 
 
Ritalin in children of this age.  Is that widely accepted, or not? 
 
A       It is not.  It is controversial, but there is some trial evidence for it and I would 
 
myself use medication in children down to the age of four. 
 
  
 
Q       Yes? 
A       Its market licence is only down to age of six. 

  
 
Q       Yes? 
 
A       And so one is going outside the recommendations at that point. 
 
  
 
Q       But you would not --- 
 
A       And I would tell the parents that it was outside the recommendations so that they 
understood that it was being done. 

  
 
Q       Yes. 
 
A       But, nevertheless, I think it is safe.  I think after a child gets to the age of four, then 
 
I think a lot of the very early development of the brain that you do not want to interfere 
 
with with medication is done. 
 
  
Q       I understand.  Now, sorry, just reading on in the letter, we see in the last sentence - 

the last paragraph, rather - on Page 5 of this letter a similar paragraph to one we have 
 
seen before: 
 
  
 
"I have made out a specimen prescription for Ritalin and 
 
Risperidone, but I know that his parents would very much 
 
appreciate it if you would copy it down on to an NHS scrip.  On 
each occasion that I alter the dosage, I will send them a fresh  

specimen prescription to bring to you.  You may care to keep 
 
them in his file". 
 
  
 
What monitoring would you expect to see in respect of this patient? 
 
A       For the physical monitoring as with older children, that is to say six-weekly checks 
in the first stages of the treatment and three-monthly once established, though in a 
 
younger child like this I think one ought to be pointing up the educational importance and 

the need to be making sure that the monitoring included informing his school, informing 
 
his teachers and making sure that they are looking carefully themselves at what the 
 
medication is doing to him.  So, monitoring in the other situation as well is probably 
 
particularly important in the younger child. 
 
  
Q       I understand.  If the contact that the parents had with Dr Cosgrove following this 

prescription in February 2003 up until July 2003, and so in that five month period -- if 
 
that contact was by telephone review alone without Dr Cosgrove seeing the patient, is 
 
that in your view appropriate? 
 
A       I would very much want information from another source besides the family.  That 
 
might very well be the teacher, but it is important.  I mean, all the guidelines stress that 
 
the idea of the medication is not to be a kind of quick fix for behaviour problems.  It is 
not the idea just to make children easier to live with at home.  And, if you do only 

monitor from the parental account, then you may be monitoring that in effect.  You may 
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be monitoring the decrease in troublesome behaviour.  And it is really not the point of the 
 
medication to be doing that.  The point of the medication is to be enhancing the child's 
 
development and especially their development in attention and impulse control.  So, you 
 
have to know something about their attention and their impulse control as well as whether 
 
they are badly behaved. 
 
  
Q       And what about face to face contact with a patient over that period? 

A       Would have been - would have been - necessary in the course of the first six 
 
months.  The protocol guidelines call for it at four weeks, but practicalities mean that 
 
sometimes one would delay it until six weeks or eight weeks. 
 
  
 
Q       I understand.  Just so then we get a complete picture of the level of medication, if 
 
you turn on, please, to Page 7, we have here some handwritten notes by Dr Judge who is a 
Consultant Child and Adolescent Psychiatrist and she records that the dosage was 5 mg 

five times a day on 16 May 2003, a total of 25 mgs a day there, do you see that? 
 
A       Yes. 
 
  
 
Q       And I think again on 6 June 2003 and 11 July 2003, Page 8 refers, again the dose is 
 
recorded as being 5 mg five times a day? 
 
A       Yes, yes, which is okay. 
  

Q       Yes.  So, that it is clear and it does not appear that I am missing anything out, 
 
Professor Taylor, I do not think at the time you were asked to prepare a report in this case 
 
you were asked to consider the papers in respect of the final of the patients with whom we 
 
are concerned, Patient H? 
 
A       Yes. 
 
  
Q       You were not so asked to do, were you? 

A       No, I think not.  No, I do not recall seeing any papers on that. 
 
  
 
MR PEARCE:   Yes.  Thank you very much, Professor Taylor. 
 
  
 
THE WITNESS:   Thank you. 
  
 
MR PEARCE:   If you wait there, please, I think Mr Morris will have some questions for 

you. 
 
  
 
THE CHAIRMAN:   Do you wish to have a break just now?  Would this be a logical 
 
point that we should have a break? 
 
  
MR MORRIS:   It might be a logical break, yes, and it will give me the opportunity to 

find a document that I am looking for. 
 
  
 
THE CHAIRMAN:   Well, we will have a break and we will reconvene at 5-to-11. 
 
  
 
Could I remind you, Professor Taylor, that you remain under oath. 
 
  
THE WITNESS:   Yes, yes. 

  
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THE CHAIRMAN:   Thank you. 
 
  
 
(The Committee adjourned for a short time
 
  
 
MR PEARCE: While the doctor is coming through I have alerted the Committee 
 
Secretary to this, when Dr Judge was giving evidence in the transcript, it is day 7, page 5, 
letter B, my learned friend  produced some extracts from the appropriate records and they 

were given the exhibit number D28 which was the next in turn, I confirmed with the 
 
Secretary that indeed they were given that letter and number, in the transcript it appears 
 
apt D26, I just wanted to read in to the transcript now that there is an error there.  It 
 
caused me some confusion last night.  But what I called D26 on page 5 of the transcript 
 
for day 7 should read D28.  I am obliged, sir.   
 
 
Cross-examined by MR MORRIS 

 
 

Professor, can I start with a few general matters.  You talked about the sea change 
 
in the profession’s approach to ADHD.  Is this a correct summary, that in spite of the 
 
scientific evidence that it is an effective therapy, many paediatricians and child 
 
psychiatrists were, at least until the late 1990s, strongly opposed both to use of the 
 
diagnosis of ADHD and to stimulant medication for more than very small number of 
cases? 


Yes.  I think that is fair comment and certainly the rates of prescription have been 
 
rising substantially ever since 1995, so there is probably now something like a one third 
 
of one per cent chance of receiving the medication.  So, yes, a sea change is a fair way to 
 
put it. 
 
 
 

Sorry one third? 

One third of one per cent. 

 
 

Which is still a very much lower than the figures in the US. Is that right? 
 

 Quite right, quite right.  Perhaps the figures there would be something of the 
 
order, depends  where you are, something of the order of five to seven per cent.  
 
Something like 20 times as common. 
 
 

In your opinion would that difference be explained by a difference of approach 

from clinicians in the two countries rather that any inherent difference between the 
 
children in those two countries? 
 

Yes, it would. The is opinion because the direct comparisons have not been done 
 
but in general the rates seem to be quite similar in most countries. 
 
 

That approach, that you accept it was right, led during the 1980s and 1990s to  

a situation in which many families were seeking in vain for drug treatment? 
 

Yes, that is quite true. 
 
 
 

Therapy was known to be effective and widely used internationally but was 
 
unavailable to them? 
 

Yes, I think many families found themselves in that situation. 
 

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Does that, I do not know if you can help, does that approach from British 
 
clinicians stem from the views that were expressed in earlier times, that this condition 
 
was really limited to those children who had some brain damage, if I can put it that like 
 
that, in terms of epilepsy or other such conditions? 
 

I think when you go further back, perhaps to the 1970s, rather than the 1980s, that 
 
would have been the case, yes, and I think that more recently, perhaps in the 1980s, the 
consideration was more that when children did have ADHD it was thought to be a fairly 

benign kind of immaturity, rather like the toddler stage going on a bit longer than it 
 
should and the fact that you are going to grow out of it and be perfectly okay. What 
 
changed practice was largely realising that that was not the case and it was something 
 
which had adverse consequences for later life. 
 
 
 

 Professor, did your own views change during the course of those decades? 

Not very much.  Not very much.  In that I think my own view in the 1970s, well, 

the late 1970s, early 1980s was this was an important treatment to give and not enough of 
 
it was being given.  So I think my view then is quite similar to what it is now. 
 
 
 

Would you accept that certainly in the latter part of the 1990s Dr Cosgrove was 
 
one of the few specialists prepared to use the treatment at that time; that he would have 
 
encountered a good deal of media and professional hostility even though the treatment 
was very well founded scientifically? 


I would that to the early 1980s and early 1990s, rather than the late 1990s because 
 
during the second half of the 1990s when Ritalin was reintroduced to the market then 
 
there was a considerable growth of ADHD clinics all over the country.  But I think that 
 
comment about his being a pioneer in the use of treatment that would apply more to the 
 
1980s. 
 
 

But as we know views changed slowly, despite published evidence.  Would it be 

fair to say that there would be large number of clinicians still in the late 1990s who were 
 
adopting the restrictive approach not really justified by the evidence? 
 

Yes, I think that is fair comment. 
 
 
 

I want to turn, please, to the specific patients.  If we can start with Patient A.   
I want to deal with the question of monitoring of that patient.  I think you made two 
 
general points in relation to monitoring, first of all there is a need for physical monitoring 

and, if I can call it, academic monitoring in relation to patients receiving, if I can put it 
 
like this, normal dosages up to about 60 milligrams a day where the physical monitoring 
 
could be confined to growth valuation and blood pressure and pulse readings? 
 

Yes, for children on Ritalin only, yes.  That is the physical monitoring.  I also 
 
mentioned the need for the psychological monitoring as well, including the reports from 
teachers. 

 
 

Yes.  Can we have a look then at what the position was in relation to Dr Cosgrove. 
 
 Perhaps the best evidence for that is the letter he wrote, we can find that in C12, pages 71 
 
and 72, he wrote this on 3 May to the patient’s GP, Dr Parry.  He makes the diagnosis on 
 
page 71, then we go and he sets out the proposed regime in relation to Ritalin, leading up 
 
to 40 milligrams, I think, I will be corrected if I am wrong, going up to the first telephone 
appointment with his parents on a day which is about 10 days after he starts the tablets:   

 
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“I will have a series”, 
 
 
 
or  
 
 
 
“I will make”, 
 
 
I am not sure,  

 
 
“a series of telephone appointments with his parents in order to monitor 
 
his progress and to find the optimum dosage and frequency through the 
 
day.” 
 
 
 
Then he goes on to talk about the product licence in relation to Ritalin: 
 

“It is not a drug of addiction or dependence unlike the available 
 
Benzodiazepines.  It does tend to cause a fall in appetite and A is already 
 
about at about 75 per cent of his pre-Ritalin level.”  
 
 
 
Just interposing there, I think we know, do we not, that this patient had already been put 
 
on a low level dose of Ritalin by other psychiatrists? 
A Yes, 
correct. 

 
 

 
 
 
“I will monitor his progress and have asked his mother to have him 
 
weighed so that we can see the cause of his weight.”  
 
 
Is it fair to say that the important thing in monitoring growth in relation to a child being 

put on Ritalin is to make sure that, if I can call it the growth trajectory, remains on track 
 
and that the child does not start deviating between the centiles on the growth chart? 
 
A Yes, 
exactly. 
 
 
 

So in relation Dr Cosgrove's concerns for and plans to monitor the patient’s 
weight, do you have any criticisms arising out of what he was proposing in that letter? 
 

That he should have mentioned height as well as weight because you can have 

changes in growth of height as well as changes in growth of weight and in some ways 
 
they are more of concern and, of course, the blood pressure and pulse rate should be in 
 
the monitoring too. 
 
 
 

But no criticism in regard to weight? 

I am not sure what he is saying because, of course, it is importance not only that 

he is weighed but that it is plotted on the growth charts.  So if what is planned is that 
 
mother is going to be away and reporting it back and he is going to be plotting it on a 
 
growth chart then that, I think, is quite reasonable at that stage of the therapy. 
 
 
 
Q     
What we do know, Professor, is that weight was, in fact, monitored by Dr Holme 
 
in his regular reviews of the Patient.  I think we have those if you look at pages 124, 125 
onwards in C12?  


A     
Yes.  
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Q     
Indeed, we have the first consultation on the 13 May, 10 days after  
 
Dr Cosgrove saw the Patient?  
 
A     
I cannot actually see that, is that on page 124, is it?   
 
  
 
Q     
125?  
A     
125, sorry.  I have got 13 May, yes.  

 
 
Q     
13 May.  In fact, there had been an earlier appointment fixed for the 9 May but the 
 
Patient did not attend. The Patient, at that stage, was seen not only by Dr Holme, it 
 
appears (the Paediatrician) but by Dr Vereker (the Consultant Psychiatrist) who had been 
 
treating the Patient?  
 
A     
Yes.  
 

Q     
I think that we know also, from Dr Cosgrove’s letter of the 3 May, that both  
 
Dr Holme and Dr Vereker would have had a copy of that letter by that stage because, if 
 
we look at page 72, Dr Cosgrove has copied his letter to both those two clinicians?  
 
A     
Yes.  
 
 
 
Q     
They would, therefore, have been aware, would they not, of Dr Cosgrove’s 
concern about the weight of the Patient and the requirement to monitor his progress in 

relation to that?  What we see there, certainly, is a note of the weight and height of the 
 
Patient (21.5 kgs, 121cms) and we have heard from Dr Holme that the figures beside that 
 
“2-9” are made in his hand and indicate that this Patient’s weight and height, indeed, 
 
were between the 2nd and 9th centiles.  It does not appear (I will be corrected if I am 
 
wrong) that a blood pressure is noted specifically in that consultation, although we do see 
 
that there was a pretty thorough examination of the heart and chest. Would that have 
included blood pressure, Professor?  

A     
I do not think so. I think that they would have recorded what it was if they had 
 
done it.  
 
 
 
Q     
If we just follow through quickly (and perhaps you can take it from me that  
 
Dr Holme saw the patient then, next saw the patient on the 13 November 1996) we see 
that at the bottom of page 125 the weight was 23.7, was 9th centiles, height 229 and that 
 
monitoring went on through into 1997. 15 May on page 126, again height and weight 

between 2nd and 9th centiles.  Just pausing there, if I can just go back to November 
 
1996? On that occasion blood pressure was noted 100 over 70 and growth was ticked.   
 
15 May, as I have all ready indicated, the height and weight remaining in the 2nd to 9th 
 
centiles.  Blood pressure (at the bottom) is noted again.  13 November, the weight, 
 
between 2nd and 9th centiles, and also height. Weight was ticked at the bottom of that 
note, blood pressure noted again.  And so on. In May 1998, November 1998 (going on), 

the weight and height remaining between the 2nd and 9th centiles. In November the 
 
height had gone up to between 9th and 25th centiles and the weight in the 9th. May 1999, 
 
9th centiles etcetera.  In relation to that Patient, his growth was monitored at that 
 
frequency throughout his receipt of medication as a result of Dr Cosgrove’s prescriptions. 
 
 Is that a satisfactory monitoring of growth?  
 
A     
Yes, I would say so.  Though – well I do not know whether that is being fed back 
to Dr Cosgrove or not, obviously the monitoring is only satisfactory if it is being sent 

back to the person who is prescribing, but if they are doing that then, yes, that is a 
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satisfactory monitoring of growth.  
 
 
 
Q     
I accept that is an extremely fair point.  I just want to check, I think that it was 
 
established when Dr Holme gave evidence - if you look, please, at the first letter back 
 
following the first consultation with Dr Holme, which Dr Vereker attended (22 May), if 
 
we look at page 93?  
A     
Where am I, sorry? 

  
 
Q     
Page 93 of that bundle?  
 
A     
That is copied to Dr Cosgrove, yes.  
 
 
 
Q     
That is copied to Dr Cosgrove.  We see there that his height and weight are both 
 
between the 2nd and 9th centiles?  
A     
Yes. I see. That is satisfactory growth monitoring.  

 
 
Q     
Again I will be corrected if I am wrong, I think that every subsequent clinic 
 
appointment resulted in a letter which was copied back to Dr Cosgrove. Page 88, 1986 
 
and 1987. May 1997, November 1997. We see 84 and 85 and so it continued.  
 
 
 
Just putting into the background of this issue of growth monitoring, if I may, Professor, 
can I take you to the American Practice Parameters, which you talked about on the last 

occasion? Have you got it C11?  
 
A     
Yes.  
 
 
 
Q     
95s, if I can take you to that page?   
 
A     
Yes.  
 
 
Q     
It is the second column. The subheading under which this appears is on page 92 

under, “Stimulants”, I think. If we look at 95s towards the bottom of the second column, 
 
I think the final paragraph: 
 
 
 
“Growth retardation resulting from stimulant use is a concern. 
 
Decrease in expected weight gain is actually small, although it may 
be statistically significant. The effect on height rarely is clinically 
 
significant. The magnitude is dose-related and appears to be greater 

with dextroamphetamine than with methylphenidate or pemoline.  It 
 
can be minimised by using drug-free periods. Preliminary data on 
 
early adolescents show no significant deviation from expected 
 
weight and height growth velocities.  Adult height has not been 
 
shown to be reduced following methylphenidate treatment in 
childhood”.  

 
 
That was a publication issued in 1997, Professor. Has there been any new evidence that 
 
would lead one to change those commentaries that we see there?  
 
A     
There has been recent evidence, yes.  The analysis of – I refer to the MTA trial 
 
(the multimodal treatment assessment trial), which was a large-scale comparison of 
 
medication against non-medication therapies in America.  That has produced evidence 
that suggests that growth retardation is more of a concern than it was thought to be 

before, of the order of 1 cms of height lost in a year’s treatment for the group as a whole.  
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Q     
Just help us, please, as to when that evidence first emerged into the public 
 
domain?  
 
A     
That is very recent. That is this year. 
 
  
 
Q     
But up until that point it would be reasonable for a clinician to be guided by these 
sorts of comments that we see in the Parameters there?  

A     
Yes. I think I should point out that they are referring, of course, to the group there 
 
and that when they say that the decrease in expected weight gain is small,  they are, 
 
of course referring to groups of children that have been studied. The whole concern is to 
 
detecting the rare problem of the child who is showing a failure to grow. The detection of 
 
a rare problem still needs to happen even though it is not a major problem or not a 
 
problem at all for those children, which is certainly the case.  
 

Q     
I am not seeking to argue for Dr Cosgrove that there is no need for monitoring of 
 
the group. It is just to set a context, if we may?  
 
A     
Yes.  It is uncommon but when it happens it is very important.   
 
  
 
Q     
Yes.  You talked about dosages and upper limit for a dose being suggested by the 
 
Practice Parameters of 0.7 mg/kg per dose.  Is that right, Professor?  
A     
That is correct, yes.  

 
 
Q     
Could we look at 95s in the Parameters?  The passage Mr Pearce directed our 
 
attention to, it is on the left-hand side on this publication, where the authors say: 
 
 
 
“The usual range for methylephenadate is 0.3 to 0.7 mg/kg per 
 
dose”.  
 

There is a significant difference, is there not, between an upper limit and that phrase, 
 
“The usual range”?  
 
A     
Yes.  There is.  It is plain that they are not stating that it is impossible to give 
 
doses outside that range, but they are also making plain that 0.7 is not a recommended 
 
average; it is an upper limit of the usual range.  
 
 
Q     
Yes.  Is it right to say that there is, in the literature, reference to patients getting 

significant improvement with doses over and above that limit of 0.7, going up to as high 
 
as 1 mg/kg dose?  
 
A     
No. I cannot think of that.  I cannot think of that. I am not aware of such evidence.  
 
 
 
Q     
I cannot produce the article but I can give you, I hope, a summary of it.  
Sprague and Sleator (1997), finding that although 0.53 mg/kg produced optimal 

enhancement of short-term memory tasks in the laboratory in ADHD children, it was  
 
1 mg/kg which produced the maximum improvement of social behaviour in the 
 
classroom. Does that ring any bells with you?  
 
A     
Yes, indeed. That was a paper which was strongly cautioned against the use of 
 
high doses of methylephenadate because it was suggesting that you should not only titrate 
 
against classroom (?) behaviour because if you did that you landed up with a dose that is 
actually harmful to the child.  I am not sure, off-hand, whether that is a daily dose or an 

individual dose that they were speaking about in that paper.  Yes, I am familiar with that 
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paper.  
 
 
 
Q     
It is Solanto and Wender 1989, using 0.9 mg/kg found fewer divergent responses 
 
over repeated testing on two work tasks, compared to a placebo?  
 
A     
I do not think - if I am remembering that paper correctly that is not a therapeutic 
 
trial. That is a paper that was intending to examine the basic questions of single doses on 
cognition. I do not think that that was intended to have therapeutic implications at all.  

 
 
Q    Funk et al 1993, findings on non-verbal creativity tasks no evidence of impairment 
 
induced by Ritalin at a 1 mg/kg dose?  
 
A     
I am not familiar with that paper.  
 
 
 
Q       Douglas, et al in 1995 using three dosage levels in their research, 0.3, 0.6 and 0.9 
mg/kg per dose, and summarising their conclusions: 

  
 
"The common pattern indicated linear improvements 
 
across dosages.  Ritalin dosages up to 0.9 mg/kg had an 
 
increasingly positive effect on measures of mental 
 
flexibility and other cognitive processes"? 
 
 
A       Well the Douglas group would normally be reporting its doses in daily doses, rather 

than in individual doses, and so I would expect that to be a reference to the total amount 
 
taken in the day. 
 
  
 
Q       But I understood that the usual way of talking about dosages now was mg/kg per 
 
dose? 
 
A       There is unfortunately an ambiguity in some recommendations that you cannot 
always be certain whether people are talking about a single dose or a total daily dose.  

You understand that I am speaking from memory about these papers.  I have not read 
 
them for this purpose. 
 
  
 
Q       I am sorry that I have sprung these upon you and, if you come back to us with 
 
further information, obviously you must be allowed to give it. 
  
 
Now can I turn to the specific concerns and risks that you raised in relation to the higher 

dosages, please, and that is particularly in relation to neurological factors.  I think you 
 
have mentioned perseveration of attention, depression and hallucinations.  In relation to 
 
perseveration, again trying to put this into context, am I right in suggesting that the 
 
American Practice Parameters which we have before us do not make reference to that as 
 
being a side effect of Ritalin medication? 
A       I would need notice of that to look through the ... 

  
 
Q       Well the heading of "Stimulants" is on Page 92S, Professor, and a general comment 
 
in the first paragraph: 
 
  
 
"In addition, most side effects are mild and easily reversed"? 
 
  
A       Yes. 

  
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"... the onset of action is rapid, the dose is easy to titrate, and 
 
positive response often can be predicted with a single dose". 
 
  
 
Now, I do not want to delay proceedings. 
A       Yes. 

  
 
Q       Maybe if during a later adjournment you were to find something that would 
 
contradict that then, of course, you must be  allowed to tell us about that. 
 
A       It may be the case. 
 
  
 
Q       Yes. 
A       And, indeed, I would not regard it as a significant problem within the usual range 

of treatments that the guidelines are about. 
 
  
 
Q       Right.  Depression of mood - and, indeed, perseveration and hallucinations - would 
 
those be the sorts of conditions that one would expect a consultant paediatrician to pick 
 
up on monitoring a child whom that paediatrician knew was on a high dose of Ritalin? 
 
A       Well, no, I do not think I would actually.  I mean there are some paediatricians who 
would, and paediatricians who have made a special study of behavioural problems and of 

the prescription of Methylphenidate might well be expected to know about that, but I do 
 
not think that most paediatricians would at all regard themselves as capable of judging 
 
either the presence of depression or alterations of concentration becoming more 
 
restricted.  I think that would be -- I do not think that would be within the competence of 
 
an ordinary paediatrician. 
 
  
Q       Would a paediatrician not be able to recognise depression of mood? 

A       I think not necessarily.  I think that they would not regard themselves as skilled in 
 
that.  Typically, paediatricians would not see that that is what they did and they would 
 
refer on to Child Mental Health Services when they suspected it in a child in their 
 
practice. 
 
  
Q       In terms of more general monitoring in terms of behavioural and academic 
 
monitoring, I would like you to help us with this please.  We have seen, or we can see, the 

letter that Dr Cosgrove wrote following three telephone consultations with the patient's 
 
mother and we see that at Pages 74, 75 and 76 of C12.  You have commented, Professor, 
 
that it is important for there to be input from the school in relation to the assessment of 
 
the child, otherwise the mother or the parent might be confining his or her comments or 
 
observations to behaviour at home rather than concentration and effort at school.  If we 
look at the first paragraph of that letter, Dr Cosgrove writes to the GP: 

  
 
"I have had three telephone appointments with Mrs A regarding 
 
A.  I have taken the Ritalin dosage up ... He is less hyperactive 
 
except in the evenings ... School are very pleased with his 
 
behaviour, concentration and motivation since the last dosage 
 
increase.  They have noticed his self-esteem has improved". 
  

It would seem - and it is not clear obviously beyond doubt, but it would seem - that that 
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information had come via the mother because those telephone conversations had been 
 
with the mother. There is no evidence that the doctor had directly telephoned the  school. 
 
 But it would also seem, would it not, that the reports being relayed back from the school 
 
were detailed and were not confined to considering his behaviour? 
 
A       Well, it just is very difficult to know that.  I mean if indeed it is the case, and I 
 
agree it is not clear, that it was coming from the mother's report, then all kinds of things 
creep in between the way that the child behaves in school and the way that parents think 

the child behaves at school.  The reports of teachers are very often slanted towards what 
 
will encourage parents and what will encourage the child.  I think that you do not really 
 
know about what is happening in school unless you do have a report from the school.  I 
 
agree, yes, I mean that is ambiguous, but if it was only coming from the mother's report 
 
about school behaviour then I think that is not sufficient. There has been some research 
 
on that which looks at the accuracy of parents' reports about school behaviour in 
matching it to teacher reports about behaviour, and it looks as though parents' reports of 

school behaviour are more similar to their reports of behaviour at home than to the 
 
teachers' report of behaviour at school. 
 
  
 
Q       Well accepting that criticism, as one must, nevertheless it does appear that the 
 
school had been certainly notified of the medication that the child was on and was giving 
 
feedback to the mother --- 
A       Yes, that is correct. 

  
 
Q       --- on the effect of that. 
 
A       Yes, it does.  Absolutely. 
 
  
 
Q       Whether or not that changed through the maternal prism is something we cannot 
 
say and you say there is a risk of that happening? 
A       Yes. 

  
 
Q       Over and above that in a clinical setting, if we can go to Dr Holme's clinical notes - 
 
and by way of example if I can take you to Page 127, which is the consultation on 13 
 
November 1997 - and the related letter from Dr Holme to the GP copied to Dr Cosgrove 
 
at Page 84, where at the top of the letter in the box the problem that was being reported 
on was Hyperkinetic Disorder? 
 
A       Yes. 

  
 
Q       And then if we go back to the clinical notes there is a reference to his school, and in 
 
fact it is the first reference in the notes I believe for that consultation: 
 
  
 
"Fisherton Manor.  Holding his own so far.  Self-esteem may be a 
little down after comparing himself with others.  Doesn't seem to 

have best friend.  Has come home three occasions with bruises", 
 
  
 
and so there is some input there from the school but, of course, we do not know whether 
 
it is direct or via the parent. 
 
   
 
And then he seems to have a checklist in relation to the various elements of the disorder: 
  

"Concentration:  Having to work on this area at school ?  How do 
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they handle this best at midway between tablet dosages. 
 
  
 
Impulsivity:  Varies emotional level up down ? to what extent 
 
  
 
Restlessness:  Dose dependent". 
 
  
It would appear that Dr Holme was conducting a pro forma review of the behavioural and 

attention aspects of the condition, would that be fair comment? 
 
A       Well, I do not see it as adequate.  I mean having read that it is very uncertain.  
 
"Impulsivity:  Varies.  Emotional level up and down", it is really very hard to know what 
 
is being meant by that.  Potentially that is quite serious because, if what is meant is that 
 
there is a lot of emotional lability that is present - he is very up and down in his emotional 
 
moods - then this may mean, either that he should be having less medication, or that he 
should be having less medication.  It is certainly an indication for enquiring further about 

what it is. 
 
  
 
Q       Right. 
 
A       So, very vague. 
 
  
 
Q       And that that is a provisional position or unresolved position is perhaps borne out 
by the letter from Dr Holme, if we look at Page 84, where it is said in the second 

paragraph: 
 
  
 
"Mrs A is awaiting reports on how well he is doing from the point 
 
of view of concentration and impulsivity at school"? 
 
  
 
A       Yes. 
  

Q       And so a recognition that more input is required, but certainly that it is being 
 
sought and obtained? 
 
A       It is in his mind, but it is not an adequate enquiry. 
 
  
 
Q       But with further reports from the school that enquiry could be completed and made 
adequate? 
 
A       Yes. 

  
 
Q       You have talked about also in this context the combination of drugs in this case and 
 
the concerns - the sort of cardiovascular concerns - about the use of clonidine and 
 
Risperidone.  Can I just deal with one matter, clonidine and the risk of hypertensive 
 
rebound I think you have talked about? 
A       Yes. 

  
 
Q       Clonidine in its licensed form is used to assist with hypertension, is that right? 
 
A       Yes, that is correct. 
 
   
 
Q       And if a hypertensive's blood pressure is reduced as a result of use of that 
 
medication and that is removed suddenly, then there can be a rebound to a hypertensive 
state? 

A       Yes. 
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Q       If that medication is used in a child who is not suffering from hypertension, is there 
 
any risk of hypertension being caused by the stopping of clonidine? 
 
A       Well that is the concern, yes.  I mean it is a concern, not an established fact.  The 
 
fluctuations in blood pressure on clonidine have not been charted specifically.  The 
 
reason for the recommendation about the maintenance of steady dose is from the point of 
view of avoidance of a hazard, rather than a hazard that has actually happened. 

  
 
Q       You talked about the use of Risperidone and the problems that that might cause and 
 
the fact that there was not until very recently any trial evidence in support of the use of 
 
that in the context of ADHD? 
 
A       Yes. 
 
  
Q       But it is right, is it not, that there had been certainly back in the late '90s open trials 

which were supportive of its use? 
 
A       Well, the interpretation of those trials was not necessarily supportive of its use.  
 
There are reports of its being used and there are reports of its being improved, but there 
 
was not anything like a standardised outcome scale or any evidence of overall 
 
improvement one way or the other.  So, it was very impressionistic. 
 
  
Q       Right.  But you would not criticise its use in this context.  What you would say is 

that an enhanced level of monitoring is definitely required? 
 
A       Yes, that is correct.  I am not criticising its use.  I have used it myself. 
 
  
 
Q       And just finally I think on Patient A, telephone monitoring I think a good way of 
 
delivering dose so long as the dose can be properly titrated with relevant information 
 
about the child and how the child is responding to the medication both in the context at 
home and the school? 

A       Yes, that is right, and preferably some assessment at the clinic of that as well in 
 
case there are undetected problems appearing with it.  There needs to be the multiple 
 
sources of evidence partly because of the kind of thing that emerged from the Sprague 
 
and Sleator study that you were mentioning, which was that you have different doses 
 
which are good for different things.  That if you titrate up to the best dose for one thing, 
you may have the wrong dose for what you are really wanting to treat. 
 
  

Q       Right.  Now, I wonder if we could move on to Patient B and we have got the letter 
 
from Dr Cosgrove at Tab 3.  You were asked in this context about Dr Cosgrove's 
 
definition of the characteristics of ADHD at Page 2, where he said that they comprised 
 
"poor concentration, impulsiveness, hyperactivity and poor motivation".                            
 
                                                                        

You take him to task in relation to the fourth of those factors - motivation.  I think 

you are saying that might be a factor but that it is not necessarily part of the diagnosis and 
 
can happen in many other conditions? 
 
A Yes, 
yes. 
 
 
 

I just want you to comment please on an extract from a publication edited by 
 
Professor Barkley called, “ADHD a Handbook for Diagnosis and Treatment”.  I wonder 
if that can be handed round? (same handed). 

 
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THE CHAIRMAN: This will be D34.   
 
 
 
MR MORRIS: I apologise to my learned friend, I should have given him a copy earlier.   
 
I omitted to do that.   
 
Professor, just help us, please, with the editor of his publiction, Professor Barkley, I think 
 
he is paced in America, is he not? 
A Indeed. 

 
 

Right at the top of the field over there.  Is that a fair comment? 
 

Yes, he is one of the well known figures in research there. 
 
 
 

In this extract from his handbook which is dated 1990 there is a passage: “ADHD 
 
as a Motivation Deficit Disorder”, which he, I do not know whether it is the editor, says: 
 

“One of the most far-reaching and exciting developments in this decade 
 
only began to emerge in the latter half of the period. It is not likely to be 
 
fully appreciated for at least another decade or more. This was the nascent 
 
and almost heretical view that ADHD was not actually a disorder of 
 
attention at all.” 
 
 
I do not particularly want to get into the technicalities of what he is saying, but he is 

setting out there, if we look to the next column in the final paragraph, a motivational 
 
model in relation to ADHD and talks about its appeal in relation to the condition: 
 
 
 
“(1) its greater explanatory value in accounting for the more recent 
 
research findings on situation variability in attention in ADHD; (2) its 
 
consistency with neuroanatomical studies”, 
 

Then regulating circuits: 
 
 
 
“(3) its consistency with studies of the functions of dopamine pathways in 
 
regulating locomotor behaviour and incentive or operant learning; (4) its 
 
greater prescriptive power in suggesting potential treatment for the ADHD 
symptoms. Whether ADHD will be come to be labelled as motivational 
 
deficit is uncertain, but there is little doubt that these new theories based 

on construct of motivation and a more functional analysis of behaviour, 
 
are basically altering the way in which we conceptualise this disorder.” 
 
 
 
Would it be reasonable for a clinician reading that to take the view that motivation could 
 
be one of the characteristics of ADHD? 

 think that an expert clinician reading that would understand the distinction 

between poor motivation in the every day sense of: ‘I am motivated to do this, I want to 
 
try’, and motivation of the more technical and neuropsychological sense that is being 
 
used here.  Professor Barkley is well known that for theory which has a good deal of 
 
support to it, but at the neuropsychological level the changes which happen are more like 
 
a failure of inhibition, not that you cannot concentrate.  It is your failure to inhibit other 
 
things and, indeed, some of the new case studies would suggest even more strongly that it 
was in  

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a neuropsychological sense a problem in the broad area of motivation rather than of 
 
attention failure. Attention deficit is a misnomer at the neuropsychological level.  That is 
 
not at all the same thing as the ordinary concept of motivation -not wanting to do things, 
 
being idle, feeling unengaged, detached.  It is a difference of order of talking about 
 
things.  Yes, I can well see that an unprepared clinician might be confused but I am not 
 
sure that would not be the intention of Professor Barkley who has been one of the great 
advocates in setting out the diagnostic criteria for ADHD of ensuring that the main 

behavioural things that you go for are, indeed, inattentiveness, impulsiveness and 
 
overactivity.  He has not suggested, indeed he has argued against adding qualities of 
 
motivation in that more general, broadly based sense of the definition. 
 
 
 

So you still criticise Dr Cosgrove for including poor motivation as one of the 
 
characteristics? 

I criticise it because it can lead to an over inclusiveness, which is if you were to 

include being poorly motivated to do things in the definition then that could well lead you 
 
to include more people in the diagnosis that should be diagnosed. You have included  
 
a non-specific bit in the definition rather than the things which distinguish it from other 
 
kinds of problems. 
 
 
 

I want to move on to Patient C, if I may, you will find that at divider 4 and 5 in the 
bundle.  Criticism here in relation to the letter of 29 May 1999 in the heads of charge that 

there was a failure in the letter, the fact of the matter is the letter does not contain any 
 
advice to the GP about appropriate monitoring of C whilst he was taking Risperidone and 
 
Ritalin.  Help us with this scenario though, please, if in fact Dr Cosgrove himself and  
 
Dr Rackham, the GP, were between them monitoring growth and blood pressure would 
 
that be an appropriate monitoring regime in the context of that patient? 
 

Yes, I would think so. This is a child on ordinary dosage.  He is on Ritalin and 
Risperidone.  So there is – he is on quite a lot of Risperidone, so there would be an issue 

about ECG there, I think.  I think a cardiogram would be proper.  But from the point of 
 
view of the growth and the blood pressure, yes, if the GP is monitoring these things and 
 
feeding that back to Dr Cosgrove, the prescriber, then that is an okay way of doing that.  
 
Though, as I say, the combination with Risperidone creates some other issues. 
 
 

Can I just ask you for your views on this, we see here clearly a critique of  
 
Dr Moses which is based on what Dr Cosgrove was being told by the patient’s mother.   

If we look over the page at page 2: 
 
 
 
“Mrs C told me that C was seen by Dr Moses…when he was five years old 
 
but she was given no diagnosis.  At this time she was being called into 
 
school every week and she considers that her son was hyperactive at that 
age.  Dr Moses C saw C again when he was six, had a half-an-hour talk 

with his mother and told her that she would see C again in one year’s time. 
 
 His mother says that Dr Moses had seen C three times in four years.  In 
 
view of the serious state that C is now in I am surprised that more has not 
 
been done for this child by the local specialist.” 
 
 
 
Can I ask you pose to you a different scenario from the one that was put to you by  
Mr Pearce, if that account given by the mother was correct would you criticise  

Dr Cosgrove for expressing surprise that more had not been done? 
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It hinges really on something which I do not know, which is how much time had 
 
elapsed between the start of the rather intensive psychological treatment and the point at 
 
which this is being done because it is reasonable, as in the various guidelines, to begin 
 
with a course of psychological therapy and, of course, that does not have to be given by 
 
the individual consultant psychiatrist and it usually is not.  In this instance what was done 
 
was more than would usually be done because of the child was taken to a day unit, which 
I presume would be for purposes of increasing behavioural training, of enhancing his 

sense of security, of working with parents, all things which are good and most children do 
 
not get that sort of level of input.  Most children get that kind of thing done with  a 
 
relatively small number of out-patient appointments.  So to get into a day patient unit is 
 
quite an intensive thing to be provided by the local child mental health service.  There is  
 
a question, I am not certain about the answer, about whether that local service went on for 
 
too long, trying to help things that way before they had gone on to medication or not.   
I am not sure about the answer on that but I do not see it as negligence by trying to do it 

by psychological input first. 
 
 
 

Again the facts are not resolved.  It is a matter for the Committee to resolve them, 
 
if they see fit.  If the position was that there had been a fairly lengthy period of intensive 
 
psychological treatment and there were still remaining marked problems of adjustment, to 
 
such a degree that social service help was being sought for support of the family and 
special education recommendations were being made, it would be proper at that point to 

actively consider the possibility of medication and treatment, would it not? 
 

Yes, it would, yes. 
 
 
 

The history here, which we have set out earlier on in the letter, of early onset, 
 
highly persistent pattern of poor behaviour, poor academic progress in school, mother’s 
 
account that he is very restless and, I think, from the clinical notes, nurse’s reports and 
observations that he was chaotic in his play and unable to control his temper, it would all 

point in the direction of ADHD, would it not? 
 

Yes, I thought so, yes, though I also thought there were pointers to other things 
 
happening.  Also pointers to insecurity in his home life which could also be contributing 
 
to that situation. This is an issue that I have seen over the years as well as when services 
 
can sometimes be a bit slow to see what can be done in therapy.  But what you need to do 
then, I think, is to try to get again a sort of a shared care approach with the local service 
 
because the need for psychological input does not disappear because medication is being 

given.  Most children, perhaps not all, but most children on medication do need 
 
psychological input too.  So if you are not providing that yourself you need to the work 
 
with a service locally that is giving it. 
 
 
 

It is presumably difficult to work with that service if that service is not prepared to 
accept a possible diagnosis of ADHD? 

A Yes. 
 
 
 

And the need for medication? 
 

That can be a problem.  Though in my experience I think that has always been 
 
resolved by discussion and professional approach and by making it plain that if 
 
medication is given it is in the spirit of a trial and if it is not helping it is not continued.  
So I do not think I can think of any instances where a service locally has been totally 

obdurate in that matter. 
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Patient D, please.  I have the documentation at divider 6.  The consultation with 
 
Dr Cosgrove was on 21 May of 1996, we have that at page 2, and it is right that the letter 
 
does not make specific reference to growth and the need to monitor growth in the letter to 
 
Dr Taylor but what we do have, Professor, I wonder if you can help us with this, is that 
 
on the 4 June, which is a few days later, after the Ritalin had been going for a few days,  
I think it was started on 24 May.  And a note from the General Practitioner, we can see it 

at D30, I do not know if you have bundle D30 there before you?   
 
A     
D30? Just a minute.   
 
 
 
Q     
Page 213. I think we know from the mother that the General Practitioner  
 
Dr Taylor was initially reluctant to prescribe the Ritalin but then contacted a consultant, a 
 
lead paediatrician on it, and it was agreed after that consultation that Ritalin could be 
prescribed and the General Practitioner agreed to do so.  We have got a monitoring 

regime set out there: height and weight three monthly, it looks like it is to be done by the 
 
practice nurse.  In the context of a patient who was being recommended a dosage of 
 
Ritalin going up to 35 milligrams a day, that would not be an unreasonable regime, would 
 
it?  
 
A     
Looks like – yes, it is fine.  Looks as if (looking at things before it) this is when  
 
Dr Barton is about, is that right?  
 


Yes, that is right?  
 
A     
Yes. Dr Barton is a quite a well-known specialist in the area.  Yes.  
 
 
 
Q     
We know that Risperidone was then added into the equation on the 17 July. 
 
We have got a doctor’s letter, we can see that at C8 divider 6 Page 5, 6, and 7?  
 
A     
C8 divider 6?  I do not seem to have a divider 8.  
 

Q     
It is the main bundle that I think you were looking at, which we have been going 
 
through with other patients?  
 
A     
Yes, I have got C6. I have got C7. I have got C9.  Sorry.  
 
 
 
MR PEARCE:  There is a confusion between tabs and exhibit--- 
  
 
THE WITNESS:  I have not got a tab 8.  

 
 
MR MORRIS:  It is tab 6. Sorry, did I say tab 8? 
 
  
 
THE WITNESS:  Sorry, tab 6.   
 
 
MR MORRIS:  Page 5.  Not very clear?  

A     
Page 5, yes.  
 
 
 
Q     
He writes this: 
 
 
 
“Since I wrote to you last, I have had three telephone appointments 
 
with Mrs D regarding D. I have taken the Ritalin dosage up from  
5 mg (to 35 mg is the total).  Initially D's aggression ceased on a  

10 mg dose and his mother was very pleased with 30 mg per day on 
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this dose his teacher could not believe the change in him.  At home 
 
his mother is finding him getting angry with tablets wore off”.  
 
 
 
There is a description of his aggression.   
 
 
 
“Clearly he needs the Ritalin but I cannot increase the dosage at 
present because his appetite has fallen considerably and he is awake 

until after midnight.  I have, therefore, decided to add low dose 
 
Risperidone to the Ritalin and have asked his mother to give him”, 
 
 
 
dosages set out there increasing, I think, to 2 mg a day at the end of that programme.   
 
 
 
“Until I have a telephone appointment with her about in 10 days 
after he starts the Risperidone”. 

 
 
I do not think you would criticise him for introducing Risperidone in 
 
those circumstances?  
 
A     
No, not necessarily. I mean I do not know all the circumstances but it is a 
 
treatment to be cautious about as it is a sort of a last resort kind of treatment in this 
 
context. He was going into it quite early. The usual recommendation would be that if you 
felt you had a sub-optimal response to one stimulant that you then try another stimulant.  

If that was not helpful then you would then try one of the other second line of 
 
medications, which at that time would probably have been an anti-depressant such as 
 
Inipromine. So the protocols suggest that you do not go to Risperidone as quickly as that 
 
because of the potential adverse effects. He is going to it quickly, but I do not  
 
– I think while it is not in keeping with the protocols and the usual guidance, I do not 
 
think it is necessarily wrong. It may have been right for the particular child.  
 

Q     
It may have been something to do with the fact that he felt that he was coming up 
 
against a ceiling in relation to stimulant medication because of the concerns about 
 
appetite and sleeplessness?  
 
A     
Yes, exactly. As I say the usual thing at that point would be to try a different 
 
stimulant and then another less - a second line drug.  
 
 
Q     
The monitoring regime that had been set up in Scotland for the child, would that 

be satisfactory in relation to the addition of Risperidone?  
 
A     
No. I think you would need more than that.  You need more frequently pulse and 
 
blood pressure monitoring when you are starting the Risperidone because you get blood 
 
pressure drops in the early stages of therapy.  As I say, I really think they should do a 
 
cardiogram as well if they are prescribing both drugs at that level because if Risperidone 
were to create an intra-cardiac conduction problem and if the Ritalin were to increase the 

heart rate then the combination of the two could be awful.  In fact, that could be an 
 
arrhythmia starting.  Improbable, but possible.  
 
  
 
He says it is low dosage Risperidone. It is not really very low dose Risperidone. That is a 
 
similar kind of regime that you will be giving in treating schizophrenia in a young person.  
 
 
Q     
I do not think I need trouble you with Patient E. If we move on to Patient F?  The 

letter in relation to this patient is at divider 10.  If I can put this scenario to you, 
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Professor: if the clinician who had previously been involved in that case with the patient, 
 
who is an adult patient, had made the comment that a concentration problem 
 
(in other words ADHD) as a diagnosis, “Is for messy kids”, in other words it is not 
 
appropriate for an adult, would it be fair to describe that as a comment born out of 
 
ignorance?  
 
A     
Yes. It sounds like an unacceptable comment, whatever it was made out. It sounds 
quite unprofessional.  

 
 
Q     
If it were right that the patient had been told that the consultant thinks you have 
 
got a personality disorder, “Which is not treatable”, again it would be fair and proper to 
 
criticise that remark, would it not?  
 
A     
Not necessarily the personality disorder remark because in many ways adult 
 
ADHD is a kind of personality disorder; it is a persistent problem, it not always comes 
and goes, it is a persisting impact upon the personality of  function.  

 
 
Q     
But if that is treatable?  
 
A     
That and many other kinds of personality disorders are treatable too. So the 
 
implication, if it is a personality disorder it is not treatable, that would not be the general 
 
view.  
 
 
Q     
That would be an inappropriate comment, would it not? “You have got a 

personality disorder and it is not treatable”?  
 
A     
I would have thought that would be – even if it he had been right and it was not 
 
ADHD, then to say, “You have got a personality disorder and it is untreatable”, is not 
 
what psychiatrist would usually say. 
 
  
 
Q     
Can I just go back, please – sorry, I am going out of order - to Patient A? I think 
that you said that in your own experience, I think, your maximum prescription of Ritalin 

was 85 mgs a day?  
 
A     
I think I said that some while back. I have been up to high doses since, especially 
 
with adult patients, of course.  
 
 
 
Q     
Right.  I just want you to help us (it is a document that the Committee does not 
have), it was in the material disclosed to me earlier today and it relates to the referral of 
 
this patient to you for a second opinion?  

A     
Yes.  Yes, indeed.  
 
 
 
Q     
I am looking at the recommendation in relation to medication, which is actually 
 
signed by your SHO but I will be interested to find to what extent you had input into this:  
 
 
“Management in relation to medication. Switch to a immediate 

release Ritalin is recommended to maximum recommended dosage 
 
of 0.7 mg/kg per day, i.e. 30 mgs TDF”,   
 
 
 
which would be 90 mgs a day?  
 
A     
Yes.  I think that is correct. I should say---  
 
 
Q     
Can you reconcile that with your 85 mgs---  

A     
Yes.   
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Q --maximum--- 
 
A     
Well, I think that when I said it, that is was true at the time. My dosage rate has, if 
 
anything, been increasing as I have appreciated the big range that people have.  I think 
 
that that 90 mgs was the highest that I have ever recommended.  It came for a particularly 
 
problematic child, who had been very much round the houses and was not responding 
in the expected way. But that was my recommendation, yes, not the SHO’s. I do not have 

that in front of me and I have not seen that for a year or more because it was faxed up 
 
yesterday when I was not at the hospital, but from recollection that would be correct.  
 
 
 
Q     
Right I do not want to take undue advantage of you but did you see the patient 
 
yourself or was it your SHO?  
 
A     
No. I saw the patient myself.  
 

Q     
Did you take a medication history?  
 
A     
No. The SHO would take the medication history and tell me about it.  
 
 
 
Q     
Just one last point, if I can ask you, Professor: did you write something in the 
 
British Journal of Psychiatry, earlier this year saying that you yourself had received 
 
threats from an anti-psychiatry organisation? 

Yes, I did.  

 
 
Q     
What was the organisation’s threat threatening you?  
 
A     
It was the Church of Scientology. 
 
  
 
Q     
What was the nature of the threats that they issued?  
 
A     
This is a little while back, but it was that I could escape the revenge that was 
going to be put upon me - I have not got the words exactly - but I could escape the 

revenge and live a natural life if I renounced my crazy views.  
 
 
 
MR MORRIS: Yes. Thank you.  
 
 
 
THE WITNESS:  It is a few years ago, but it is still rankles.  
 
 
Re-examined by MR PEARCE 

 
 

Yes.  Could I just return to that literature to which you are referred, in the sense of 
 
you have been asked about it, Professor Taylor, just so that I correctly understand what 
 
you are saying about it?  I think that we hear, with the exception of the paper suggested, 
 
I think by Funk et al, not the paper that was actually produced, there were four references 
to literature about the levels of prescription?  

A     
Yes.  
 
 
 
Q     
I think of the four references you were aware to a greater or lesser extent of three 
 
of them, but the fourth you said you had not heard of?  
 
A     
I could not recall it at the time.  
 
 
Q     
You could not recall?  

A     
Yes.  
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Q     
Excluding the one you cannot recalled, therefore, no doubt you cannot comment 
 
on it, in your understanding do any of the three other items of literature referred to 
 
support a higher therapeutic dosage than the levels of which you have been speaking? 0.7 
 
mg/kg?  
 
A     
No, they do not. That is to say either they are specifically arguing against it (in the 
case of Sprague and Sleator arguing that the higher doses do adverse things to your 

cognition, your understanding) or that the trials are not therapeutic trials, they are things 
 
that are designed in the laboratory to show what the drug is doing, rather than to be 
 
saying what the practice ought to be.   
 
 
 
Q       And forgive me if I am asking a stupid question but, just so that I am clear, why can 
 
one not carry over from trials in the laboratory to therapy at the kind of levels that may be 
talked about in the laboratory trials? 

A       Yes, I think the key reason for it is that ADHD is a complex problem.  It is not one 
 
deficit.  It is several different problems.  In a laboratory experiment you will be wanting 
 
to find out what the dose response is between medication and one of those components.  
 
It may for instance be the ability to switch your attention selectively from one thing to 
 
another, which would typically need a low dose to deal with it and would be worsened at 
 
a high dose, or it might be a laboratory test such as preferring to wait and hold yourself 
back - the more motivational aspect of refraining from jumping in to do things in the first 

place - which would require a higher dose.  So, I think it is quite proper for experimenters 
 
to be looking at the effect of those dose response upon different bits of 
 
neuropsychological function. 
 
  
 
Q       Yes. 
 
A       But of course in the real world we are not treating neuropsychological function, we 
are treating children, and what we want to have an impact upon is about their ability to 

develop normally.  So, it is a much more overall judgment that you need to make about 
 
response in a trial. 
 
  
 
Q       I understand.  I understand.  Could I ask you specifically about two matters relating 
 
to Patient A, Professor, and I think for this purpose I need to turn up the Exhibit C12. My 
first question is about weight monitoring.  You were referred to Pages 71 and 72 in D12? 
 
A       Yes. 

  
 
Q       You will recall that this was the early letter of 3rd May 1996 from Dr Cosgrove to 
 
the General Practitioner in which reference is made on Page 72, the second page of the 
 
letter, to a fall in appetite and the need to monitor progress and weight? 
 
A       Yes. 
  

Q       Further down on the same page the third full paragraph on that page begins thus, 
 
does it not: 
 
  
 
"I understand from Mrs A that Dr Vereker is concerned about his 
 
weight which although it has not dropped has not increased 
 
either.  However, I have been told that his weight is on the 50th 
centile and this does give us a lot of leeway in raising the dose of 

Ritalin". 
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Bearing those two sentences in mind, can I just ask you now to turn over to Page 125 in 
 
that bundle which is Dr Holme's note following a clinic on 9 May 1996 - I am sorry, 13 
 
May 1996 - and so it is a clinic ten days later, where the weight is recorded at 21.5 kgs 
 
and Dr Holme tells us that he marked that as being the 2nd to the 9th centile? 
 
A       Yes, indeed. 
  

Q       Do you see that on Page 125? 
 
A       Yes, indeed.  Yes. 
 
  
 
Q       Now if the Committee reaches the conclusion that in the consultation with Dr 
 
Cosgrove he did not measure this patient's weight but took this patient's weight from what 
 
he was told, what would you have to say about that as to his clinical treatment? 
A       Well, that I think would just be wrong.  You have to measure the child yourself.  If 

he has just taken the weight as told to him by another, then that really would not give him 
 
anything like the information he needs to be monitoring the effect of the medication and 
 
especially with a concern about his appetite. 
 
  
 
Q       I see.  Now, in the same bundle could I ask you to look at Page 68? 
 
A       Yes. 
  

Q       You were asked about monitoring of blood pressure and pulse, I think, and you will 
 
see that on 3 July 1999, this is a letter from Dr Cosgrove to Dr Holme and I think it is 
 
apparent from this letter that Dr Cosgrove has seen this patient with face to face contact 
 
on 30 June 1999, the second paragraph indicates that Dr Cosgrove took the blood 
 
pressure and took the pulse rate on four separate occasions concern having obviously 
 
been raised about a tachycardia by Dr Holme.  Do you see the third paragraph: 
  

"I asked his mother to try taking his pulse and it would appear 
 
that she does not find this too easy so that her previous readings 
 
of 60 and always less than 100 are unreliable". 
 
  
 
If Dr Cosgrove was relying upon this patient's mother to take the pulse, would that in 
your opinion -- and presumably to communicate it to him.  I think it is implicit in that 
 
paragraph that figures have been passed on to Dr Cosgrove.  Would that represent 

adequate monitoring of pulse? 
 
A       No, I do not think that would be adequate, and it would be unnecessary because it 
 
can be done through the local family doctor. 
 
  
 
MR PEARCE:   Yes, I follow that. 
  

Yes, thank you.  I have no further questions, sir. 
 
  
 
THE CHAIRMAN:   Thank you very much.  It is now open to the Panel if they have any 
 
questions.  The Panel has no further questions and so that I assume concludes your 
 
evidence, Professor Taylor. 
 
  
THE WITNESS:   Thank you very much. 

  
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THE CHAIRMAN:   Thank you very much for coming to assist us. 
 
  
 
 MR PEARCE:   Thank you, sir.  Thank you, Professor. 
 
  
 
(The witness withdrew
 
  
MR PEARCE:   Sir, that concludes the case for the GMC. 

  
 
THE CHAIRMAN:   Thank you very much. 
 
  
 
Mr Morris, I am not sure if the case for the Defence has actually concluded? 
 
  
 
MR MORRIS:   Sir, I do not wish to conclude the case for the Defence.  I just want to 
confirm one matter, which I would need to do, as to what course I now propose to take.  I 

wonder if the Committee might consider taking an early adjournment and resuming an 
 
hour hence? 
 
  
 
THE CHAIRMAN:   And when would you wish or when do you think we should be 
 
resuming? 
 
  
MR MORRIS:   Well, the matter I wish to investigate will take a very short while.  I 

could then come back and be less elliptical with the Committee and perhaps the 
 
Committee would prefer that before having a luncheon adjournment? 
 
  
 
THE CHAIRMAN:   Yes.  Well, what I could suggest is that we could break for lunch 
 
just now and the Committee will be available to recommence at 1:45 or at whatever time 
 
thereafter you find appropriate. 
  

MR MORRIS:   Well I am content with 1:45, yes. 
 
  
 
THE CHAIRMAN:   Are you happy with that, Mr Pearce? 
 
  
 
MR PEARCE:   Yes, although - and I may or may not be anticipating what it is that is 
going through my learned friend's mind - it might be that to take ten minutes now to 
 
examine it might give us a clearer view of the course.  I think my learned friend was 

rather hinting at that and then pulled back from saying it, but I think that that is what his 
 
thinking is, if I anticipate it rightly, and I notice him nod.  Frankly it might assist us all, 
 
and it might assist me in terms of what I need to be working on in the next hour or so, if 
 
we were a little clearer as to where the case is going.  You will follow that, if it is the end 
 
of my learned friend's case, then the next stage is me making my closing submissions. 
  

THE CHAIRMAN:   Closing submissions, yes. 
 
  
 
MR PEARCE:   And not that I am not very keen and willing to do so, but it does make a 
 
difference as to how I spend my next hour or so. 
 
  
 
THE CHAIRMAN:   Right.  Well, what we will do is we will break just now and you can 
call us back in when you have got more information.  Clearly if no more evidence is 

being led we are into the closing submissions. 
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MR PEARCE:   Absolutely, sir. 
 
  
 
THE CHAIRMAN:   Whereas if further evidence is being led then that is a different ball 
 
game altogether. 
 
  
MR PEARCE:   I understand, sir. 

  
 
THE CHAIRMAN:   So, we will adjourn just now. 
 
  
 
MR MORRIS:   I am very grateful. 
 
  
 
(The Committee adjourned for a short time
  

THE CHAIRMAN:   Mr Morris? 
 
  
 
MR MORRIS:   Sir, I am grateful for that short adjournment. 
 
  
 
I am going to make application under Rule 50 (1) of the Rules that the Committee receive 
 
before them the Witness Statement or Proof of Evidence that was made by Dr Cosgrove 
in relation to these matters dated - I am sorry, just give me a moment please - 23rd 

October 2002. 
 
  
 
Now I have alerted my learned friend that I propose to make that application, Dr 
 
Cosgrove not being here to give evidence himself, and he understandably before hearing 
 
me make that application and responding to it would wish to have sight of the document 
 
which I seek to put before the Committee and to take instructions as to the approach that 
the Council are going to adopt to the application and that is what I will do now.  But 

given those factors, sir, what I would invite the Committee to do is to adjourn now and 
 
allow my learned friend to absorb the document and take instructions and, once that has 
 
been done, I can make the application fully and then Mr Pearce can respond to it. 
 
  
 
THE CHAIRMAN:   Mr Pearce? 
  
 
MR PEARCE:   Yes, sir.  I was aware that the application might be made and I was aware 

that my learned friend was being elliptical. I have not been shown a copy of the statement 
 
thus far, for which I do not criticise my learned friend for a moment.  I understand why 
 
that is.  I am told it is a very lengthy document.  Replying to the principle of whether it 
 
ought to be admitted under Regulation 50 may not require a careful consideration of 
 
every paragraph in the document, it may be matters of more general application than that, 
but you will understand that I do seek both to read the document and - a matter which 

may be at least as time consuming as that - take instructions on the document before I 
 
respond to my learned friend's application. 
 
  
 
What I would invite you to do is to adjourn now until 2 o'clock, which will give us just a 
 
little bit over an hour, and I will give you a progress report if I am not ready then.  Now 
 
given where we are in timescale terms I am obviously particularly concerned that we 
should make rapid progress with this, and I know you will be concerned with it as well 

because no doubt the application will take some little consideration by the Committee, 
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and so I would like to think that I was as ready as soon as possible to 2 o'clock. 
 
  
 
THE LEGAL ASSESSOR:   If it assists both Counsel the advice that I would give to the 
 
Committee, at least on what I have been told so far, is the same advice that I gave to the 
 
Committee when it was your application to admit Dr Chubb's and Dr Dover's evidence. 
 
  
MR PEARCE:   That is helpful, if I may say so. 

  
 
THE CHAIRMAN:   Well, since it is under the same rule it would only be logical if the 
 
advice were the same. 
 
  
 
So, we will accede to your request and we will be available at 2 o'clock, or as soon as 
 
possible thereafter. 
  

MR PEARCE:   I am obliged, sir. 
 
  
 
THE CHAIRMAN:   Thank you. 
 
  
 
(The Committee adjourned for lunch
 
 
MR MORRIS: Sir, I am grateful for the time you have allowed both myself and Mr 

Pearce.  As I indicated before the adjournment I make application under Rule 50 for  
 
Dr Cosgrove’s witness statement to be admitted into evidence before you.  Can I say at 
 
the outset that I do not seek to make any submission that the statement is admissible 
 
under the provisions of sections 23 and 25 of the Criminal Justice Act 1988 because I do 
 
not have instructions as to the current whereabouts of the Doctor and, therefore, I am 
 
unable to submit, for example, that he is not available by reason of his absence overseas. 
So I go immediately to Rule 50, which states this: 

 
 
“(1) The Professional Conduct Committee may receive oral, documentary 
 
or other evidence of any fact or matter which appears to them relevant to 
 
the inquiry into the case before them: 
 
 
Provided that, where any fact or matter is tendered as evidence 
 
which would not be admissible if the proceedings were criminal 

proceedings in England, the Committee shall not receive it unless, after 
 
consultation with the Legal Assessor, they are satisfied that their duty of 
 
making due inquiry into the case before them makes its reception 
 
desirable.”   
 
 
The first issue, therefore, in my submission, you have to consider is whether or not this is, 

or may contain matter which is apparently relevant to the inquiry into the case before you. 
 
 This is a witness statement that was formulated by the Doctor in relation to the 
 
allegations that were forwarded to him by a Rule 6 letter and in preparation of a response 
 
to be put before the Preliminary Proceedings Committee.  It deals with some, but not all 
 
of the current heads of charge, so it does not deal with head of charge 11, that is Patient H 
 
or Patient G.  It does not deal with the last two patients but does deal with patients A to F. 
 In my submission, there can be little dispute but that the material within the document is 

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or would appear to be relevant to the inquiry into the case before you in as much as it sets 
 
out the Doctor’s case in relation to the allegations made against him. 
 
 
 
The next consideration then you have to make is whether or not to overrule the proviso 
 
that such evidence shall not be perceived if it is inadmissible in criminal proceedings 
 
unless, after consultation with the Legal Assessor, you are satisfied that your duty of 
making due inquiry into the case before them makes its reception desirable.  

 
 
In my submission, it is clearly desirable that this document be received into evidence 
 
before you.  It is relevant to the issues that you have to decide and in satisfying yourself 
 
that it is part of your duty to make due inquiry into the case, in my submission, you have 
 
to ensure that in making inquiry into the case the inquiry is conducted fairly and it would, 
 
in my submission, not be, it would deprive Dr Cosgrove of a fair hearing in this case if 
his witness statement were not before you at all. 

 
 
Obviously the weight to be attached to that witness statement is a matter which you will 
 
have to consider carefully and clearly you will not accord as much weight to it as you 
 
would had the Doctor given evidence in accordance with that statement and been 
 
available for cross-examination by Mr Pearce and to questions from your Committee.  
 
But that is, in my respectful submission, another issue which does not effect the question 
of admissibility and desirability of having that document before you.   

 
 
 So if I can put it in a nutshell, you cannot, in my submission, make fair inquiry into this 
 
case without having that document before you. It behoves you to consult with the learned 
 
Legal Assessor in deciding whether or not part of your duty of making due inquiry is to 
 
have that document before you and if I can take you - we are grateful for the learned 
 
Legal Assessor's suggestion that his advice would be similar to the advice that he gave in 
relation to Mr Pearce's application to admit the witness statements of Dr Dover and  

Dr Chubb – to day seven, page 42C your learned Legal Assessor said this: 
 
 
 
“If you reach the point that the evidence is inadmissible as per the rules of 
 
evidence”, 
 
 
that is a reference to the Criminal Justice Act,  
 
 

“which I have described to you, you then have to consider, if you are 
 
going to make a due inquiry into this case, is the reception of that evidence 
 
desirable. That is very close to the question of whether or not the evidence 
 
is in itself relevant to the charges.” 
 
 
I just interpose there. In my submission, there can be very little doubt as to the relevance 

of the charges in this document. 
 
 
 
“It will hen be a question of fact whether or not you consider that 
 
evidence, as such, that it crosses the line from being relevant to being 
 
desirable, its reception being desirable.  I do not think I can elaborate on 
 
the words desirable and relevant, they are English words used and it is a 
question of fact for you to decide that.” 

 
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The desirability, in my submission, arises out of the need to accord the Doctor a fair trial 
 
in relation to these allegations.   
 
 
 
Those are my submissions. 
 
 
 
MR PEARCE: Sir, our position is that we are neutral on this application.  We do not 
oppose it, nor do we accept that the statement ought to be admitted.  We invite you to 

hear my learned friend’s application.  We can assist in these ways, I hope.  First of all, I 
 
have had an opportunity to look at the statement and there can be no question but that it 
 
contains very little information on the charges before you.  We thoroughly, wholly accept 
 
that it contains relevant material.  Secondly, when you are considering the issue of 
 
desirability the absence and the reasons for the absence of the witness are matters which, 
 
in our submission, you can take into account and that is for this reason, that if you admit  
a statement such that is, just as the statement you admitted last week, the same point 

arises, where the author is not available for cross-examination it might, in certain 
 
circumstances, be considered undesirable that the evidence go in without the opportunity 
 
of cross-examination.  The reasons why the doctor is absence are at least potentially 
 
relevant to that. Unlike the position last week my learned friend is not in a position where 
 
he can give the Committee any good reason for the absence of the doctor.  As in all cases 
 
where the statement is admitted without the author being called you do not have the 
opportunity to hear the evidence tested.  It may very well be right that goes at least to the 

issue of the weight you attach to the document, as it does to whether you should admit it, 
 
but the point is there to be made.   
 
 
 
May I also make the point, sir, that this witness statement has exhibits to it that include 
 
documents from Patient B, Mrs C and Mrs E.  I have made inquiry about this, in each 
 
case they are signed documents.  In the cases of Mrs C and Mrs E you have heard from 
them in any event.  I do not think you will find there is any radically different information 

there.  By admitting the statement you would, through the fact that it contains an exhibit, 
 
also be admitting information from Mr B, admittedly in the form of a signed document 
 
from him, and it may very well be that if you were separately asked to consider the 
 
reception of that statement you would consider it desirable to do so.  I simply draw that 
 
out, one has not only the statement itself, but other information within the statement 
comes from other sources.  We invite you to consider whether to exercise your powers, 
 
but we are neutral (Inaudible). 

 
 
THE CHAIRMAN: Mr Morris, do you want to come back in on the nature of the exhibits 
 
that are attached to the document? 
 
 
 
MR MORRIS: Sir, no I do not.  In my submission, they are relevant to the issues 
concerned.  If it is felt separate application ought to be made in relation to the statement 

by Mr B I do so make that application for the same reasons that I make in relation to the 
 
witness statement itself.   
 
 
 
Sir, all I would say otherwise in response to my learned friend is that the absence of good 
 
reason for the Doctor not being here goes, in my submission, much more to the issue of 
 
weight than the issue of admissibility itself, particularly where the statement in this case 
is from the defendant, the subject of the allegation, who is on trial as opposed to 

prosecution witnesses.  
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MR PEARCE: May I just make one concession, so it is clear.  I agree that as well as the 
 
statement being relevant, the statement of Mr B that I referred to is also relevant and no 
 
separate consideration arises in relation to that. 
 
 
 
THE LEGAL ASSESSOR: Can I ask both counsel if they know of any authority that 
bears on the interpretation of the meaning of the word desirable?  I do not know--- 

 
 
MR PEARCE: I know of none. 
 
 
 
MR MORRIS: No. 
 
 
 
THE LEGAL ASSESSOR: All I can do is repeat the advice I gave in relation to Dr 
Chubb and Dr Dover.  It is a matter for the Committee to decide whether they are 

satisfied that their duty of making due inquiry into the case before them makes the 
 
reception of the document desirable.  What I would say is this, if you come to the 
 
conclusion that it is desirable, and there does not seem to be any doubt that this is relevant 
 
evidence which is being sought to be adduced, I would be advising the Committee when I 
 
come to give the advice before going into camera that the weight which can be attached 
 
to Dr Cosgrove’s evidence and to the evidence of Dr Dover and Dr Chubb, the weight 
that can be attached to that evidence is lessened by the fact that none of those witnesses 

have been subject to cross-examination.  So I think you have to consult with the regards 
 
the desirability of admitting this evidence.  I would say it is a matter for you to decide, 
 
but one way in which the matter could be dealt with is to receive the statement in 
 
evidence and then to take into account the fact that there is an absence of cross-
 
examination in assessing its weight.   
 
 
THE CHAIRMAN: You are looking a little quizzical, Mr Pearce. 

 
 
MR PEARCE: I am not meaning to, sir.   
 
 
 
MR MORRIS: No, thank you. 
 
 
THE CHAIRMAN: At this point we go into camera.   
 
 

STRANGERS THEN, BY DIRECTION FROM THE CHAIR, WITHDREW  
 
AND THE COMMITTEE DELIBERATED IN CAMERA 
 
 
 
STRANGERS HAVING BEEN READM ITTED 
 
 
THE CHAIRMAN:  Mr Morris, the Committee has considered your application and has 

decided that the witness statement should be allowed. 
 
 
 
MR MORRIS:  Sir, I am grateful for that.  I hope that the Committee will forgive me for 
 
not anticipating the outcome of your deliberations, we have not had it copied yet (it is a 
 
bulky document) and we will do that now so that each Committee member can have a 
 
copy of it.   
 

Just logistically, as to how we proceed now, it is, as I have indicated, a bulky document 
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and I think that it probably comprises of about 200 pages.  My learned friend, as you 
 
understand, has only had sight of it for a couple of hours and, therefore, I would 
 
anticipate that before he begins submissions -  I am sorry, this piece of evidence is the 
 
sole piece of evidence that you are going to receive in the case of the Doctor at this stage. 
 
 It, having been received into evidence, will be the case for the Doctor.  It will take the 
 
Committee some time, I think, to read that document and no doubt you will consider that 
you do need to read it before my learned friend starts his submissions. I think that 

my learned friend will require further time, in turn, to formulate his submissions, having 
 
had the chance to absorb the material.  
 
 
 
I would, therefore, propose - perhaps the most satisfactory timetabling arrangement 
 
would be if the document went into the evidence now and the Committee had the 
 
opportunity to read it and if submissions on the evidence were to begin first thing 
tomorrow morning.  

I have discussed that with my learned friend and I take the view that this case could 
 
comfortably conclude by a reasonable hour on Friday, if that course of action were taken.  
 
 
 
THE CHAIRMAN:  Is it your intention that the document be read into the transcript 
 
in the same way as the earlier documents that were submitted in this way?  Or is it the 
 
submission that the Committee would adjourn now and read the document and accept 
the evidence within that document already expressed and that we start with closing 

submissions? Or do you want to make further submissions on the document tomorrow 
 
morning?   
 
  
 
MR MORRIS:  No, I do not.  I would be content if it were taken as read rather than have 
 
it read into the transcript, which would be extremely lengthy and, I think, perhaps not an 
 
altogether helpful procedure.  
 

THE CHAIRMAN:  So be it. We will accept the document now. We could adjourn the 
 
hearing and reconvene at 9.30 tomorrow and we will have closing submissions 
 
at that stage.  
 
 
 
MR PEARCE:  Yes.    
 
 
MR MORRIS:  Yes.  

 
 
THE CHAIRMAN:  Thank you very much.    
 
     
 
(The Committee adjourned until 9.30 the following day
 
 
 

 
 
 
 
 


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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
 
Thursday, 17 June 2004 
 
Held at: 
St James’ Buildings 
79 Oxford Street 
Manchester M1 6FQ 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Ten) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was not present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of Transcribe UK 
Tel No:  0208 614 5799) 
 
-------------------------------------- 
 
 
 
 

 
 
 
 
INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
  CLOSING 
SUBMISSION 
by 
MR 
PEARCE 
   1 
 
 
CLOSING SUBMISSION by MR MORRIS  
 
 
20 
 
 
 
LEGAL ASSESSOR’S ADVICE                                                       36 
 
  DETERMINATION 
      38 
 
 
____________________ 
 

 
 
 
 
 
 

THE CHAIRMAN:  Good morning.   I will just confirm that the Panel has received this 
 
witness statement, the response to the initial communication from the GMC, and we will 
 
label the bundle D35. 
 
 
 
MR MORRIS:  Sir, that evidence having been admitted, I call and submit no further 
 
evidence.  That is the case for the doctor. 
 

THE CHAIRMAN:  Thank you very much. 
 
 
 
MR PEARCE:  Sir, may I start off by making certain general comments on the evidence 
 
before this Committee, turning to the individual charges and then to other general matters 
 
relating to the judgement that you are making at this point in the proceedings.   
 
 
In my introduction to general matters, may I start from Dr Cosgrove’s statement?  You 

may think, sir, that that statement contains much invective directed at a number of people, 
 
some of those named in charges, other people from who we have heard during the course 
 
of this hearing, others of whom we have heard mention, still others who have played 
 
little, if any, part in the proceedings.  I urge you from the beginning, sir, not to be swayed 
 
against Dr Cosgrove if you consider that that statement does contain invective, regardless 
 
of whether it can be justified; not to be swayed against him into thinking that because he 
has criticised others in that document that those heads of charge with which we are 

concerned here are therein made out. 
 
 
 
The tone of that statement is, you may think, of little assistance to you in dealing with 
 
matters at this stage of the proceedings, save in one respect, and that respect is this.  
 
When you are considering criticisms that we make of Dr Cosgrove for acting in an 
 
unprofessional, an unjustifiable or an unsustainable manner in criticising others, when 
you are considering that assessment and whether that is made out, it may be that at times 

the tone of Dr Cosgrove’s statement assists you in making that judgement. 
 
 
 
Equally, as we have invited you not to hold against Dr Cosgrove any invective that you 
 
may find in his statement, we invite you not to hold against Dr Cosgrove the fact that you 
 
have not heard from him in evidence.  He is not obliged to be here, he is not obliged to 
give evidence in respect of these charges.  In our submission, his failure to do so should 
 
not be held against him at this stage of the proceedings in any way, shape or form, save 

for one – and this is not so much holding it against him as how you assess the evidence.  
 
Again, when you come to make judgements about whether comments that have been 
 
made are justified, are sustainable, are professional, if you find that, as it were, on the 
 
face of the documentation these comments cannot, you might think, be justified and 
 
sustained, then his failure to give evidence before this Committee to give those 
explanations as it were deprives you of one limb of evidence that might have assisted 

him.  But that is not holding against him, that is simply assessing the evidence before you 
 
and having regard to the fact that though you have a statement he has not been cross-
 
examined on it, you have not been able to test the weight of what he has to say insofar as 
 
he seems to justify the relevant charges. 
 
 
 
Turning to those comments on Dr Cosgrove’s statement, I shall again, whilst remaining at 
the level of the general rather than the particular, to make certain other comments on the 

evidence that you have heard.  Firstly, it is my submissions that all the witnesses who 
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have appeared before this Committee have been doing their best to assist, and I say that 
 
regardless of whether witnesses I have called on behalf of the GMC or whether they are 
 
the witnesses who my learned friend called on behalf of Dr Cosgrove.  Nobody, you may 
 
think, has come here to lie or to pull the wool over the eyes of this Committee.  People 
 
may have different viewpoints, those viewpoints may or may not be correct; their 
 
recollection of events may or may not be correct, but in my submission all who have 
come forward to give evidence have done so honestly.  That, sir, will not detract from 

your need to assess the weight and reliability of that evidence – and when I deal with 
 
individual charges I will seek to point out respects in which, I submit, some evidence is 
 
clearly to be preferred to others. 
 
 
 
Also at this stage of the journey, just returning to Dr Cosgrove’s statement for the 
 
moment, you will want to consider the manner in which evidence is put forward by 
witnesses.  In respect of Dr Cosgrove’s statement that, you may think, is particularly 

important because, dealing as far as one can from a written statement as opposed to oral 
 
evidence, the manner in which Dr Cosgrove argues his case is in marked contrast to that 
 
in which other witnesses, particularly professional witnesses, have given evidence before 
 
this Committee.  May I give two examples of that by contrasting Dr Cosgrove’s statement 
 
with first of all the evidence of Dr Moses and, secondly, the evidence of Professor 
 
Taylor? 
 

Sir, you may think there is no question but that Dr Cosgrove had the interests of his 
 
patients at heart.  He feels very strongly about it.  His strong feelings may have led him 
 
into the situation in which he faces charges and admits charges of this nature, but you 
 
may think he undoubtedly seeks to act in the best interests of patients.  Equally though, 
 
sir, you have heard from Dr Moses.  Was she not also a doctor who was seeking to act in 
 
the best interests of patients?  She has never suggested that Dr Cosgrove was not also so 
motivated.  We have never suggested that, but you may think it is obvious from 

Dr Cosgrove’s statement that he does not share that view of Dr Moses.  He does not hold 
 
the view that she has the best interests of patients in mind.  He categorises her in a group 
 
of psychiatrists who, he expresses the view, have an arrogance, an egocentricity that 
 
blinds them to the facts and they are concerned only with their own reputations (says he). 
 
 Is Dr Cosgrove in his statement bringing a balanced view here?  We suggest not. 
 
 
Contrast Dr Cosgrove with Professor Taylor.  You might have been quite interested in 

Professor Taylor’s approach, because when he explained the spectrum about the ADHD 
 
diagnosis, about the use of medication for ADHD, you will see that in that spectrum 
 
Dr Cosgrove lies at one end of the spectrum and others – and perhaps this is true of 
 
Dr Moses, although I do not think we heard it put in this way but perhaps it is true of 
 
Dr Moses, that she is at the behavioural end of the spectrum rather than the medication 
end, if I can be as simplistic as to put it that way.   

 
 
You will realise that Professor Taylor was way over to Dr Cosgrove’s end of the 
 
spectrum in terms of medication.  Professor Taylor accepts though that there are different 
 
approaches and there is a role for clinicians to cover the problem in different ways and 
 
that there are different opinions, and that opinions may be valid, even those which he 
 
does not himself hold.  He was, you may think, careful in his evidence, weight up 
arguments on both sides, making sensible and reasonable concessions when it was 

necessary to do so.   
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In contrast to that, Dr Cosgrove’s statement comes over in a dogmatic fashion, in my 
 
submission, accepting nothing other than that he is right and that anybody who disagrees 
 
with him is wrong.  That is evidence, in my submission, about which you ought to be 
 
careful. 
 
 
Finally by way of general comments on the issues of evidence, I just touch upon hearsay 

evidence really to anticipate what the learned Legal Assessor will advise you.  You will 
 
no doubt listen to him with a great deal of respect.  I urge you to exercise caution where 
 
the only evidence on a point is hearsay evidence; that is evidence from a person who has 
 
not given evidence before you, not been cross-examined before you.  I urge you to 
 
exercise caution in respect of that evidence.  There may be points which you find you can 
 
accept such evidence.  It may be that it is difficult to accept such evidence, certainly to 
support a charge where we have to prove it beyond reasonable doubt unless that evidence 

is supported by other evidence, either unchallenged or where you have heard cross-
 
examination and accepted that other evidence.  That is by way of comment on issues of 
 
evidence. 
 
 
 
In terms of categorisation of charges, it is perhaps helpful to have in mind the categories 
 
of issue that arise here.  If I divide the allegations between those relating to prescribing 
and monitoring of medication in the one category and in the other category the criticism 

of other medics, taking those two categories separately, first of all in the medication 
 
category, the issues there break down themselves, I think, into two categories (I hope I 
 
get this right).  The first is those where there is in fact an issue as to what happened, and 
 
there are some of those, particularly in respect of patient A, to which I will turn in due 
 
course.  Secondly, there are those issues in respect of medication that relate to the 
 
judgement of that medication; whether what was happening with the medication, 
prescribing, monitoring, was appropriate. 

 
 
In terms of criticisms of others, again we have the same breakdown of categories, do we 
 
not?  The factual issues, essentially, is what we factually say that the charge is made out, 
 
and then there are issues of assessment as to whether what was said was inappropriate, 
 
unprofessional and unsustainable.  As I go through the evidence, I hope I will be able to 
point to the aspects of evidence that support our case. 
 
 

In terms of the factual issues relating to medication, most (but not all) are admitted – and 
 
I have indicated there are issues certainly about patient A.  In respect of factual issues 
 
relating to criticisms, my understanding is at those points at which they are not admitted 
 
the issue is not essentially what was said but whether the charges correctly reflect what 
 
was said – and, again, I will deal with those in a little detail when we get to them. 
 

May I turn to the issue of monitoring before I deal with individual charges?  I want, if 
 
I may, now to begin to refer to the evidence in a little more detail. 
 
 
 
In doing so I will give references to appropriate parts of documents and transcripts, with 
 
the exception, I regret to say, of yesterday’s transcript which I have not had an 
 
opportunity to look at.  I will give you page references that hopefully permit us to 
proceed with some reasonable speed.  In many respects I will not invite you to look at the 

documents now.  If you have the references you most probably will have the points in 
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mind in any event.  If you do not, if you have the references, I hope it will enable you to 
 
look at the appropriate documents in due course. 
 
 
 
In terms of monitoring, can I refer you, first of all, to the European guidelines that 
 
Professor Taylor spoke of, then to Professor Taylor’s own writing and protocol on the 
 
subject and then to the additions that he had to say in the course of evidence.  The 
European guidelines appear at page 296 of C10 and they are spoken of in the transcript 

for day 5, page 39, letters A to E.   
 
 
 
Those guidelines, in my submission, emphasize three particular matters of relevance.  The 
 
first is the physical monitoring of blood pressure and pulse every six months and on 
 
changing the dose; secondly, measures and recordings of height, weight and appetite on a 
 
six monthly basis and, thirdly, checks as to psychological or behavioural or psychiatric 
symptoms such as perseveration on a six monthly basis.  That is published guidance that 

was available to Dr Cosgrove at the relevant time. 
 
 
 
Professor Taylor’s own protocol appears in exhibit C10 at page 313 and was dealt with at 
 
some length by him in evidence on day 5 at page 30 G to page 32 D.  Professor Taylor’s 
 
own protocol would suggest as follows:  that one checks initial weight and cardiovascular 
 
status; secondly, that school reports are obtained at the outset; thirdly, that there is 
monitoring of weight, height and other physical features on a monthly basis for the first 

six months and then every six months thereafter; fourthly that school reports be obtained 
 
monthly for six months and then every six months thereafter; fifthly that the doctor with 
 
responsibility for the care should be reviewing the patient personally every six months. 
 
 
 
In speaking of those guidelines, Professor Taylor amplified them by indicating that it was 
 
not sufficient to obtain information over the telephone.  A share care scheme, for 
example, with a General Practitioner might be appropriate for physical monitoring and 

you will recall Professor Taylor was quite willing to accept that with some of the patients 
 
we are concerned with here it was perfectly appropriate to use a shared care scheme, but 
 
such a scheme needed to be properly set up and established.  You may think it needed to 
 
have clear rules established as to where responsibilities lay.   
 
 
Professor Taylor was also clear that this monitoring scheme was appropriate for the 
 
provision of Ritalin alone for dosages of up to about 16 mg per day.  Polypharmacy, 

co-prescribing, the use of more than one drug at the same time and/or higher dosages 
 
would require more careful attention.  They would require more careful attention in 
 
respect of the monitoring of behaviour and any psychiatric issues.  One would be 
 
particularly concerned about symptoms such as perseveration, depression or 
 
hallucinations.  The introduction of Risperidone itself requires proper cardiovascular 
monitoring, blood pressure, pulse and ECG.   

 
 
Finally, on monitoring, Professor Taylor was keen to emphasize the need for there to be 
 
direct contact with the school, for school reports not to come via parents.  It is important 
 
that we look at his reasoning for that a little further, because when we come to one of the 
 
patients this is an issue that is raised by Dr Cosgrove in his statement.  Professor Taylor’s 
 
reasoning, you may think, is essentially two-fold in respect of this.  The first is that if one 
obtains one’s school report from the parent, then one is dependent on what the school and 

how the school chooses to communicate with the parent.  The school may, for example, 
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wish to emphasize the positive features of the child’s behaviour to a parent when that 
 
does not in fact genuinely reflect what is happening in the classroom.  The danger there is 
 
that through teachers and other educational officers desire to communicate in a positive 
 
manner or in a particular manner they may mislead the parents. 
 
 
 
The second is that the parents themselves might, when making their assessment of what is 
happening at school, pay too much attention to what is happening at home.  You may 

recall Professor Taylor referred to evidence relating to this.  Doctor Cosgrove suggests  
 
– and I will come to the relevant point in a moment – that this is about not trusting the 
 
parents and that there is some implicit criticism of parents in saying the school reports 
 
must come from the school, because you cannot trust parents, you may think it amounts 
 
to.  That is not what Professor Taylor is saying.  Clearly, when a parent has a child in his 
 
or her presence and company for weekends or evenings and when a parent hears of what 
has happened at school during the day, there is only a risk that the parent, entirely 

inadvertently, will put a gloss on any school report and will interpret what the school has 
 
said in the light of the parents’ own experiences.  It is not to criticise parents.  It is an 
 
aspect of the reality of one’s perception in a situation such as this.  Again, Professor 
 
Taylor emphasises the good reasoning for contact with the school. 
 
 
 
Sir, I have now completed dealing with general matters and I will turn to the individual 
charges.  You may have the heads of charge before you and it is convenient for us just to 

run through them patient by patient if we may.   
 
 
 
Head of charge 1 is admitted and we need not trouble ourselves with it.  Head of charge 
 
2, relating to Patient A, in respect of whom the witness you heard give evidence was 
 
Dr Holme.  Of course, these charges relate to prescribing an increasing level of drugs to 
 
Patient A and to the monitoring and assessment that took place.   
 

If I may deal with 2(b), none of which is admitted, first of all, might I deal with the 
 
figures referred to in 2(b) as to the levels and the fact of the prescription.  In my 
 
submission, those details are supported by the evidence which you have heard in all 
 
cases, save for two inaccuracies that I will draw to your attention.  The first is this:  that 
 
the figure of 62.5 mg per day in (ii) appears wrongly.  The evidence in the form of a letter 
from Dr Cosgrove to the General Practitioner, which is in exhibit C12, page 74, indicates 
 
that the dosage of Ritalin at that stage was 47.5 mg per day, in fact it having increased to 

60 mg per day by November 1996.  You will see that in exhibit C12, page 88. 
 
 
 
The figures with which, for the purposes of the monitoring, we are particularly concerned 
 
with are the higher figures thereafter.  A daily dosage of 100 mg per day is supported by 
 
the document at exhibit C4, page 128.  One sees reference to prescription of Risperidone 
at 1 mg twice per day at that stage.  As at 23 March 1998 the Ritalin dose appears to have 

been 110 mg per day.  That is exhibit C12, page 73.  The Risperidone dose was 2 mg per 
 
day.  Finally, by May 1999 the Ritalin dose is 130 mg per day.  The Risperidone is 2 mg 
 
per day and Clonidine is also being prescribed.  That appears from exhibit C12, page 77.  
 
From those figures and those documents I trust you may make out which of those heads 
 
of charges are made out and which are not made out.   
 
 
The material points are essentially, you may think, that it makes little difference for the 

purpose of assessing monitoring, which is the real nub of this matter, whether it was 47.5 
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or 62.5 per day and little difference whether it was 1 mg of Risperidone or 2 mg of 
 
Risperidone. 
 
 
 
As I understand it, apart possibly from that detail Dr Cosgrove’s real argument in respect 
 
of head of charge 2(b) is that he was not prescribing the drugs and that it was the General 
 
Practitioner.  That statement is made at paragraph 17.21 of his witness statement.  Whilst 
it may be the case that it was the General Practitioner who was signing the prescription, 

you may think that it is utterly clear from the documentation that the General Practitioner, 
 
of whom no criticism is made by saying this, was signing the prescription at the level that 
 
Dr Cosgrove wished the General Practitioner to prescribed, as it were deferring to 
 
Dr Cosgrove.   
 
 
 
If you look in exhibit C12, page 74, you will see from Dr Cosgrove’s own 
correspondence that this is exactly what he is doing.  He is setting the levels and the 

General Practitioner, perhaps quite sensibly in the circumstances, was deferring to Dr 
 
Cosgrove’s knowledge, experience and expertise.  Therefore, other than his not being the 
 
hand that actually signs the document, prescribing is exactly what Dr Cosgrove is doing.   
 
 
 
Interestingly on this point, on this argument, it is perhaps worth nothing what 
 
Dr Cosgrove himself says about one of the other patients, that is Patient C.  I will, if 
I may, read to you from his witness statement.  Paragraphs 18.53 and 18.54, then 18.82.  

This is about Patient C, a patient where again it was the general practitioner who was 
 
signing the prescription.   
 
 
 
“18.53: 
 
 
 
Because the parents could simply not afford the cost of the 
medication, I asked the GP to prescribe the medication on the 

NHS.  Nevertheless, it was necessary for me to monitor his 
 
progress on the medication, both the beneficial and side effects, so 
 
the first appointment I had with his parents was about ten days 
 
later. 
 
 
18.54 
 
 

After being on my prescribed medication for just ten days” 
 
 
 
- that is my emphasis –  
 
 
 
“his mother could report to me that aggression and abusiveness had 
completely gone.  Patient C’s grandmother was now willing to 

have him stay over the weekend, something she had given up doing 
 
some eight months ago because of his dreadful conduct. 
 
 
 
18.62 
 
 
 
He remained well throughout the time he was under my care, with 
a good appetite and sleeping pattern.  He was healthy the whole 

time with no dystonia, no dysconesia.  He was able to manage in 
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mainstream school because of the medication I” 
 
 
 
- my emphasis –  
 
 
 
“was prescribing and was described as doing well there.  He had 
 
been saved by me from going to a residential special school.” 
 

Essentially, you may think, what Dr Cosgrove is doing is, where it suits him to take 
 
responsibility for the prescribing, to say, “Look at the wonderful things I was doing for 
 
Patient C as a result of my prescription.” He claims the credit for prescribing it, but when 
 
it suits him not to say so, he denies that he was prescribing it.  In reality he was 
 
prescribing, he was deciding the levels, he was monitoring.  The general practitioner – of 
 
whom I say again, no criticism made – was simply signing the documentation in order to 
permit the patient to have the prescription on the NHS. 

 
 
I turn to 2c, the monitoring of Patient A.    There is no indication on any of the 
 
documentation or in any of the evidence that you have heard, that Dr Cosgrove saw 
 
Patient A between May 1996 and May 1999.  There is every indication on the 
 
documentation and from Dr Cosgrove’s own statement that he did not see the patient, 
 
though he never expressly states that. 
 

The letter that Dr Cosgrove wrote to the general practitioner, Exhibit C12 page 74, makes 
 
reference only to telephone appointments following the initial appointment he made in 
 
1996 and it is quite apparent from that letter that the prescription of Risperidone was 
 
made without Dr Cosgrove having seen the patient after the initial appointment. 
 
 
 
Dr Holme understood that Dr Cosgrove was not seeing the patient.  Dr Cosgrove, perhaps 
most tellingly in his witness statement, deals at paragraph 17.32 and 17.4, with the 

reasons that he was not seeing the patient or his parents, relating to financial reasons – 
 
understandable in their way, as long as the monitoring was adequate.  It is quite clear, in 
 
my submission, from that evidence that Dr Cosgrove was not seeing the patient.  Yet, 
 
Dr Holme made it utterly clear in his account in the witness box and in his letter to the 
 
general practitioner – that is Exhibit C12 page 93 – that he, Dr Holme, was not 
undertaking the responsibility of managing this prescription of Ritalin, still less any 
 
subsequent prescription of Risperidone or Clonidine. 

 
 
Professor Cosgrove’s case in his witness statement is summarised, I think, at paragraph 
 
17.4 when he says – and I will just read it to you: 
 
 
 
“I would like to re-emphasise again and again that Dr Holme was 
monitoring Patient A’s growth and adequately assessing his weight 

in Salisbury at the appointment that he himself booked with A’s 
 
mother for A to be seen there.” 
 
 
 
Clearly Professor Cosgrove was relying on Dr Holme to do some monitoring, not on the 
 
face of that part of the statement or, as I see it, the rest of the statement, was he expecting 
 
him to monitor, for example, the psychiatric side effects.  Of course, if those had arisen 
and been obvious to Dr Holme he might have referred to them but there was no 

arrangement about that and, even that which is referred to – growth and weight – is 
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inadequate for the kind of monitoring Professor Taylor considers appropriate, 
 
cardiovascular, ECG, matters of that nature.  
 
 
 
Where is the review of school reports?  It is clear from what Dr Cosgrove has to say in 
 
one of the enclosures to his statement – and this is enclosure I, paragraph 4.30 to 4.32 – 
 
that is a document, if you recall it, headed, “Response to the letter from Dr Christopher 
Holme, consultant community paediatrician.” 

 
 
It is apparent from paragraphs 4.30 and 4.32, that Dr Cosgrove was not contacting the 
 
school.  In justification of this or in criticism of Dr Holme for apparently having 
 
suggested that Dr Cosgrove should have been in contact with the school, he criticises 
 
Dr Holme for saying that mothers should not be trusted to report what schools say to 
 
them about their sons’ progress.   
 

That is the point I was making earlier.  This is not a matter of trust; it is a matter of 
 
getting accurate information that is not filtered through the point of view of another 
 
person who, for a variety of reasons, may not receive the information accurately or may 
 
not communicate it accurately.  It is not a question of trust, but it is clear from that 
 
statement that Dr Cosgrove was not contacting the school. 
 
 
Dr Holme was not purporting to monitor the psychiatric condition.  Professor Taylor 

emphasised the importance of this, in particular at the very high dosages with which we 
 
are concerned here. 
 
 
 
These were very high dosages.  Professor Taylor, who is an expert who, you may think, is 
 
more willing than many to prescribe drugs such as Ritalin, has never prescribed at this 
 
kind of dosage.  Nor, in my submission, does any of the literature that we have heard, 
whether it be Professor Taylor’s or that put to Professor Taylor, on the interpretation we 

have of it, support a prescription of anything like this kind of level.  That is not to say it is 
 
wrong.  It is not charged as being wrong; we are not saying it is wrong.  It is to say that in 
 
those circumstances monitoring is particularly important.   
 
 
 
In Patient A’s case, if I may say so, monitoring was particularly lax.  Even the initial 
measuring of Patient A’s weight appears to have been faulty.  We have heard from Mrs C 
 
and Mrs E that Dr Cosgrove or possibly a nurse – I know not which and it does not matter 

for these purposes – measured the weight of their child.  I do not dispute that, they said 
 
that in evidence and I did not challenge them on the accuracy.   It is quite clear from the 
 
documentation that Dr Cosgrove did not measure Patient A’s weight.  He says as much.  
 
He makes the error of the centile in which the weight lies and in so saying says that he 
 
was told the weight lay in the 50th centile.  So, Dr Cosgrove was clearly relying upon that 
which he was told, which may have been misinterpreted but does rather beg the question, 

you may think, as to whether what happened here was that Dr Cosgrove asked somebody, 
 
presumably mother, “How heavy is he?” and did the parent reply, “He is on the 50th 
 
centile” or did the parent reply, “He weighs X” and Dr Cosgrove translated that to the 
 
50th centile?  We do not know.  You might think it is almost certainly one or the other 
 
but either way, this is lax.  This is lax practice even, you may think, on the standards that 
 
Dr Cosgrove himself sets in terms of appropriate monitoring.  
 

Then what of the measuring of blood pressure in this case?  You will recall that this 
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patient developed tachycardia and we see in Exhibit C12, to which I will just refer for 
 
accuracy’s sake, C12 pages 68 and 69, Dr Cosgrove’s letter when this is drawn to his 
 
attention.  In the third paragraph, page 68: 
 
 
 
“I asked his mother to try taking his pulse and it would appear that 
 
she does not find this too easy so that her previous readings of 60 
and always less than 100 are unreliable.”   

 
 
This is poor monitoring on any version of events, to expect a mother who clearly, on this 
 
evidence, was not in fact able accurately to record pulse, to do so is, you may think, a 
 
matter of great concern.  Interestingly – and I do not criticise this in point of fact, but 
 
interestingly – what is then suggested by Dr Cosgrove is that Patient A’s godmother 
 
should monitor the pulse rate.  She is a nursing sister.  She is clearly qualified to do it 
and, as I say, I do not criticise that suggestion at all, but it perhaps demonstrates how in 

Patient A’s case monitoring was being anticipated was taking place and, for example, the 
 
extent to which Dr Cosgrove was relying upon Dr Holme, the extent to which he was 
 
relying upon that information that came from the family. 
 
 
 
Sir, dealing with (iv) of 2c in respect of Patient A, the withdrawal of Clonidine, it is, you 
 
may think, quite apparent that no warning was given about this.  It is apparent from 
Dr Cosgrove’s statement that he does not think there is any risk of the withdrawal of 

Clonidine having a deleterious effect on Patient A’s blood pressure, because he says as 
 
much in his witness statement in enclosure I at paragraph 7.11 to 7.13.  He speaks of the 
 
rebound effect and says essentially that that will only happen in a patient who is taking 
 
this drug for hypertension. 
 
 
 
Other witnesses have expressed concern about this, particularly Professor Taylor.  It is 
clearly a risk.  It is a risk, in my submission, of which Dr Cosgrove should have been 

warning the general practitioner. 
 
 
 
Finally in respect of patient A, to say this of  Dr Holme’s position.  He was, you may 
 
think, a careful, caring doctor.  He was carrying out his duty as a paediatrician to see this 
 
child on a six monthly basis.  It is perfectly understandable that in so doing he should 
measure weight and height, he should record blood pressure, he should look for any 
 
reported signs and any apparent signs of any problems with this patient, but to say that 

thereby Dr Cosgrove could effectively delegate the monitoring without any clear 
 
arrangement, without it being clear to Dr Holme what was expected of him is, in our 
 
submission, simply not acceptable.  Professor Taylor made it clear an ordinary 
 
paediatrician, albeit a consultant paediatrician, cannot be expected to have the knowledge 
 
and experience necessary for this kind of monitoring.   
 

I move on, if I may, to Patient B.  The relevant charge is charge 3.  the witnesses from 
 
whom you have heard are Dr Al Shabdner and Dr Humphreys.  These, of course, are 
 
charges relating to criticising other doctors. 
 
 
 
Looking at 3c, the non-admissions in respect of 3c, relate to the contents of the letter and 
 
are, you may think, essentially grammatical in nature in the sense that what is being said 
on behalf of Dr Cosgrove was that the letter says not that the doctor whom he had been to 

see had been rude and unhelpful but that Dr Cosgrove had been told that the doctor who 
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was being seen had been rude and unhelpful.  I ask you to read that letter; you will make 
 
your own judgment as to what is being said by Dr Cosgrove in the letter and as to 
 
whether he himself is adopting and associating himself with the comments that apparently 
 
come from Mr B.  I invite you to say that he is doing so. 
 
 
 
In point of fact, justified or unjustified, accurate or inaccurate, as to whether what Mr B 
found, what Mr B told Dr Cosgrove or whatever, you may think that those two matters 

are not part of this charge anyway and it is the criticism of the doctor as being guilty of 
 
medical negligence, as demonstrating professional incompetence, and Dr Cosgrove does, 
 
by admitting 3c(v) and (vi) is adopting those allegations.  He is not simply saying “Mr B 
 
told me that this doctor was negligent”, he was saying “This doctor was negligent.  This 
 
doctor was incompetent”. 
 
 
Fairly sensibly and realistically, it is admitted on Dr Cosgrove’s behalf that those 

comments were likely to cause the reader to doubt Dr Al-Shabner’s knowledge and/or 
 
skills.  They clearly were likely to do so.  Were they unprofessional?  Were they 
 
unsustainable?  You have heard what Dr Al-Shabner had to say about that consultation.  
 
He denied the criticisms that had been made; he denied that he saw no role for the 
 
diagnosis of ADHD in an adult; he indicated that further investigations were required 
 
before a proper diagnosis could be made in that patient’s case.  Whatever the patient may 
have had to say to Dr Cosgrove there was a real risk here, and a risk which we say came 

to pass, that in making criticisms of this kind Dr Cosgrove was saying things which were 
 
not in fact accurate and which were likely to interfere with the proper care of patients. 
 
 
 
Dr Cosgrove has taken what Mr B says at face value, apparently; he has then adopted 
 
those comments and used them to make wide disparaging comments of Dr Al-Shabner.  
 
At paragraph 14.1 of his written statement, Dr Cosgrove makes clear that he still 
considers this doctor to be guilty of medical negligence.  This is not acting as an advocate 

for patients – a matter which I will touch upon a little later in my submission.  This, in my 
 
submission, is Dr Cosgrove advocating his own superiority or belief in his superiority to 
 
other psychiatrists in their approach to issues such as ADHD. 
 
 
 
I have readily accepted, and do readily accept, that robust criticism has a strong and 
proper place in the medical system.  Strong comments are made and that can be perfectly 
 
proper.  But this goes well beyond what amounts to proper criticism.  These are 

comments made in ignorance of the true situation in a manner that is likely to make it 
 
more difficult for this particular doctor, Dr Al-Shabner, to carry out his professional tasks 
 
because Mr and Mrs B, to whom a copy of the letter is sent, are being told that 
 
Dr Cosgrove thinks Dr Al-Shabner is guilty of medical negligence – information that they 
 
can themselves take account of and disseminate to anyone else they wish to do so.   
 

A general practitioner receives the letter.  What is he to make of this?  Is he supposed to 
 
say, “A consultant is telling me that this particular doctor, with whom I have a working 
 
relationship is negligence.  I shall not use that doctor any more”?  What is the general 
 
practitioner to make of Dr Cosgrove’s position?  Is the general practitioner to think “I am 
 
not happy for patients to be referred to Dr Cosgrove because when I refer them to 
 
Dr Cosgrove I receive a letter that is critical and goes to a patient” – critical of Dr Moses. 
In all manners this interferes with the proper, you may think, medical care and treatment 

of patients. 
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I have referred to the passages from Good Medical Practice, notwithstanding our debate 
 
about the page numbers.  This criticism clearly offends against that, in our submission, 
 
and in common sense it offends against proper team working and proper medical care. 
 
 
 
I indicated earlier that from Dr Cosgrove’s witness statement one could derive certain 
ideas as to what his approach to criticism of other doctors is.  I will, if you will just 

excuse me, just read through paragraph 14.5 and 14.6 of the witness statement so you can 
 
see something of how Dr Cosgrove seeks to justify and explain his criticisms.  This is 
 
directed to the Preliminary Proceedings Committee, for reasons that are perfectly 
 
understandable: 
 
 
 
“Members of the PCC, if you disagree with what I have said in 
private about and to Dr Al-Shabner, then I will have no alternative to 

believe that you do not care about Mr B’s experience of 
 
Dr Al-Shabner, both as a person and as a psychiatrist.  I will 
 
conclude that you care more about Dr Al-Shabner’s hurt feelings 
 
than you do about Mr B’s hurt feelings.  I will realise that you are in 
 
power for the protection of psychiatrists in their clinical practice – as 
 
long as they do not commit an act against a patient of which a 
society itself would disapprove – and not for the protection of 

patients. 
 
 
 
It is axiomatic in our society that ignorance of the law is no 
 
protection from being disciplined by the law.  It must be axiomatic 
 
also that ignorance of a disorder (ADHD), which is common and 
 
which does occur in adults according to the ICD10 & DSM4 
international classifications, is no protection from being disciplined 

by those who govern the professional conduct of psychiatrists.  If 
 
you find in favour of Dr Al-Shabner and not me, then you will be 
 
officially condoning ignorance of a disorder which he should have 
 
known about, and you will be doing a grave disservice to the citizens 
 
of this country.” 
 
 
I say be careful with the tone of this.  It is strong.  Do not necessarily hold it against 

Dr Cosgrove – save this, that does this not really amount to battle lines?  There were two 
 
sides to this.  You are either on Dr Cosgrove’s side, you agree with him and you agree 
 
that his way of doing it is the way of doing it, or you are on the other side of the line and 
 
you do not agree with Dr Cosgrove, in which case you are ignorant, you are doing a grave 
 
disservice to other people, you are not caring for patients.  It is as simply as black and 
white, as straightforward as that, in Dr Cosgrove’s view.  When one reads passages like 

that, the reasoning behind that, it perhaps comes as no surprise to see Dr Cosgrove 
 
making criticisms of this nature.  But can that truly be sustained?  Is that truly a 
 
professional way to act?  We say clearly not. 
 
 
 
You will have noted Professor Taylor’s comments about Dr Cosgrove’s own letter in 
 
division 3 of the bundle and his characterisation of ADHD; his mention of there being 
four elements, including motivation, what he has to say about dopaminergics and 

suchlike.  Professor Taylor considers that the contents of this letter do not represent 
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conventional medical thinking.  Perhaps the passage of time will prove Dr Cosgrove to be 
 
right on his understanding of this condition, but it is clearly the case that there are 
 
different schools of thought, at the very least, and that Dr Cosgrove fails to recognise that 
 
in what he has to say about unprofessionalism. 
 
 
 
May I turn to patient C, charges 4 and 5, in respect of whom you heard from Dr Moses 
and you heard from Mrs C?  Charge 4 relates to monitoring, charge 5 relates to criticism. 

 Dr Moses gave evidence on Thursday of last week.  She was, you may think, eminently 
 
sensible and balanced in her approach.  She maintains that her team had thought of 
 
ADHD as a diagnosis but were not convinced that was correct; they took a behavioural 
 
management approach.  You will have noted from Professor Taylor’s evidence that there 
 
were different schools of thought on the role of behavioural management but that 
 
behavioural techniques are important – important often in conjunction with the use of 
medication.  You will have noted Professor Taylor’s comments yesterday, that he feels a 

great deal was done for this patient at the unit; it might not have been done in the way 
 
that Dr Cosgrove would have liked but a great deal was done for the patient. 
 
 
 
You will have noted from Dr Cosgrove’s statement at paragraph 20.23 that he describes 
 
Dr Moses as having “insufferable egocentricity”.  Is that right?  Is that how you found her 
 
last week?  In my submission, she was not so, either in her behaviour, in her explanations, 
nor in any sensible view as to what happened. 

 
 
In terms of the monitoring charge, it was clear from what Professor Taylor had to say that 
 
proper communication between consultation prescribing and recommending in situations 
 
such as this on the one hand and general practitioner carrying out monitoring is of vital 
 
importance.  We do not have any documentation that indicates there was a written 
 
protocol or written arrangement for monitoring in that case.  There should have been 
some clear protocol arrangement.  We have already seen in the case of patient A what can 

happen if doctors are at the very least at cross purposes as to how monitoring is taking 
 
place.  We do not know, for example, what was said about measuring different 
 
cardiovascular issues in this case, notwithstanding the fact that Risperidone was being 
 
prescribed.  So, in our submission, although the monitoring charge is not admitted, 
 
paragraph 4e is clearly made out. 
 
 
In terms of the criticisms at charge 5, the only one not admitted, 5b(ii) is again, I think (if 

I can put it this way) a grammatical issue.  My learned friend will, I understand it, 
 
contend that the letter says Dr Cosgrove is not saying that Dr Moses had seen Master C 
 
only once, Dr Cosgrove is saying that Mrs C had told him that Dr Moses had seen Master 
 
C only once.  I invite you to read that letter and, if you do so, it is, in my submission, 
 
utterly apparent that Dr Cosgrove is adopting precisely this criticism; he himself is 
asserting it, he is not simply passing on what someone else has to say. 

 
 
What happened in the middle of 1998 in respect of patient C did in fact lead to a 
 
breakdown of medical care, in my submission.  It was not this letter that caused it in point 
 
of fact, it was previously the fact that patient C was seen by Dr Cosgrove that a diagnosis 
 
of ADHD was made and that patient C returned to the clinic saying “I have ADHD” as if 
 
that justified everything.  Here there was, in my submission, a clear failure of team 
working by Dr Cosgrove.  His involvement might have been justified, his prescription 

might have been correct, but to do that without working jointly with those who had care 
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already for Master C was, in our submission, inappropriate.  This is not simply a case of 
 
saying that everything went terribly well once Dr Cosgrove took over.  As Professor 
 
Taylor says, behavioural therapy techniques are almost always required in addition to 
 
medication.  Here was one up and running with Dr Moses doing a great deal for patient C, 
 
destroyed, you may think, by Dr Cosgrove’s approach – and if it had not been destroyed 
 
by what he said in the consultation it would have almost certainly have been destroyed by 
this letter, seen by parents, that would have caused them greatly to doubt Dr Moses’ 

competences and abilities. 
 
 
 
I said at the outset that in my submission all witness came to assist the Committee and to 
 
tell the truth and were honest, even if not necessarily accurate in their recollection.  
 
Mrs C, in my submission, falls very much into that category.  Her evidence was 
 
unsatisfactory in this sense – and this is not a criticism of her, in any way, shape or form.  
One is dealing with matters a significant time ago in respect of which she did not have 

records before her.  She asserted facts in a dogmatic fashion as to how many times and in 
 
what circumstances Dr Moses had seen her son.  She had no documents to support this.  
 
She said, for example, that Dr Moses had only seen her son once; that Dr Moses was not 
 
attending on that unit.  How could she have known that?  She may suspect it but how 
 
could she have known that? 
 
 
She said, and maintained, that Dr Moses had said that her son would be better off in a 

children’s home.  You may have noted through reading Dr Cosgrove’s statement that 
 
nowhere does he make that allegation; nowhere does he mention Dr Moses is supposed to 
 
have said this.  He does mention the possibility of residential schooling, that this had been 
 
raised.  He actually said it was raised by the local education authority, not Dr Moses.  It 
 
may be, you think, that Mrs C does not perhaps know much about the education system 
 
and social care, that Mrs C may have been confused between residential schools and 
children’s homes – but nowhere is this attributed to Dr Moses, it is attributed to the local 

education authority.  Yet if Mrs C had these concerns and shared these concerns with 
 
Dr Cosgrove, it is inconceivable, is it not, that one of her concerns would not have been 
 
“What will Dr Moses say?  That my child should be in a children’s home?  It is 
 
outrageous” or words to that effect.  If that had been said by Dr Moses, it would have 
 
been in Dr Cosgrove’s letters, it would have been in his statement – but he never said 
that. 
 
 

As I indicated, there is room to understand how Mrs C might be confused between a 
 
residential school and a children’s home.  There is absolutely room to understand how, 
 
with the passage of time, Mrs C might be confused about who it was who said it.  You 
 
can be, in my submission, quite satisfied that this was not a; comment made by Dr Moses. 
 
 It was not in her style, you may think, having heard from her, to speak in this kind of 
way. 

 
 
I have no doubt that Mrs C, in giving her evidence, genuinely agrees with the criticisms 
 
that were made by Dr Cosgrove in this letter.  Her genuine belief in them does not, in my 
 
submission, for a moment excuse Dr Cosgrove writing a letter of this nature.  It does not 
 
make this letter sustainable, it does not make this letter professional.  Again, this kind of 
 
letter will only act to undermine patient/doctor relationships.  How could Mrs C, if she 
had any confidence in Dr Moses in July 1999, before she saw this letter, continue to do so 

after she saw this letter? 
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Is the answer, and I think this is the answer Dr Cosgrove would put, in terms of his 
 
statement, that she already had no confidence.  “I am simply recording what she had to 
 
say.”  Was that truly the case or was Dr Cosgrove not giving some kind of credibility to 
 
concerns Mrs C herself may have had and turning those doubts and concerns into, as it 
 
were, established fact in her mind?  We will see when we come to Mrs E, Wendy 
Samways and the complaint in respect of the Oxfordshire Mental Health Care Trust how, 

in my submission, the evidence supports the fact that Dr Cosgrove’s criticisms snowball 
 
into persuading parents that all is not well with care. 
 
 
 
One other aspect of what Dr Cosgrove has to say in respect of this patient deserves a 
 
mention.  That is paragraph 18.74 of the statement and I will read it to you.  It is one short 
 
sentence, 
 

“Mrs C has now developed angina through all this NHS care of her 
 
son.” 
 
 
 
You may wonder what Dr Cosgrove’s basis for saying that is in the statement.  Is he 
 
again putting issues in a black and white sense, your are with him or you are against him? 
 
 In my submissions, the criticisms that we set out in respect of Patient C are clearly made 
out. 

 
 
Patient D, from whose mother we heard, we can be very short with indeed.  The 
 
allegation is one that the examination was inadequate, in that Dr Cosgrove did not weigh 
 
or take this patient’s blood pressure.  It was a short consultation. You heard from his 
 
mother.  His mother gave her evidence clearly on this point.  There is no evidence to 
 
contradict this and, in my submission, that allegation is most clearly made out.  Again, it 
is apparent, from the course of what happened with Patient D, that there were no proper 

arrangements made for monitoring the treatment.  I do not think I need to repeat what I 
 
have said already about the necessary and appropriate monitoring. 
 
 
 
I will move, if I may, to charges 7 and 8, which relate to Patient E.  The relevant 
 
witnesses from whom you heard were Mrs Samways and Mrs E.  From Mrs Samways’ 
point of view, it is clear from her dealing with the parents that they were happy with the 
 
investigation process.  Of course, they had a complaint.  They were complaining, but the 

process they had no complaint about, until Dr Cosgrove became involved and she knew 
 
nothing of any complaint until she read that letter from Dr Cosgrove.   
 
 
 
You heard from Mrs E on Tuesday.  Mrs E is clearly concerned for the welfare of her 
 
child, and understandably so.  She, if I may say so, clearly believed strongly in what she 
was saying.  She was not lying to this Committee and I do not suggest that for a moment. 

 She accepts that she had expressed no concern about this investigation process before Dr 
 
Cosgrove’s letter was sent to her.  She had consented to the disclosure of notes.  She had 
 
not revoked such consent.  She had agreed, and you may think from her evidence, was 
 
keen to have a review.  She had not suggested that she had changed her mind. 
 
 
 
She said in evidence that from speaking to the Community Health Care and so on, doubts 
had been put in her mind.  But, when one actually looks at the contents of Dr Cosgrove’s 

letter, one may wonder how she can have had any of the doubts that he speaks of without 
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him having expressed those to her.  He says that Dr Kenyon was not sufficiently 
 
independent to do justice to this inquiry.  What is the source of that information?  Who is 
 
it who makes this criticism of Dr Kenyon?  You may think it is utterly apparent from the 
 
correspondence that that is Dr Cosgrove’s criticism.  Dr Kenyon was insufficiently expert 
 
to conduct such an inquiry whilst Dr Cosgrove was, in essence, sufficiently expert to do 
 
so.  You may think, again looking at the tone of the letters from Dr Cosgrove, that that 
was a criticism that clearly came from him.   

 
 
That the investigation was programmed, in the words of the letter, to ensure that the Trust 
 
would come out with a clean bill of health.  Mrs E never said she had expressed a view of 
 
that nature and, indeed, until this stage had been happy for this kind of review to take 
 
place.  The inquiry would be a whitewash.  She said about that that it did in fact turn out, 
 
in her view, to be a whitewash.  What may be happening here is that one has a process of 
Dr Cosgrove expressing his view, the review taking place, Mrs E not being satisfied with 

the outcome, rightly or wrongly I do not know, but then adopting the criticism that 
 
Dr Cosgrove made at the time.  But were these criticisms she herself had?   
 
 
 
Perhaps it is interesting to note that one of the documents enclosed in with Dr Cosgrove’s 
 
statement is a letter from Mrs E to the General Medical Council in July 2001.  One of the 
 
things it says, and this is enclosure E, a typed letter, 
 

“Dr Cosgrove has not in any way distressed our family.  Quite the opposite.  We 
 
are grateful now…” 
 
 
 
my emphasis, 
 
 
 
“…that Dr Cosgrove has not sent out Patient E’s records, not out of mischief 
making but out of support for our cause.” 

 
 
Her use of the word “now” may make you think that it was only after the event that she 
 
was glad that Dr Cosgrove had not sent all the records.  It was certainly not something 
 
that she knew about, consented to or encouraged at the time. 
 
 
In our submission, the conduct of Dr Cosgrove here was inconsistent with this review 
 
taking place in the appropriate manner, that it was he and not Mrs E who was blocking 

the progression of the review by not supplying notes and that he ought to have been 
 
willing so to supply them.  His criticisms thereafter of the inquiry and what it would 
 
involve is perhaps anticipating that his position in this black and white world that he sees 
 
will not be made out cannot, in our submission, be justified. 
 
 
Yet again, Dr Cosgrove shows a failure to work in a team with other health professionals. 

 He indicates that he is acting as an advocate in one case.  It does not actually relate to 
 
this patient.  Paragraph 15.97 is interesting reading when you seek to assess these 
 
comments made by Dr Cosgrove and whether they are justified, 
 
 
 
“What is wrong with me acting, not only as…” 
 
 
that particular patient’s, 

 
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“…consultant psychiatrist but also as his ADVOCATE in regard to what I 
 
considered to be incompetent diagnosing, treating and professional misconduct 
 
towards this innocent and helpless psychiatric patient.  I believe that as a fellow 
 
citizen of the UK alongside the patient, I have a right and a duty to formally 
 
complain about what I, as a skilled and caring psychiatrist, perceive to be serious 
 
professional misconduct on the part of…” 
 

the doctors in that particular case. 
 
 
 
Like all advocates, if I may say so as one myself, the danger comes when there is a 
 
blurring of lines between the advocate advancing a case on the one hand and expressing a 
 
personal view on the other hand.  Those are lines that Dr Cosgrove has repeated crossed 
 
and, in so doing, has in our submission caused damage to the relationship between patient 
and doctor and has caused difficulty in proper medical care for patients.   

 
 
I move on to Patient F.  The relevant heads of charge are under paragraph 9 and this 
 
relates to criticisms of colleagues, Dr Chubb and Dr Thomas.  We heard from Dr Thomas. 
 
 Dr Chubb’s witness statement was read.  I have already express caution about you taking 
 
witness statements where the author has not been cross-examined, save and except where 
 
that evidence is consistent with evidence of witnesses from whom you have heard.  You 
have heard from Dr Thomas and you may think there is a consistency that allows you to 

accept what Dr Chubb says as well.   
 
 
 
These are strong criticisms from Dr Cosgrove. Having heard from Dr Thomas herself, 
 
you may conclude that the criticisms that are being made simply cannot be justified.  
 
What is a patient to make of receiving a copy of a letter of this nature?  Dr Chubb and Dr 
 
Thomas are arguable guilty of medical negligence, making assertions with therapeutic 
nihilism, were leaving room for formal complaint to the Fitness to Practise Directorate of 

the General Medical Council.  How are patients expected to have confidence in other 
 
medics when Dr Cosgrove is saying things of this nature?  Perhaps Dr Cosgrove believes 
 
that they should not have confidence in other medics apart from himself, but, in our 
 
submission, that cannot justify this kind of behaviour. 
 
 
Was Dr Thomas competent?  Frankly, even if she was not competent, you may think 
 
these are quite unjustifiable, unprofessional and unsustainable comments.  In fact, you 

heard from her.  You heard her explanation as to her role and the fact that she went to 
 
speak to Dr Chubb, what they were considering in terms of further investigation in this 
 
case.  They were considering a diagnosis.  They had not rejected ADHD.  They were 
 
considering referring the matter to somebody who was more expert in ADHD in adults.  
 
Was she in fact guilty of any negligence?  Not for a moment, you may think. 
 

Did she make the problem of ADHD as a concentration problem for messy kids?  You 
 
heard her give evidence.  You saw the kind of person she was.  Did she make a comment 
 
of that nature?  She denies it.  You may think she very clearly did not. 
 
 
 
The only factual part of head of charge 9 which is disputed, as I understand it is ©(ii), 
 
whether Dr Thomas had made that statement.  Again, if you look at the letter you will, in 
my submission, conclude that Dr Cosgrove is indeed saying that Dr Thomas had made 

that statement, not just that he had been told that.  If you have any doubt about that at all, 
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can I refer you to paragraph 15.94 of Dr Cosgrove’s statement when he says this,  
 
 
 
“Well, I accept Mr F’s statement that Dr Thomas DID say that ‘ concentration 
 
problem is for messy kids’ and that ‘the consultant thinks you have a personality 
 
disorder which is untreatable.’  I am confident that nothing I have stated as a 
 
quote from Mr F is wrong or incorrect.  I do not believe that Mr F is lying.  It is 
just the sort of comment that a psychiatrist would make to a patient when that 

psychiatrist does not know about nor believe that ADHD occurs in adults, and 
 
when that psychiatrist is face to face with a patient who has asked whether he 
 
might have ADHD which he has read about for poor concentration is one of the 
 
four major characteristics of ADHD.  To respond by saying that ‘a concentration 
 
problem is for messy kids’ is a totally appropriate and contextual comment for a 
 
psychiatrist to make in order to dismiss the diagnosis of ADHD.” 
 

He clearly is adopting the comment there.  What does he say in his statement of Dr 
 
Thomas?  He says this at paragraph 15.93, 
 
 
 
“Of course, Dr Thomas will make a statement to the effect that she did not say to 
 
Mr F that ‘a concentration problem is for messy kids’ and that ‘the Consultant 
 
thinks you have a personality disorder which is untreatable.’  And she will believe 
that society will accept her version of what happened in that consulting room, 

because psychiatric patients cannot be trusted, especially those who have just been 
 
given a diagnosis of personality disorder.  The psychiatrist is ALWAYS right in 
 
what she says and what she does, and the psychiatric patient is ALWAYS wrong.” 
 
 
 
Again, I am afraid we have Dr Cosgrove painting things in the most black and white 
 
fashion.  There is material in the form of a signed statement from Mr F saying that these 
things were said.  No doubt that is a genuine statement by Mr F.  I am not for a moment 

saying that somebody in whom a diagnosis of personality disorder has been, rightly or 
 
wrongly, cannot be trusted to give evidence.  That would clearly be nonsense.  Dr 
 
Cosgrove is seeking to paint things wholly unrealistically in a black and white fashion.   
 
 
 
You have heard Dr Thomas give her evidence.  You have been able to assess what she 
has to say on this.  You have not had an opportunity of assessing what Mr F had to say, 
 
whether, for example, he might have confused something that was said to him on another 

occasion by someone else, whether he might have confused things that he had read about 
 
being said of ADHD.  One simply does not know.  What one does have is Dr Thomas’s 
 
evidence, which, in my submission, was consistent and powerful. 
 
 
 
Patient G, paragraph 10.  These are allegations relating to prescription and monitoring.  
You heard evidence from Dr Judge on this point.  You may think that the evidence is 

clear, both as to the levels of prescription, but in any event it is admitted that both Ritalin 
 
and Risperidone were prescribed, and, secondly, that the only monitoring that took place 
 
was by telephone.  Yet this was in a four year old child.  Again, Professor Taylor does not 
 
criticise the prescription of Ritalin in a four year old child, although I think many medics 
 
would not do it themselves.  He does not criticise it.  We do not criticise it.  It is 
 
acceptable, so long as there is proper monitoring.   
 

There was not proper monitoring here.  He lost weight after this prescription started.  
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Risperidone was prescribed on the first consultation, yet there was no ECG and there was 
 
no follow up by Dr Cosgrove himself, save by telephone, which may be adequate review 
 
in certain circumstances.  It most certainly was not in these. 
 
 
 
Patient H.  Charge 11 refers to this.  There is an admission of the factual background to 
 
these criticisms.  There is an admission that what was said, and this is Dr Dover, was 
likely to cause the reader to doubt the knowledge and skills of Dr Dover.  This is the one 

charge in respect of which I have called no evidence from a witness before you, because 
 
Dr Dover was read.  I accept that my comments on hearsay evidence here rebound to say 
 
that you must take what Dr Dover says with a deal of salt, given that he has not been 
 
cross-examined in front of you.   On the other hand, most of what is here is actually 
 
admitted and it is a matter of inference and judgment from the evidence. 
 
 
In the second place, there is in fact no evidence contradicting what Dr Dover has to say. 

You may think, in the absence of evidence contradicting him, and in the absence of 
 
evidence to justify what was said in that letter, that you have no difficulty that (d)(i) and 
 
(ii) of paragraph 11 of the heads of charge are made out. 
 
 
 
I return to my general comments.  Dr Cosgrove has, in my submission, painted a picture 
 
or has in his mind a picture of a black and white world, of people being on his side or 
against him and if they are against him, then he considers any criticism to be justified, 

regardless of how that may affect therapeutic relationships.  That conduct, for the 
 
purposes of matters that you are considering at the moment and at this stage of the 
 
proceedings, is, in our submission, clearly sufficient potentially to amount to serious 
 
professional misconduct.  It is so sufficient potentially, even on the doctor’s own 
 
admissions that he has repeatedly in the statement and in letters made comments that are 
 
likely to cause readers to doubt the knowledge and skills of doctors, and that he has done 
so in letters.  He describes them in the passage I read earlier as being made privately.  

They were not made privately.  They were made in letters copies to parents, to other 
 
medics and in a manner that was likely to lead information to be passed on or, at the very 
 
least, to affect therapeutic relationships.  That conduct, for the purpose of these charges, 
 
cannot, in our submission, be justified or sustained.  It is unprofessional.   
 
 
Sir, unless I can assist the Committee further, those are my submissions. 
 
 

THE CHAIRMAN:  Thank you very much, Mr Pearce.  I wanted to check with you.  In 
 
charge 2 I think you indicated that there may be some errors in the figures in some of 
 
these heads. 
 
 
 
MR PEARCE:  Yes. 
 

THE CHAIRMAN:  Is it my understanding that these heads of charge are not being 
 
amended? 
 
 
 
MR PEARCE:  I was not proposing to amend them, sir, simply for this reason, that if I 
 
make out the point on prescribing, then in my submission the other heads are clearly there 
 
and 47.5 as against 62.5 will not, in our case, make any difference to your assessment of 
the issues.  It is not central to the issue and it did not seem to me in that circumstance that 

it was necessary for me to seek to amend it. 
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I appreciate that the implication of that is that you will not find for me on those heads.  I 
 
do understand that.  I do not invite you to find for me, notwithstanding the fact that I have 
 
said the evidence does not support it. 
 
 
 
THE CHAIRMAN:  I think the Legal Assessor wants to say something.  
 

THE LEGAL ASSESSOR:  Can I just raise the point about the inferences that may be 
 
drawn from Dr Cosgrove’s failure to give evidence.  Can I indicate here and now that my 
 
instinct, if you like, is to say that no inferences – or certainly not adverse inferences – 
 
should be drawn on that failure in the circumstances of this case.   
 
 
 
The difficulty that I have is that as regards the criminal rules of evidence, if I can draw 
your attention to Section 35(3) of the Criminal Justice and Public Order Act 1994, 

Section 35.  That reads: 
 
 
 
“Where this sub-section applies, the court or jury” 
 
 
 
- and for that I interpose the Committee –  
 
 
“in determining whether the accused is guilty of the offence 

charged, may draw such inferences as appear proper from the 
 
failure of the accused to give evidence, or his failure without good 
 
cause to answer any questions.” 
 
 
 
Now, the law is hard stuff when it is written down.  What do you say about that section? 
 
 
MR PEARCE:  I say that you should not draw inferences against the doctor in these 

circumstances.  There may be circumstances, possibly before this Committee, certainly 
 
there may be circumstances in criminal cases, where a body may take the view that an 
 
inference can be drawn that the reason the doctor – the Defendant – has not given 
 
evidence is that they are guilty and they have got no answer to the charges, for example, 
 
or that they do not want to put themselves through the process of being cross-examined.  
These are the kinds of arguments that may arise. 
 
 

In the circumstances of this case, given that Dr Cosgrove has not been present through 
 
this part of the proceedings, that really, you might think, would be a difficult inference to 
 
draw in any manner that allowed you to be satisfied so that you are sure on any of the 
 
points with which we are concerned.   
 
 
There are other explanations to why Dr Cosgrove might not be here that are perfectly 

valid and possibly more valid than that he believes that he has not got a defence to these 
 
charges.  Indeed, that which we have got in his statement suggests he believes he does 
 
have a defence to the charges, so it is not an inference I would seek to draw and I hope I 
 
have not suggested that I would invite you to draw such an inference, because I was not 
 
meaning to do so.  
 
 
THE LEGAL ASSESSOR:  I do not want to put words into your mouth but can I 

summarise it this way, that you accept that Section 35 exists and is applicable but, in the 
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particular circumstances of this case, you are content for me to advise that no inference – 
 
and certainly no adverse inference – should be drawn as to why he has chosen not to give 
 
evidence? 
 
 
 
MR PEARCE:  Indeed so.  Indeed, so, sir.  I am quite happy with that.  Of course, the fact 
 
that he has not answered some of the charges is not – I am not saying that that tends to 
prove that he is guilty of those charges.  It simply does not assist you in dealing with 

those charges but that, of course, is a separate point, a technicality.  
 
 
 
THE LEGAL ASSESSOR:  I am grateful for that.  I could not just ignore the express 
 
words of the Statute.  I hope you understand that.  
 
 
 
MR PEARCE:  I understand, sir.  
 

THE LEGAL ASSESSOR:  Can I just briefly turn to Mr Morris and see if he is content 
 
with that position? 
 
 
 
MR MORRIS:  Sir, I think I would go a little further and say I would submit that Section 
 
35 does not apply because for it to apply there has to be a refusal by the doctor to give 
 
evidence.  I hope I have got it right. 
 

THE LEGAL ASSESSOR:  The actual words, if I can read it to you, are, sub-section 3: 
 
 
 
“Where this sub-section applies the court or jury in determining 
 
whether the accused is guilty of the offence charged, may draw 
 
such inferences as appear proper from the failure of the accused to 
 
give evidence or his refusal.” 
 

- I think that is what you were thinking –  
 
 
 
“without good cause to answer any questions.” 
 
 
 
Can I just say, are you content with the position that I have outlined with Mr Pearce? 
 
 
MR MORRIS:  Yes, indeed so, sir. 

 
 
THE LEGAL ASSESSOR:  I am grateful.  
 
 
 
THE CHAIRMAN:  I think it would be appropriate if we had a short break just now and 
 
take your submissions after the break, so we will come back at just after 11.30. 
 

(The Committee adjourned for a short time) 
 
 
 
MR MORRIS:  Sir, may I start by gratefully adopting what Mr Pearce said to you by way 
 
of opening general comments in relation to the general approach to evidence that you 
 
ought to adopt, in particular in relation to documentary witness statements that have been 
 
put before you by both sides.  Also, the warning he uttered about making improper 
inferences from the tone of Dr Cosgrove’s statement, which was written for the purposes, 

as can be clearly seen, of the Preliminary Proceedings Committee.  
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May I add an additional caution, which is that we are at this stage – I say “we”, that is 
 
presumptuous; you are at this stage – dealing with findings of fact that have to be made in 
 
relation to the particular heads of charges that have not been admitted.  I do caution that it 
 
is necessary to confine yourselves at this stage to those heads of charges as they are 
 
drafted to see whether the evidence is such that you can be sure that they are established 
as facts. 

 
 
It may be that my learned friend in addressing you in relation to these matters, has strayed 
 
into and submitted in relation to matters that do not go directly or indirectly to the 
 
particular heads of charge with which you are concerned.  It may very well be that some 
 
of the submissions he made would be perfectly appropriate at the next stage of these 
 
proceedings, if and when we arrive at that stage. 
 

May I give you an example where I think caution is called for.  In relation to Patient A, 
 
he tells you that Dr Cosgrove was not contacting the school directly and that therefore he 
 
fell outwith the guidance promulgated by Professor Taylor. 
 
 
 
There is no head of charge relating to that issue.  Similarly, in relation to the issue of the 
 
taking of blood pressure of Patient A, there is no head of charge which suggests failure to 
measure blood pressure by Dr Cosgrove was irresponsible monitoring. 

 
 
No doubt both those matters would be of significance and relevance when it comes to 
 
considering the circumstances leading up to any facts that are found proved or admitted at 
 
the next stage.  At this stage, I submit that they have no relevance and should be put out 
 
of your mind. 
 
 
Similarly, by way of final example, in relation to Patient C, where my learned friend 

talked about there having been a breakdown in medical care not caused by the letter that 
 
was written and which is, effectively the sole subject – or is the sole subject - of head of 
 
charge 5 in relation to which it is suggested that the comments he made there were 
 
unprofessional, unsustainable, likely to cause the reader to doubt Dr Moses’ knowledge 
 
and skill. 
 
 
What effect Dr Cosgrove’s earlier consultation with the patient and the patient’s mother – 

and perhaps father – in relation to the continuation of medical care at the unit and the fact 
 
that apparently the child had returned to the unit and said, “There is no point in my 
 
undergoing what you are suggesting because I have got ADHD and your proposed 
 
treatment will not help. It is suggested that that is an indication of the failure of joint 
 
working, continuum working, between different clinicians.  
 

Again, in my submission, at this stage, it is not relevant to the matter in hand which is the 
 
question of the letter and the significance of that letter. 
 
 
 
Can I, then, turn to the heads of charge and the outstanding non-admitted facts which you 
 
will have to decide whether or not are proved.   
 
 
In relation to Patient A – and I take the patients sequentially – head of charge 2, my 

learned friend is right when he says that really the issue here behind the non-admissions 
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relates to the question of whether or not there was as prescription by Dr Cosgrove or a 
 
recommendation for a prescription.  It is somewhat, I concede, a technical submission on 
 
Dr Cosgrove’s behalf that I make, but it does have some substantive effect, in my 
 
submission.  
 
 
 
That he was not actually prescribing, I would submit, is made out in the last paragraph of 
the letter that he wrote in this regard.  It is at C12 page 72.  I do not ask you to turn it up.  

I will read it to you: 
 
 
 
“I have made out a private prescription for Ritalin but I know that 
 
his parents would very much appreciate it if you would copy it 
 
down on to an NHS scrip.  On each occasion that I alter the dosage 
 
I will send them a fresh private prescription to bring to you.  You 
may care to keep them in his file.” 

 
 
He also sets out that in his witness statement, as Mr Pearce told you, at 17.21. 
 
 
 
The significance between him actually issuing a prescription with the intention that the 
 
patient or the patient’s parents should get that dispensed and sending it to the general 
 
practitioner, not only in my submission is one of trying to assist the patient or patient’s 
parents financially, but there is also this significance inasmuch as the invitation to the 

general practitioner to issue the prescription on the NHS imports automatically an 
 
obligation on that practitioner to exercise his or her own independent judgment before 
 
agreeing to copy the prescription as recommended by the doctor.   
 
That will have some bearing in relation to head of charge 2c. 
 
 
 
I say no more about the inaccuracy in 2b(ii).  It is admitted that that is not an accurate 
figure and as it stands, that particular head, 2b, cannot, in my submission, be found 

proved.   
 
 
 
Can I turn to 2c and deal first of all with the issue of irresponsible monitoring in the 
 
context of heads of charge paragraphs (ii) and (iii) and also I think connected to that (v).  
 
Really they are allegations of not making an adequate assessment of the patient’s weight, 
not monitoring the patient’s growth and not advising the patient’s general practitioner to 
 
monitor Patient A as above. 

 
 
I take (v) as drafted to be a reference to the monitoring requirements and failures alleged 
 
in (ii) and (iii) in relation to weight and growth. 
 
 
 
In relation to those heads, the background is set out again in the letter, the first letter that 
he wrote at page 72.  Again, I do not ask you to look it up.  It is 3 May 1996.  It is clear 

from the letter that he was alert to the decline in the patient’s appetite and the knock-on 
 
effect that might have on the patient’s weight.  Talking about the use of Ritalin and, of 
 
course, we remember that this patient already was being prescribed Ritalin by Dr 
 
Vereker: 
 
 
 
“It does tend to cause a fall in appetite and A is already at about 
75% of his pre-Ritalin level.  I will monitor his progress and have 

asked his mother to have him weighed so that we can see the 
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course of his weight.” 
 
 
 
It is clear also from that letter that Dr Cosgrove was either misinformed as to his current 
 
weight or miscalculated the weight that was given to him in assessing the relevant centile 
 
the patient was on.  That misapprehension on his part was, in the context of the patient 
 
care, rapidly corrected within weeks by the receipt of Dr Holme’s letter of 22 May where 
Dr Cosgrove was made aware that this patient’s weight was in fact not on the fiftieth 

centile but was between the second and ninth centile.  That is page 93 of C12.  That is the 
 
background. 
 
 
 
The allegation is that he did not make an adequate assessment of the patient’s weight and 
 
did not monitor the patient’s growth, which I take to include both weight and height.  It is 
 
admitted for the purposes of this particular patient that there is no evidence before you 
that Dr Cosgrove himself weighed or measured the height of patient A and, indeed, if one 

reads his letters the indication is to the contrary – that he did not.  That failure personally 
 
to measure, in my submission, does not make for irresponsible monitoring because 
 
Professor Taylor has accepted in giving evidence before you that it is quite appropriate to 
 
delegate that function to a relevant clinician, usually to a general practitioner. 
 
 
 
That delegation, in my submission, does not have to be formally set out in a written 
protocol signed by both parties, ideal though that might be.  The significant factor is to 

establish whether or not such a delegation took place and was effective.  In my 
 
submission, it is clear from what happened that Dr Cosgrove could be satisfied that such a 
 
delegation of monitoring of height and growth had taken place and was effectively being 
 
done. 
 
 
 
I say that and I make that submission because Dr Cosgrove received correspondence from 
Dr Holme in these circumstances, and that is the letter of 22 May from Dr Holme.  The 

circumstances are these, first that Dr Holme had received Dr Cosgrove’s letter expressing 
 
a desire to have the patient’s weight monitored because of the concern about loss of 
 
appetite.   
 
 
 
Secondly, Dr Cosgrove knows that at that consultation on (I think it was) 19 May – it 
may have been 16 May – that not only was Dr Holme present, the paediatrician, but also 
 
Dr Vereker, the other treating psychiatrist, was present for a large part of that 

consultation.  Therefore, that the paediatrician had a psychiatric input into that 
 
consultation.  Both of them knew about the Ritalin context and what had been 
 
recommended by way of prescription by Dr Cosgrove in terms of dosages.   
 
 
 
Thirdly, Dr Cosgrove would have known that Dr Holm had measured the patient’s height 
and weight because he was told so in the letter – they were both between the seventh and 

ninth centiles. 
 
 
 
Fourthly, that Dr Holme had – and it is perhaps important that I quote him on this – in his 
 
letter to Dr Cosgrove said: 
 
 
 
“I have offered to keep an eye on A’s overall growth and 
development and I will see him again in six months.” 

 
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I would submit on the basis of that knowledge that Dr Cosgrove had at the time that he 
 
was entitled to conclude that Dr Holm had at the least agreed to share responsibility for 
 
monitoring the growth (weight and height) of the patient and, for what it is worth – and it 
 
is not at this stage – blood pressure.   
 
 
 
It was, in my submission, ingenuous of Dr Holm in evidence before you to dispute that he 
was taking or had agreed to take any responsibility for monitoring the patient’s height, 

weight and blood pressure.  I say that that lack of disingenuous approach of Dr Holm is 
 
borne out if you look at what he was writing at the time and during the course of the 
 
subsequent consultations, because in all of those subsequent consultations blood pressure 
 
was taken and it was taken not in the general review of health (although that may well 
 
have been done) but in the specific context of the problem of ADHD.  You will see, if 
 
you look at all the clinic letters that follow those clinic appointments, they are headed 
“ADHD Problem” or “Hyperkinetic Problem” and copied to Dr Cosgrove. 

 
 
So that was the arrangement in place and the reasonable understanding that Dr Cosgrove 
 
was about to attach to those arrangements, about which he knew and about which he was 
 
kept informed. 
 
 
 
He also, of course, was himself monitoring the patient by telephone in conference with 
the mother, and he writes again in July – again at C12, at 68 to 69 (I do not ask you to 

look it up) – where, in the light of specific concerns from the mother, it is clear that he is 
 
not merely relying on Dr Holme’s six monthly checks in relation to weight, it is clear that 
 
he is seeking further assistance from the mother in terms of weight:   
 
 
 
“He is growing in height and his weight is satisfactory.” 
 
 
We also have, of course, Dr Holme’s comment in one of his letters on page 86 at C12, 

that Dr Cosgrove kindly checks his progress by telephone every two months or so.   
 
 
 
That is the factual background.  Those are the reasons why, I submit, it cannot be 
 
established on the evidence that there was here an inadequate assessment of the patient’s 
 
weight or an irresponsible monitoring of the patient’s growth as alleged in (ii) and (iii). 
 
 
In relation to the relation (v): 

 
 
“you did not advise Patient A’s General Practitioner to monitor 
 
Patient A as above”, 
 
 
 
as a fact that is not disputed but in the context that it is put in as an element or an item of 
irresponsible monitoring, it is, because of the monitoring arrangements that had been 

established not in this case with the GP but with the paediatrician.   
 
 
 
I turn to (i), which is on a different topic really, the allegation of a failure to see the 
 
patient in person between May 1996 and May 1999, that fact amounting to an item of 
 
irresponsible monitoring.  Again, it is conceded that he did not in fact see the patient 
 
between those dates – the evidence clearly points that way and is not contested by 
Dr Cosgrove.   

 
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Does it amount to irresponsible monitoring?  The allegation arises, in my submission, in 
 
this context, that because here we have a patient (a) who was on a high dose of Ritalin, 
 
over and above 60mgs, and (b) who was on other medication, namely Risperidone and 
 
Clonidine, there was a need for personal assessment by the treating psychiatrist because 
 
of the risk of such factors as hallucination, depression, perseveration of attention.  You, of 
 
course, are not bound by Professor Taylor’s views on the desirability of personal 
assessment in those circumstances and in the light of those risks, and you are entitled to 

consider the whole body of expert evidence, whether it be in the form of oral evidence 
 
from Professor Taylor or other literature that has been put before you and cited to you.  
 
 
 
I just say this in relation to the particular risks.  In relation to hallucination, Dr Cosgrove 
 
says at paragraph 13.9 of his enclosure J, which is his response to an original letter from 
 
Professor Taylor, he cites there what the manufacturers of Ritalin, Novartis, say about the 
risks of hallucination from the administration of that drug, namely that they are less an 

0.1 per cent or less than one in 10,000, and that the risk – and this is something not 
 
coming from the manufacturers but from Dr Cosgrove himself – is further reduced in the 
 
context of his treatment of this patient because with the addition of Risperidone, an 
 
antipsychotic, he suggests that the risk of hallucination is further reduced.   
 
 
 
Perseveration of attention:  not mentioned as a significant side effect in either the practice 
parameters document or the document which we have at C10 page 331 under their “Side 

Effects” heading.  If it does not make it into those documents presumably it was safe for 
 
Dr Cosgrove to disregard that as a possible or significant risk in this case. 
 
 
 
Depression:  it was said by Professor Taylor that that is something that really only a 
 
psychiatrist could properly anticipate; it is something that a paediatrician might not be 
 
able to detect.  Again, you are not bound by that assertion by the professor and, of course, 
you can bring your own knowledge to bear on that.  But it would seem, in my submission, 

strange that a paediatrician, alert to the medication that this patient is on, might not be 
 
able to detect clinical signs of depression when seeing patients – which is certainly 
 
something that a general practitioner might be expected to detect when seeing patients. 
 
 
 
So for those reasons I make the submission that the fact that the he did not see the patient 
during those three years from the first appointment in May 1996 is not an indexed item of 
 
irresponsible monitoring. 

 
 
Item c(iv): 
 
 
 
“you did not warn Patient A’s mother that sudden withdrawal of 
 
Clonidine could have a deleterious effect on Patient A’s blood 
pressure.” 

 
 
Again, as a matter of fact, I do not dispute that Dr Cosgrove did not so warn, and it is 
 
clear from the tenor of his witness statement that that was the case, his view, that it was 
 
not necessary to warn. 
 
 
 
That that was not irresponsible.  He sets out in some length his reasoning for that in his 
witness statement.  I will get the reference correct.   It is enclosure I, paragraphs 7.12, 

7.13 and 7.14.  The concern that Professor Taylor had expressed in relation to the 
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prescription of Clonidine and the use of Clonidine is the possibility of rebound in relation 
 
to blood pressure.  Dr Cosgrove makes the point in 7.12 that clearly, if you are treating a 
 
hypertensive with high blood pressure and the treatment reduces the blood pressure to 
 
normal levels, there is a risk on sudden removal of the hypertension recurring.   
 
 
 
What he submits is that, in using Clonidine in the treatment of ADHD, you are not 
treating a hypertensive, but you are treating a person with normal blood pressure and 

therefore there is no risk of triggering hypertension by a sudden discontinuing of the 
 
medication.  In any event, he goes on to say at 7.13 that the dose he was prescribing, 0.1 
 
mg per day is such that dose withdrawal effectively takes place every day, because of the 
 
life of that particular drug.  He cites a mean plasma life of 13 hours with a range of 10 to 
 
20 hours, which means that a once a day dose is being withdrawn from the body every 
 
day.  Finally, at 7.14, that if there is still any remaining doubt, the recommendation for 
withdrawing a patient from the dose is to reduce the amount by 0.1 mg per day.  That in 

fact was the dose that was being administered in that particular case.  
 
 
 
Again, for those reasons, I submit, it is not an index of irresponsible monitoring in failing 
 
to warn the patient’s mother about Clonidine and that particular problem. 
 
 
 
Patient B.  This is solely concerned with the significance of the comments that he makes 
in the letter of 3 December 1999, which is in C8 at divider 3.  My learned friend is right 

when he says that there is a grammatical point being made here in relation to © (ii) and 
 
(iii) of head of charge 3.  In my submission, what the doctor was doing here in that letter 
 
was, first of all, reporting what he had been told as fact by the patient, that the doctor 
 
whom he had seen had been rude and unhelpful and had been scruffily dressed.   
 
 
 
Whether or not that was adopted later on does not undermine the grammatical point I 
make that he was not himself directly asserting in the letter – he could not – that Dr Al-

Shabner was rude and unhelpful and was scruffily dressed.  It was an accurate report of 
 
what he was told by the patient.  That is established by the patient’s own statement, which 
 
one finds at enclosure H to the doctor’s statement.  From that report by the patient, and on 
 
the assumption that it was correct, Dr Cosgrove has drawn the inferences that are stet out 
 
in (iv) (v) and (vi) in head of charge 3©.   
 
 
Those inferences are, in my submission, on the assumption that what he has been told is 

correct, are reasonable inferences to draw, namely that he knew nothing about ADHD, 
 
that he was guilty of medical negligence and the doctor who the patient had seen had 
 
demonstrated professional incompetence.  That is on the basis of what he was told in the 
 
letter on page 3.   
 
 
“Anyhow this specialist declares, I was told, there is nothing I can do for you.” 

 
 
Indeed, this fits with Dr Al-Shabner telling you that he had left the diagnosis open to the 
 
patient.   
 
 
 
“I find this a truly amazing statement.  Surely it is the doctor/specialist who makes 
 
the diagnosis, that it is not something to be left up to the patient.  This doctor says 
that he did inform the patient he may or may not have deficit syndrome, as he 

calls it, and I somehow let him at least start thinking of why it is that important to 
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him at this moment in time.  It is clear from Dr Al-Shabner’s total misuse of the 
 
words “deficit syndrome” that he knows nothing about ADHD.  In view of this 
 
appalling failure of knowledge about ADHD and in view of Dr Al-Shabner’s 
 
failure to elicit the simply dreadful level of the patient’s motivation, in view of his 
 
rudeness as reported by the patient, in view of the statement, ‘There is nothing I 
 
can do for you’ when ADHD responds so well to Ritalin and Dexamphetamine, I 
must formally register my strong disapproval of the medical negligence of this 

doctor.” 
 
 
 
Those inferences that he draws from what he was told by the patient are, in my 
 
submission, reasonable ones to draw.  They may be bold, but they are reasonable on the 
 
basis of what he was told.  Therefore, those criticisms are not unfounded or unsustainable, 
 
which is the allegation he faces here at (d)(ii).   
 

I think it may help if we look at the origin of that word and where it may well have been 
 
drawn from by whoever drafted this head of charge.  It would appear to come from the 
 
1998 edition of “Good Medical Practice”, which I think you will find at tab 3, where at 
 
paragraph 29 under “Working with Colleagues”, the practitioner is told, 
 
 
 
“You must not make any patient doubt a colleague’s knowledge and skills by 
making unnecessary or unsustainable comments about them.” 

 
 
That translates in coming up to date in the 2001 edition at tab 4, which I think was the 
 
passage we had problems with on the pagination, paragraph 35, 
 
 
 
“You must not undermine patients’ trust, the care or treatment they receive or in 
 
the judgement of those treating them by making malicious or unfounded criticisms 
of colleagues.” 

 
 
These criticisms, in my submission, were not unfounded and unsustainable, inasmuch as 
 
they were based on the honest, genuine recollection of the patient.  As to the meaning of 
 
the word “unsustainable”, and I would submit there does not really appear to be any 
 
significant difference between that word and the word “unfounded” which is to be found 
in the more recent edition of “Good Medical Practice”.   
 
 

It is also suggested that those comments were unprofessional.  If they were sustainable 
 
comments based on a reasonable foundation, which in my submission they were, namely 
 
the patient’s own honest recollection of what he was told, then he is acting 
 
unprofessionally in communicating those comments to the patient’s GP, to the patient 
 
himself, who after all is the author of the facts on which those comments are based, and 
indeed Dr Al-Shabner himself.   

 
 
My reasoning for making that submission is to be found elsewhere in “Good Medical 
 
Practice” under the heading “Your Duty to Protect all Patients.”  If we look at the 1998 
 
edition, paragraph 23 at tab 3 says, 
 
 
 
“You must protect patients when you believe that a doctor’s or other colleague’s 
health, conduct or performance… 

 
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obviously “performance” is the relevant word here, 
 
 
 
“is a threat to them.” 
 
 
 
At paragraph 24, 
 
 
“Before taking action you should do your best to find out the facts.  Then, if 

necessary, you must follow your employer’s procedures or tell an appropriate 
 
person from the employing authority, such as the Director of Public Health, 
 
Medical Director, Nursing Director or Chief Executive or an officer of your Local 
 
Medical Committee or a regulatory body.  Your comments about colleagues must 
 
be honest.  If you are not sure what to do ask an experienced colleague or contact 
 
the General Medical Council.  The safety of patients must come first at all times.” 
 

It is perhaps helpful to look at how that translates in the more recent edition of 2001, tab 
 
4, under the heading “Dealing with Problems in Professional Practice.  Conduct or 
 
Performance of Colleagues.”  At paragraph 26, 
 
 
 
“You must protect patients from risk of harm posed by another doctor’s conduct, 
 
performance or health…” 
 

Again, “performance” is the relevant word, 
 
 
 
“…including problems arising from…” 
 
 
 
I do not need to deal with that. 
 
 
“The safety of patients must come first at all times.  Where there are serious 

concerns about a colleague’s performance it is essential that steps are taken 
 
without delay to investigate the concerns, to establish whether they are well 
 
founded and to protect patients.” 
 
 
 
What Dr Cosgrove was doing, in my submission, was no more and no less than was 
required of him or advised to him in “Good Medical Practice” in relation to dealing with 
 
a perceived problem in the performance of a colleague.  It was not necessary in deciding, 

where he is advised in the earlier edition, to do your best to find out the facts, for him to 
 
go further than to establish that the account he had been given by the patient was a bona 
 
fide, genuinely held, honestly believed statement of fact by the patient.   
 
 
 
It is not for him to investigate and come to a settled conclusion as to whether or not what 
the patient is saying is correct.  In any event, he notified Dr Al-Shabner of what the 

patient was saying.   
 
 
 
That this was the motivation behind what the doctor was doing is set out in his witness 
 
statement at paragraph 40.8.  I do not take you to it, but it makes clear in that paragraph 
 
that he was saying, “What is one to do?  One is entitled to take steps to seek to protect the 
 
patient.” 
 

Those paragraphs in the 1998 edition of “Good Medical Practice”, paragraphs 23 and 24 
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and the paragraphs in the later edition at 26 dealing with conduct and performance of 
 
colleagues, and particularly paragraph 26 in the later edition, make it clear that the doctor 
 
does not have to conduct his own personal investigation into establishing whether or not 
 
the facts are well founded.  He has to take steps to put in train a process.  It does not have 
 
to be conducted by him.  It may be conducted by others to establish whether they are 
 
well-founded. 
 

I say that and I draw support, I hope, from this analogy.  Suppose a female patient goes to 
 
see a consultant gynaecologist and tells that consultant, “Doctor, I saw the other day one 
 
of your colleagues, another consultant gynaecologist and in conducting a breast 
 
examination of me, he so manipulated my breasts in a way that was not consistent with a 
 
proper examination of the breasts” and she describes a touching, for example, a fondling 
 
of the breast, which is wholly inconsistent with a proper breast examination. 
 

That consultant considers that, if that account is correct, she is describing an indecent 
 
assault, a criminal offence.  He or she then decides to report what the patient has told him 
 
to the patient’s GP in a letter, copying that letter to the patient and, indeed, to his 
 
colleague, the consultant gynaecologist.  Can he be criticised for so doing?  In my 
 
submission, not.   
 
 
He is not obliged beyond establishing that the patient has given him a bona fide account 

to conduct his own investigation into whether or not those facts are true or false, correct 
 
or incorrect.  That is clearly a matter for others to take forward.  The step he takes is to 
 
report it to the general practitioner. 
 
 
 
Is he the subject of criticism for not going, as it suggested he should do, to the relevant 
 
clinician’s own employers, the medical director, etc?  Not, in my submission, a failing on 
the doctor’s behalf, on the doctor’s part and, indeed, it is a more humane, less drastic step 

to report such a matter to the patient’s general practitioner, because whereas a Medical 
 
Director, you may think, would be bound to act and set in train an investigative process, 
 
whether it be by the police or the employing trust, by reporting the matter to the patient’s 
 
general practitioner, who is perhaps the patient’s closest, best known clinician, he is 
 
taking a less drastic step, he is referring the matter to a clinician who can, perhaps, act 
more as an intermediary and would have the ability to discuss the matter further with the 
 
patient before deciding whether and, if so, how, to take the process further. 

 
 
If I can summarise my submissions in relation to Patient B, (a) he receives an account, a 
 
factual account, which he reports accurately in his letter to the general practitioner.  He is 
 
satisfied that the account is genuine, honestly held and believed by the patient.  He draws 
 
a reasonable inference from that that what he has been told is a description of 
incompetence and negligence on the part of his colleague clinician and writes such in his 

letter.   
 
 
 
That is a proper foundation for writing such a comment and it is not unprofessional to 
 
report those facts and his inferences drawn from those facts to the general practitioner, 
 
the patient’s general practitioner, with a copy to the patient and the person who he 
 
criticises on the basis of reported facts. 
 

Patient C falls into two parts; the first, monitoring in relation to head of charge 4 and, 
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second, the nature of the complaint made by Dr Cosgrove in the letter of 7 July 1999, 
 
head of charge 5, concerning Dr Moses. 
 
 
 
First of all, the question of monitoring and advice.  The letter of 29 May sets out the 
 
recommendations as to the prescription of Risperidone and Ritalin.  It did not contain any 
 
advice to the GP about the appropriate monitoring of the patient while he was taking 
those drugs and it is suggested that that failure was irresponsible and not in the best 

interests of the patient.  So, it is an allegation really that boils down to a failure to advise 
 
the patient’s GP about appropriate monitoring of the patient on that medication. 
 
 
 
What happened here was just as with patient A.  In the letter to the general practitioner, 
 
Dr Rackham, in his final paragraph he sets out: 
 
 
“I have made out a private prescription for Ritalin and Risperidone 

but I know that his parents would very much appreciate it if you 
 
would copy it down on to an NHS scrip.  On each occasion that I 
 
alter the dosage I will send them a fresh private prescription to 
 
bring to you.  You may care to keep them in his file.” 
 
 
 
Again, that triggers an obligation on the part of the general practitioner to exercise his or 
her own independent judgment before agreeing to transcribe those prescriptions and issue 

NHS prescriptions to the patient’s parents, or the patient’s mother.  
 
 
 
That independent judgment, the doctor, Dr Cosgrove, is entitled to consider, would be 
 
exercised as, indeed, it was, in my submission, because you have the uncontradicted 
 
evidence from the patient’s mother, Mrs C, that Dr Rackham did, indeed, check the 
 
patient’s height, weight and blood pressure on a regular basis, namely every eight to 
twelve weeks, a regime which Professor Taylor accepted in evidence would have been an 

acceptable monitoring regime. 
 
 
 
It is for that reason, in my submission, that it cannot be said that the failure to set out that 
 
advice, namely the need to monitor blood pressure, height and weight, was irresponsible 
 
and not in the best interests of the patient, because he was entitled to assume an exercise 
of independent judgment by the GP in the light of the proposed prescription of this 
 
particular medication.  If the doctor had any concerns about what he was to do, he was 

there and available, ready to answer those concerns. 
 
 
 
May I suggest an analogy from another field, though still within the psychiatric field.  A 
 
Community Drugs Team sees a patient who is a heroin addict, assesses the patient and 
 
feels that it is appropriate that that patient is prescribed methadone in order to treat the 
heroin abuse.  Because of budgetary constraints, the CDT is not able to prescribe itself 

the methadone and writes a letter to the patient’s general practitioner recommending a 
 
prescription of an appropriate amount of methadone to the patient.   
 
 
 
That CDT, in my submission, is not obliged to say in the letter, “Before you do so you 
 
ought to examine the patient and take urine samples from the patient to ensure that the 
 
patient is opiate positive.”  Those are matters, in my submission, that the CDT can 
properly leave unsaid, relying on the independent judgment that has to be exercised by all 

general practitioners when they come to prescribe.  When they prescribe drugs they are 
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expected to know the effects of drugs, how they need to be monitored following 
 
prescription and, if they do not, they must raise it with the specialist who is inviting them 
 
to make that prescription. 
 
 
 
Of course, here we know that Dr Cosgrove had the additional clinical luxury that from 
 
time to time Mrs C brought her son to see him in person for face-to-face consultations, 
where he could reassure himself that the monitoring that the GP should have been doing 

and was doing in this case was, in fact, in place.   
 
 
 
Patient C, I move on to head of charge 5, which is the letter that was written by Dr 
 
Cosgrove on 7 July 1999.   
 
 
 
Again, the same scenario, in my submission, exists here as did for Patient B. Dr Cosgrove 
was reporting accurately the patient’s medical history as given to him by the patient’s 

mother.  My learned friend was good enough to accept, concede, that Mrs C was doing 
 
her best to be accurate before you and was not a dissembling or dishonest witness.   So, 
 
that is the first plank, in my submission. 
 
 
 
The second, it was a reasonable inference to draw from that history to say that more 
 
should have been done for the patient and, in particular, that it would have been proper 
actively to consider medication as something that had not, on Mrs C’s account, been 

done.  That is an inference with which Professor Taylor agreed when that scenario was 
 
put to him in evidence, that it would be a proper inference to come to that conclusion that 
 
more could be done for this patient. 
 
 
 
That was the inference that Dr Cosgrove drew and set out not explicitly, perhaps, but 
 
inferentially in the letter when reporting what he was told by the patient’s mother. 
 

That is the second plank.  Because it is a reasonable inference based on bona fide given 
 
information, it was a sustainable comment to make and it was not unprofessional to report 
 
that comment to the patient’s GP, the patient’s parents and to Dr Moses herself, the 
 
subject of the critical comment. 
 
 
Patient D.  The allegation here is in relation to the consultation on 21 May 1996.  It deals 
 
with, at 6d, the allegation is that:   

 
 
“The examination on that occasion was inadequate in that you did 
 
not weigh him, you did not take his blood pressure.” 
 
 
 
I accept that the evidence is all one way on that in relation to the fact that he was not 
weighed by Dr Cosgrove himself and did not have his blood pressure taken either by Dr 

Cosgrove.  I make that concession, albeit in the light of other evidence from other 
 
patients, the parents have given evidence before you, where the suggestion is that that 
 
was done in their cases.  In this case the evidence would point in that direction. 
 
 
 
The issue, then, is whether or not the failure to weigh, the failure to take blood pressure 
 
on that initial occasion, was an inadequate examination of the patient.   
 

Again, I submit this.  Dr Cosgrove knew that in making the recommendation for 
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prescription that he did in his letter in the same terms as the earlier letters that I have 
 
already taken you to, that would trigger the general practitioner’s need to exercise his or 
 
her independent judgment.  Indeed, it did trigger an exercise in judgment, as we know.  
 
The GP - I think it was Dr Taylor at that time, before the transfer to Dr Spence – took the 
 
view that she should not prescribe Ritalin and went to consult the consultant psychiatrist 
 
who had given a second opinion in relation to this child at the request of the mother, 
Dr Barton, a child psychiatrist well known to Professor Taylor.  Dr Barton referred the 

issue over to the hitherto treating psychiatrist, Dr Robinson and, as a result of consulting 
 
Dr Robinson, got approval to prescribe from Dr Robinson that which Dr Cosgrove was 
 
recommending should be prescribed and a monitoring regime was put in place, as we see 
 
from the notes that are set out in the chronology I have put before you. 
 
 
 
Again, in my submission, Dr Cosgrove was entitled to consider that the appropriate 
monitoring relevant to that drug and its use in the treatment of ADHD would be put in 

place following reference of the prescription of the general practitioner.  Dr Cosgrove 
 
would be able to secure reassurance on that issue of physical monitoring during the 
 
telephone consultations he would have with the patient’s mother when he titrated the 
 
doses according to the feedback that he was getting from the mother in relation to the 
 
effects of the medication on the child’s behaviour, both at home and at school. 
 
 
I do, however, have to make one concession in relation to he allegation of a failure to 

make proper arrangements for monitoring the effects of treatment which he provided for 
 
the patient, and that is this.  It is clear from the monitoring regime that was put in place 
 
that it omitted the monitoring of blood pressure.  Height and weight were to be monitored 
 
on a three-monthly basis and there does not appear to be any evidence from the clinical 
 
records that blood pressure was also monitored.  It is accepted that that would be part of 
 
the appropriate regime.  I would have to concede on Dr Cosgrove’s behalf that that is 
something he should have picked up during the course of the telephone conversation and 

take action upon, and there is no evidence that he did so.  So to that limited extent I 
 
would concede that there had been a failure under head of charge 6f. 
 
 
 
Patient E, and there are two elements to this:  head of charge 7 is the failure to supply 
 
notes; head of charge 8 the comments in the letter of 3 October 2000.  My submission in 
relation to the allegation of impropriety and unprofessional behaviour in relation to the 
 
failure to supply notes is that in refusing Miss Samways’ request Dr Cosgrove was acting 

with the consent and authority of the patient’s mother, Mrs E.  The patient’s mother was 
 
questioned by your Chairman specifically about her state of mind and the background to 
 
the refusal by Dr Cosgrove to disclose the notes and she told you that it was a shared 
 
decision not to disclose the notes.  The issue about not disclosing the notes was, she felt, 
 
probably raised by her during the course of a routine telephone consultation at which 
Dr Cosgrove would have telephoned her for the purpose of monitoring the child. 

 
 
She had not made a written reversal of her previous written consent to disclose the notes 
 
because she took the view that the doctor’s letter would effectively deal with that issue.  
 
My learned friend says that there is a significant passage in a letter she wrote to the 
 
General Medical Council and the use of the word “now”, suggesting that it was 
 
something that with hindsight she was prepared to ratify the refusal.  That is not borne out 
by the evidence that was given by the patient’s mother before you, nor is it borne out, in 

my submission, by another letter which she wrote which you have at enclosure Q to the 
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witness statement – and I will read you the relevant passages: 
 
 
 
“I am writing out of complete support for you.” 
 
 
 
So it is clear it is a sort of testimonial letter in support. 
 
 
“I am amazed about the allegations against you, on behalf of treating 

my son.  I am in full and total backing of yourself on this matter. 
 
 
 
I find that Wendy Samways handling of this matter to be rude and 
 
offensive, she wrote that I would be concerned about your refusal to 
 
send copies of the notes that you hold, which was offensive and I felt 
 
and I still feel you acted out of E’s best interest.” 
 

She then goes on to describe how E came to him as an unhappy, mixed up, crazy child.  
 
She goes on to say this: 
 
 
 
“The NHS Trust did not pick up the fact that E also was suffering 
 
from Tourettes, which is a feat in itself. 
 
 
As I was in dispute with the Trust over E’s care, I do feel your 

actions helped us to come to a quicker resolution without any 
 
inappropriate questioning of the care you were giving E, which I feel 
 
would have happened, which in turn would have dragged out our 
 
complaint with the Trust, and so I can only give you many thanks for 
 
preventing this from happening.   
 
 
I think that the GMC should bear more mind to medical neglect than 

to question consultants manners, especially when parents of patients 
 
give full permission to act in any particular way, ie refusal to send 
 
copies of notes!!” 
 
 
 
So she is there making quite clear her authority – prior authority, in my submission, of 
Dr Cosgrove’s refusal to forward the notes. 
 
 

The letter he writes, the subject of head of charge 8, 3 October 2000:  all the factual 
 
matters that appear in the letter are admitted.  Again, the comments that he makes in that 
 
letter about inadequate care – and if I can deal with that head first, separately from the 
 
others at (ii), (iii) and (iv).  At (i): 
 
 
“that Patient E had been inadequate care by an employee of the 

Oxfordshire Mental Healthcare NHS Trust.” 
 
 
 
Again, in my submission, based on reports from the parents, accurately reported by the 
 
doctor.  It was reasonable, I submit, to criticise the refusal to prescribe Risperidone  
 
– which was the nub of his allegation of inadequate care.  I say that because the fact is 
 
that the doctor himself prescribed Risperidone and no criticism is made of him for so 
doing.  It was reasonable to report that comment of inadequate care to the manager of 

complaints at the Trust in accordance with the arguments I have set out before on 
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previous occasions based on what a doctor should do as set out in Good Medical 
 
Practice.  So sustainable comment; it was not unprofessional to report to the complaints 
 
manager. 
 
 
 
In relation to the comments at (ii), (iii) and (iv) about the nature of the investigation that 
 
was going to be carried out, those comments echoed, if the evidence of Mrs E is correct, 
views that had already been expressed by the Community Health Council from whom 

Mrs E sought advice and assistance in the prosecution of her complaint, and it also 
 
accorded with the view which was already held by the parents as a result of their 
 
discussion with the Community Health Council representative.  So his comments about 
 
whitewashing and inadequacy of the investigation as set out in (ii), (iii) and (iv) were 
 
based on and echoed comments already made by the CHC and the parents themselves.  
 
They were again, therefore, in my submission, sustainable comments and it was not 
unprofessional to report those comments to the complaints manager of the Trust – who, 

after all, was setting up the inquiry about which criticism was made. 
 
 
 
Patient F--- 
 
 
 
THE CHAIRMAN:  I am sorry to interrupt you, Mr Morris.  I wonder if I might suggest 
 
that this could be an appropriate point to have a break?  I understand that the Legal 
Assessor’s advice will last about 15 minutes, so we are going to have to come back after 

lunch anyway, and it might be as well to have a break just now.  You could complete 
 
your submission and we could then get the advice of the Legal Assessor. 
 
 
 
MR MORRIS:  Yes. 
 
 
 
THE CHAIRMAN:  So we will recommence at ten-to two. 
 

(The Committee adjourned for lunch) 
 
 
 
MR MORRIS:  Patient F, head of charge 9:  the allegation here relates to the comments 
 
made in the letter written by the doctor on 17 November 2000 in divider 9.  Again, I 
 
make the same submission I have made in respect of previous commentaries by the 
doctor.  The doctor was reporting accurately what the patient had told him, and on the 
 
basis of that report the doctor drew some inferences which he set out in that letter.  What 

he had been told is that the doctor, it had been felt, had not listened to the patient when he 
 
was talking about his personal understanding of the ADHD condition; that the doctor had 
 
told him that ADHD was a concentration problem and it was for messy kids – in other 
 
words, it was not relevant in an adult context – and from that he drew the inference that 
 
that was an ignorant comment and that both Dr Thomas and her supervising consultant 
were arguably guilty of medical negligence in relation to that.  In relation to the allegation 

also in the report that the consultant reported back to Dr Thomas, who in turn reported to 
 
the patient, “The consultant thinks you have got a personality disorder which is not 
 
treatable”:  the comment about that was that that was therapeutic and negligent. 
 
 
 
Finally at (vi), a comment about medical negligence, if it was being asserted that there 
 
had been negligence if the patient responded to treatment that had been given by 
Dr Cosgrove and that the failure to listen to the patient and in not knowing what ADHD 

was – that it was not a real condition in adults – led to the complaint. 
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You will have heard what Professor Taylor’s view was about the comment that ADHD is 
 
a concentration problem and that it is for messy kids.  He took the view that, if said, that 
 
was both unprofessional and unacceptable, and he expressed the view that psychiatrists 
 
would not usually say that you have got a personality disorder and it is untreatable, and 
 
therefore inferentially it criticised that comment, if it were made. 
 

So again, in my submission, they were reasonably founded comments, therefore 
 
sustainable, and not unprofessional to report those comments in the letter to the general 
 
practitioner with a copy to Drs Thomas and Chubb. 
 
 
 
Patient G:  the criticism there relates to the irresponsible monitoring in not making an 
 
adequate assessment of patient G’s weight, not monitoring patient G’s growth and not 
adequately monitoring any possible side effects.  In my submission, the Council has an 

evidential problem here.  There is, in my submission, no evidence of an absence of 
 
physical monitoring by the general practitioner and, again, I would say that delegation 
 
would be appropriate to the practitioner. 
 
 
 
The prescription was a recommendation to the General Practitioner.  There is therefore 
 
the automatic conclusion that the General Practitioner was obliged to exercise his or her 
independent judgment.  There is no evidence that that judgment was not so exercised, 

whether by evidence from the General Practitioner or evidence from the clinical notes.  
 
Indeed, if one looks at the letter of 27 May of divider 10, page 9, from Dr Hales to Dr 
 
Judge, the GP is there saying, 
 
 
 
“His height recorded in the clinic today was 108 cm.  His weight was 16 
 
kilograms.  His mother says that his weight has dropped a kilogram since starting 
the medication.” 

 
 
It suggests, in my submission, that there was a monitoring regime in place in relation to 
 
this child.   
 
 
 
Finally, if I can come to Patient H, again it is a commentary case surrounding the letter of 
19 July 2003.  It is the same framework to my submissions.  There is no evidence but that 
 
the facts related to the doctor were accurately recorded in the letter, that the facts as 

related were honestly recollected by the patient.  Those were these:  Dr Cosgrove says, 
 
 
 
“I understand that H was seen by Dr Dover about a year ago for one appointment. 
 
 I was told by Mr and Mrs H that Dr Dover told them that he did not believe in 
 
ADHD and that it was too Americanised.  I was informed that Dr Dover told H’s 
parents to go away and to sort out their own lives.  I was also told that Dr Dover 

did not read H’s school reports, not did he ask to see them.  According to H’s 
 
parents, his head teacher was concerned at what Dr Dover had told the parents to 
 
do, namely to go away and to sort out your own lives.” 
 
 
 
Again, on the basis of that account, honestly given by the patient’s parents to the doctor, 
 
he was being told about a clinician who did not believe in the concept of ADHD and, on 
the basis of that, it was a perfectly reasonable comment to make that if that were the case 

he might be in trouble with re-validation by the General Medical Council. 
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The comment again in relation to the failure to study school reports is reasonable in my 
 
submission, based on the parameters we have been told about, the guidelines and the 
 
protocols suggested by Professor Taylor and that he had not behaved professionally in not 
 
arranging a second opinion when asked to do so.  Again, it is a perfectly reasonable 
 
comment to make.  Again, therefore, it is a sustainable commentary and not 
unprofessional in being reported to the patient’s General Practitioner with a copy to Dr 

Dover.   
 
 
 
THE CHAIRMAN:  I am sorry to interrupt, Mr Morris.  Did I miss out any reference to 
 
10©?  My recollection is that 10©(i) and (ii) were not admitted at the outset of the 
 
hearing. 
 
 
MR MORRIS:  Sir, I think that was right. 

 
 
THE CHAIRMAN:  My recollection was that it appeared to be admitted in the first 
 
round, but then the admission of 10©(i) and (ii) was withdrawn.   
 
 
 
MR MORRIS:  Sir, yes.  I think in the light of the evidence I am not in a position to make 
 
any submission that that is not the case.  Sir, those are my submissions. 
 

THE CHAIRMAN:  Thank you very much.  I now turn to the Legal Assessor. 
 
 
 
THE LEGAL ASSESSOR:  I have prepared a written advice, which I propose to read into 
 
the record.  The point has now been reached when the Committee has to decide which, if 
 
any, of the unadmitted facts in the heads of charge they find proved.  Then the Committee 
 
has to decide whether or not those facts so proved, if any, taken with the admitted facts 
are insufficient to support a finding of serious professional misconduct or, put another 

way, whether those facts are capable of constituting serious professional misconduct.   
 
 
 
Taking the factual task first, I am required to remind you that the burden of proving these 
 
facts rests on the General Medical Council and the standard to which you must find each 
 
of them individually proved is beyond reasonable doubt so that you are sure of each of 
them individually.  There is a danger that this familiar advice becomes with repetition 
 
simply an incantation.  It is a living practical principle of justice and my advice is that 

you should keep it to the forefront of your minds at all times when evaluating the 
 
evidence. 
 
 
 
Turning to the second task, you have to be satisfied that the admitted facts and those 
 
found proved, if any, are capable of amounting to serious professional misconduct.  In 
deciding whether or not this is the case, my advice is that if you are left in any doubt as to 

whether they are so capable  - and I stress that word “capable” – of constituting serious 
 
professional misconduct, the benefit of any doubt should be given to Dr Cosgrove.  
 
 
 
What is serious professional misconduct?  It is conduct which has a link with the practice 
 
of medicine and which, in the circumstances of the case, represents serious breach, 
 
whether by omission or commission, of the rules and standards, written and unwritten, 
ordinarily required to be followed by the registered medical practitioner.  It does not 

require moral turpitude.  As this case involves allegations concerning the medical 
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performance of Dr Cosgrove, e.g. his failure to monitor, I should add that gross 
 
professional negligence may fall within the ambit of serious professional misconduct.  
 
But, it has to be something far more than that which simply gives rise to a civil liability 
 
for negligence.  The negligence has to be something that truly calls for the opprobrium 
 
that inevitably attaches to a disciplinary charge for that type of conduct to be serious 
 
professional misconduct.   
 

That is the general advice I wish to give, but there remain a number of specific points that 
 
I need to briefly refer to. 
 
 
 
Firstly, Dr Cosgrove has not given evidence in person before you.  No inference and 
 
certainly no adverse inference should be drawn as to why he has chosen not to do so.  Dr 
 
Cosgrove is entitled to have the case decided solely on the evidence before the 
Committee which, of course, includes the evidence called in his defence.  An allegation 

has been made against him and he is entitled to require the General Medical Council to 
 
prove it and to prove it beyond reasonable doubt in the face of the evidence that he has 
 
chosen to present. 
 
 
 
Secondly, some of the evidence before you is in the form of unadmitted written 
 
statements, i.e. the contents are not admitted by the other side.  Pre-eminently this 
includes the statement of Dr Cosgrove himself and the exhibits attached to that statement. 

 For the General Medical Council the statements of Dr Chubb and Dr Dover are in this 
 
form.  These constitute evidence before you and may be properly used in making findings 
 
of fact, whether positive or negative, either favourable or adverse to Dr Cosgrove.   
 
 
 
However, my advice is that, in considering how probative the evidence is, i.e. its weight, 
 
you should, before making any findings of fact on the basis of that evidence, caution 
yourselves that the makers of those statements have not been subjected to cross-

examination and, consequently, the evidence is not as weighty as evidence you find 
 
compelling and credible after cross-examination.  That mental note of caution made, i.e. 
 
if you remind yourself of the absence of cross-examination, the weight that you place on 
 
those statements thereafter is entirely a matter for you.   
 
 
Thirdly, half of the charges relate to letters written by Dr Cosgrove to other medical 
 
practitioners.  It is a characteristic of those charges that the contents are said to be both 

unprofessional and unsustainable.  In relation to the allegation of them being 
 
unprofessional, I advise that, in deciding whether they are proved beyond reasonable 
 
doubt, the professional standards to be applied are those prevailing at the time the letters 
 
were written.  Regard may properly be had to the “Good Medical Practice” publication 
 
current at that date. 
 

In deciding whether the contents of the letters are proved beyond reasonable doubt to be 
 
unsustainable, and I note here that the General Medical Council by the use of that word 
 
allege that the contents are not capable of being sustained, which is, you may feel, more 
 
emphatic than alleging that they are simply not correct.   
 
 
 
I advise that you are required to take into account all the evidence, including that of the 
defence witnesses and the statement of Dr Cosgrove.  Once considered, the weight 

attached to a particular piece of evidence is then a matter for you. 
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Fourthly, the remainder of the charges include those that relate to the monitoring by Dr 
 
Cosgrove and the effect of the drugs prescribed by him.  They include allegations of 
 
irresponsibility, that his examination was inadequate and that a failure to forward medical 
 
notes was, inter alia, inappropriate and failure to advise monitoring of a patient’s 
 
prescribed drugs was irresponsible and not in the best interests of the patient.  
 

Taking these allegations as being allegations against the actual medical performance of 
 
Dr Cosgrove, my advice is that in deciding whether or not these allegations are proved 
 
beyond reasonable doubt, regard should be had to the medical standards and knowledge 
 
prevailing at the time of the alleged default and not that which is known today at the date 
 
of the hearing.   
 
 
Fifthly, you should consider each head of allegation separately.  Each head should only 

be found proved if you are satisfied such that you are sure of it.  This vital principle may 
 
be illustrated by a specific point which I wish to make about charge 2.  Each allegation in 
 
2(b)(i) to (vi) should be so considered separately and to the requisite standard of proof.  
 
So should each allegation in 2(c)(i) to (v).  When that is done, as a separate exercise, you 
 
should consider if the facts in 2(c)(i) to 2(c)(v) that are found proved themselves prove 
 
beyond reasonable doubt that the allegation made in the opening sentence of 2(c), i.e. 
irresponsible monitoring, is so proved beyond reasonable doubt.  In this way the cardinal 

principle of the General Medical Council having the burden of proving each allegation to 
 
the point where you are sure is given practical effect. 
 
 
 
Lastly, my role is to advise you on the law.  You are not obliged to follow my advice.  
 
However, should you wish not to follow it, I advise you to state in your determination the 
 
reasons why you decline to do so and to state what you consider to be the appropriate 
law.  Let me make it quite clear that this is not out of some kind of injured professional 

pride, but for the infinitely more important reason that Dr Cosgrove, and for that matter 
 
any reviewing Court, will then know with certainty what law was applied in this case. 
 
 
 
That is my advice. 
 
 
THE CHAIRMAN:  I take it there is no dissent from that advice. 
 
 

MR MORRIS:  No, sir. 
 
 
 
MR PEARCE:  No, sir. 
 
 
 
THE CHAIRMAN:  At this point we will now go into camera. 
 

STRANGERS, THEN, BY DIRECTION FROM THE CHAIR, WITHDREW 
 
AND THE COMMITTEE DELIBERATED IN CAMERA
 
 
 
 
 
Mr Morris, the Committee have given detailed consideration to all the evidence adduced 
 
in this case, and have taken account of the submissions made by Counsel and the advice 
given by the Legal Assessor.  They have borne in mind that the burden of proof rests on 

the GMC and that the standard of proof required is that they should be sure, beyond 
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reasonable doubt.  The Committee have considered each head and sub-head of charge 
 
separately.  Accordingly, they have made the following findings on the facts: 
 
 
 
Head 1 has been admitted and found proved. 
 
 
 
Head 2(a) has been admitted and found proved 
Head 2(b)(i) has been found proved 

Heads 2(b) (ii) and (iii) have been found not proved 
 
Heads 2(b)(iv) and (v) and (vi) have been found proved 
 
 
 
The Committee considered Heads 2(c)(i) to (v) as factual heads of charge initially and 
 
then considered their findings in relation to the stem of that head of charge. 
 
 
Heads 2(c)(i) and (ii) have been found proved 

Head 2(c)(iii) has been found not proved 
 
Heads 2(c)(iv) and (v) have been found proved 
 
Stem of Head 2(c) has been found proved in relation to heads 2(c)(i), (ii), (iv) and (v) 
 
only. 
 
 
 
Heads 3(a) and (b) have been admitted and found proved  
Head 3(c)(i) has been admitted and found proved  

Heads 3(c)(ii) and (iii) have been found proved 
 
Heads 3 (c)(iv), (v) and (vi) have been admitted and found proved  
 
Heads 3(d)(i) and (ii) have been found proved  
 
Head 3(d)(iii) has been admitted and found proved  
 
 
 
Heads 4(a), (b), (c) and (d) have been admitted and found proved  
Heads 4(e) (i) and (ii) have been found proved 

 
 
Head 5(a) has been admitted and found proved  
 
Heads 5(b)(i) has been admitted and found proved 
 
Heads 5(b)(ii) has been found proved 
 
Heads 5(b)(iii), (iv) and (v) have been admitted and found proved  
Heads 5(c)(i) and (ii) have been found proved 
 
Head 5(c) (iii) has been admitted and found proved  

 
 
Heads 6(a), (b) and (c) have been admitted and found proved  
 
Heads 6(d)(i) and (ii) have been found proved 
 
Head 6(e) has been admitted and found proved  
 
Head 6(f) has been found proved. 
 

Heads 7(a), (b) and (c) have been admitted and found proved  
 
Heads 7(d)(i) and (ii) have been found not proved 
 
 
 
Heads 8(a) (i), (ii), (iii) and (iv) have been admitted and found proved  
 
Heads 8(b)(i) and (ii) have been found proved 
 
Head 8b(iii) has been admitted and found proved 
 

Heads 9(a) and (b) have been admitted and found proved  
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Head 9(c)(i) had been admitted and found proved 
 
Head 9(c)(ii) has been found proved 
 
Heads 9(c)(iii), (iv), (v) and (vi) have been admitted and found proved 
 
Heads 9(d)(i) and (ii) have been found proved 
 
Head 9(d)(iii) has been admitted and found proved  
 
 
Heads 10(a) and (b) have been admitted and found proved  

Heads 10(c)(i) and (ii) have been found proved 
 
Heads 10(d)(i) and (ii) have been found proved 
 
Head 10d(iii) has been found not proved 
 
 
 
Heads 11(a) and (b) have been admitted and found proved  
 
Heads 11(c)(i), (ii) and (iii) have been admitted and found proved  
Heads 11(d)(i) and (ii) have been found proved 

Head 11(d)(iii) has been admitted and found proved  
 
 
 
Having reached findings on the facts the Committee then considered whether the facts 
 
found proved would be insufficient to support a finding of serious professional 
 
misconduct.  The Committee concluded that they would not be insufficient 
 
 
The procedure now is that the Committee will now invite Mr Pearce to adduce evidence, 

if he wishes to do so, as to the circumstances leading up to the facts which have been 
 
found proved, the extent to which these facts indicate serious professional misconduct on 
 
the part of Dr Cosgrove and as to his character and previous history.  After that, the 
 
Committee will invite Mr Morris to address them on those matters and also to adduce 
 
evidence in mitigation, if he wishes to do so. 
 
 
The Committee will then proceed to consider whether Dr Cosgrove has been guilty of 

serious professional misconduct in respect of those facts which have been found proved 
 
against him and, if so, they will go on to consider their determination as to whether or not 
 
they should make any direction regarding his registration. 
 
 
 
In the event that the Committee were to find that the doctor is guilty of serious 
professional misconduct, the Committee would wish both Counsel to make reference to 
 
the Indicative Sanctions Guidance when making submissions on sanction, using the 

criteria as set out in the guidance to draw attention to the issues which appear relevant to 
 
this case. 
 
 
 
Mr Pearce and Mr Morris, I am conscious of the time of day and I would suggest that we 
 
defer any further submissions until tomorrow morning, if that is in agreement with you.  
 

MR PEARCE:  I agree, sir.  That would certainly suit my convenience. 
 
 
 
THE CHAIRMAN:  Would nine o’clock be an inappropriate time to start tomorrow? 
 
 
 
MR PEARCE:  That is fine, sir. 
 
 
THE CHAIRMAN:  Until tomorrow at nine. 

 
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The hearing was adjourned until the following day 
 
 
 
 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 
 
 
 


 
 

 
 

 
 
 
 
 


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GENERAL MEDICAL COUNCIL 
 
PROFESSIONAL CONDUCT COMMITTEE 
 
 
On: 
 
Friday, 18 June 2004 
 
Held at: 
St James’ Buildings 
79 Oxford Street 
Manchester M1 6FQ 
 
 
 
 
Case of: 
 
PATRICK VERNON FINN COSGROVE MB BS 1968 Lond 
(Day Eleven) 
 
 
Committee Members: 
Professor N Mackay (Chairman) 
Dr A Hamilton 
Mr J Matharu 
Dr B Stanley 
Mr R Briden (Legal Assessor) 
 
-------------------------------------- 
 
MR D MORRIS, of Counsel, instructed by Messrs RadcliffesLeBrasseur, appeared on 
behalf of Dr Cosgrove, who was not present. 
 
MR R PEARCE, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on 
behalf of the Council. 
  
-------------------------------------- 
 
(Transcript of the shorthand notes of Transcribe UK 
Tel No:  0208 614 5799) 
 
-------------------------------------- 
 
 
 
 

 
 
 
 
INDEX
 
 
 
 
 
 
 
 
 
 
         Page 
 
 
 
 
SUBMISSIONS BY MR PEARCE RE PART 2                                 1 
 
                              
 
 
SUBMISSIONS BY MR MORRIS                                                      6 
 
 
 
LEGAL ASSESSOR’S ADVICE                                                       16 
 
 
 
DETERMINATION                                                                            19 
____________________ 
 

 
 
 
 
 
 

THE CHAIRMAN:  Good morning.  When you are ready, Mr Pearce. 
 
 
 
MR PEARCE:  Sir, there are various matters I seek to deal with in submissions at this 
 
stage.  If I may start with dealing factors relevant to the circumstances of the heads of 
 
charge found proved, you have heard the evidence in respect of those.  There is one 
 
matter I ought to bring to your attention that is relevant when one comes to the issue of 
the Indicative Sanctions Guidance.  That is this:  that the initial rule 6 letter in this case 

was sent out on 1 October 2002.  It referred at that stage to patients A to F inclusive and 
 
made allegations both in respect of disparagement of colleagues, if I can put it that way, 
 
and prescribing and monitoring practices.  You will have noted that the final two charges, 
 
10 and 11, relating to patients G and H both relate to matters in the year 2003, that is to 
 
say events after the rule 6 letter was sent out referring to the charges in respect of patients 
 
A to F inclusive.  The relevance of that chronology will be apparent to you if you look at 
the Indicative Sanction Guidance.  I will draw it to your attention when I get to that 

section of the Indicative Sanctions Guidance.  Beyond that I think I can add nothing to 
 
what you have heard in evidence in terms of the circumstances of the allegations. 
 
 
 
I move on to the question of whether this amounts to serious professional misconduct.  It 
 
is, on the face of the charges that we allege that it is, it is, I hope, apparent from the way 
 
that I have put the case why we allege it amounts to serious professional misconduct.  In 
essence, there is a two-fold point here.  The first is that the conduct admitted in some 

cases and found proved in other cases of this doctor risked putting patient care at risk.  
 
There was a possibility that patient care would be put at risk and this was not a good 
 
standard of practice and care as can be expected from a doctor.   
 
 
 
Sir, we accept that on the evidence you have heard, and I anticipate from documents that 
 
will be put in front of you by way of mitigation that you may form the view that this 
doctor’s practice was patchy, patchy in this sense:  that, although you have made findings 

in respect of aspects of his practice and care that may indicate to you that it is 
 
unsatisfactory, you have heard evidence already and you will, I anticipate, hear evidence 
 
from my learned friend suggesting that in other case his practice has been good.  We 
 
acknowledge that this is not a case of us saying that this is all bad practice and an 
 
unremittingly bad picture. 
 
 
The second aspect of the seriousness of the conduct that we indicate is that not only did 

Dr Cosgrove’s actual conduct put patient care at risk, but also that his conduct, 
 
particularly in terms of disparagement, was likely to interfere with the care of patients by 
 
other professionals.  In respect of that, I refer you again, as I have done in the past, to the 
 
comments about working with colleagues in the various editions of “Good Medical 
 
Practice.”  I referred you to them in opening.  They have been referred to in closing 
submissions and you will be aware of them. 

 
 
If I may move on from that area to dealing with the question of character and the history 
 
relating to Dr Cosgrove, there are no previous findings against this doctor. In terms of 
 
history outside the matters you are concerned with here, there is one document I seek to 
 
produce to you in the course of these submissions.  I have mentioned it to my learned 
 
friend and I produce this documentation if I may.  (Same handed
 

THE CHAIRMAN:  This will be C15. 
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MR PEARCE:  This is correspondence from Dr Cosgrove to the General Medical Council 
 
in March of this year.  The relevant parts of this letter, dated 16 March of this year, are 
 
that Dr Cosgrove indicates that he has retired from medical practice.  He encloses a copy 
 
of a letter to this effect sent to his patients.  He indicates that from 4 February this year he 
 
ceased to hold any private practice positions, to make out prescriptions and to sign 
 
medical certificates of any sort.  From that letter one sees what Dr Cosgrove’s current 
stance is in respect of medical practice.  The attached letter is there for the sake of 

completeness, no more than that.  It indicates that he has had to close the Bristol Priority 
 
Clinic because of the need to register with the now replaced National Care Standards 
 
Commission.   
 
 
 
May I finally turn to the Indicative Sanctions Guidance. 
 
 
THE CHAIRMAN:  Before you do so, Mr Pearce, could I check the situation in the light 

of this letter of 16 March 2004 from Dr Cosgrove?  He talks about not paying his annual 
 
subscription so that his name would not be maintained on the Medical Register.   
 
 
 
MR PEARCE:  Yes.  My understanding is that it is not as straightforward as this, that if 
 
one does not pay one is not on the Register.  He is on the Register. 
 
 
THE CHAIRMAN:  That is what I thought.  I thought I should make that very clear in the 

hearing, that although you do not pay your annual fee, if there are outstanding issues with 
 
the General Medical Council, your name is not removed from the Register until these 
 
outstanding issues are resolved. 
 
 
 
MR PEARCE:  That is exactly my understanding. 
 
 
THE CHAIRMAN:  Are you agreed on that, Mr Morris? 

 
 
MR MORRIS:  Sir, I am. 
 
 
 
MR PEARCE:  May I turn finally to the Indicative Sanctions Guidance, which I think 
 
you will have in front of you.  We take up the invitation you made to address you on this 
guidance in this way:  if I might, first of all deal with paragraphs 10 to 14 of the 
 
Guidance, which deal with the purpose of the sanctions, you will have thoroughly in the 

forefront of your mind the balance between the public interest identified in paragraphs 11 
 
and 12, particularly in this case paragraph 11, in all three sub-paragraphs (a) (b) and (c), 
 
the balance between that paragraph and the public interest, on the one hand, and, on the 
 
other hand, the proportionality which is quite rightly referred to in paragraph 13. 
 
 
If I might then deal in ascending order with the options available to you, first of all, it is 

open to you to conclude, if you do find serious professional misconduct, to conclude the 
 
case with no action.  It is a matter for you whether, on your assessment of the evidence, if 
 
you find serious professional misconduct, that would be appropriate.  It would perhaps be 
 
inconsistent with our submission as to the severity of what is here involved.   
 
 
 
If I can turn to the sanctions as they are listed at page 9 onwards, in respect of reprimand,  
 

“The sanction may be considered where most of the following factors are present: 
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Evidence that behaviour would not have caused direct or indirect patient harm.” 
 
 
 
We say that that is not so.  There is a possibility of direct or indirect patient harm here. 
 
 
 
“Insight into failings.” 
 
 
We say the evidence and the inferences to be drawn from the conduct of Dr Cosgrove 

strongly suggest he does not have insight into the failures that have been identified.  
 
 
 
“Isolated incident which was not deliberate.” 
 
 
 
This was neither isolated nor not deliberate. 
 
 
“Genuine expression of regret and apologies.” 

 
 
You do not have those. 
 
 
 
“Acting under duress.” 
 
 
 
Clearly, you may think there is no relevance to that here. 
 

“Previous good history.” 
 
 
 
Certainly, Dr Cosgrove does make out that one. 
 
 
 
“No repetition of behaviour since incident.” 
 
 
In respect of that I addressed you on the chronology and the timing of the rule 6 letter, 

since there has been a repetition of behaviour since the initial allegations were drawn to 
 
the doctor’s attention. 
 
 
 
“Rehabilitative and corrective steps taken.” 
 
 
There is no evidence that they have been taken. 
 
 

“Relevant and appropriate references and testimonials.” 
 
 
 
I think you are going to see a number of references and testimonials.  We would submit 
 
that it cannot be said that most of those factors are present for the purposes of considering 
 
whether a reprimand is appropriate.  They are, of course, not exhaustive. 
 

I turn to conditional registration. 
 
 
 
“No evidence of harmful, deep seated personality or attitudinal problems.” 
 
 
 
This is an area that may cause the Committee concern, particularly the question of 
 
attitudinal problems.  The Committee may be concerned that the entirety both of the 
evidence and of the conduct of Dr Cosgrove is rather strong evidence of attitudinal 

problems and an indication that those attitudinal problems are indeed deep seated. 
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“Identifiable areas of doctor’s practice in need of assessment or retraining.” 
 
 
 
It may very well be that there is scope for that in respect of prescriptions and monitoring. 
 
 
 
“No evidence of general incompetence.” 
 

I have submitted already that patchy is the word I would use.  The evidence we have 
 
adduced probably would not lead to the conclusion that the doctor was generally 
 
incompetent.  
 
 
 
“Potential willingness to respond positively to retraining.” 
 
 
All the evidence and the inferences to be drawn from the evidence suggest, in my 

submission, that there is neither potential nor willingness to respond positively. 
 
 
 
“Patients would not be put in danger either directly or indirectly as a result of 
 
conditional registration itself.” 
 
 
 
No doubt if conditional registration were considered you would seek to frame conditions 
so as not to put any patients in danger.   

 
 
“The conditions will protect patients during the period they are in force.” 
 
 
 
That is a matter for the conditions themselves.  The last one there, when considering 
 
conditional registration, is perhaps the most difficult one. 
 
 
“Is it possible to formulate appropriate and practical conditions to impose on 

registration?” 
 
 
 
In my submission, it is not if you accept the argument that I advance as to deep seated 
 
attitudinal problems on the part of the doctor.   
 
 
Moving on to suspension, 
 
 

“The sanction may be appropriate when some or all of the following factors are 
 
apparent: 
 
 
 
A serious incidence of misconduct where a lesser sanction is not sufficient.” 
 
 
Of course, under the rules you do not get this far unless the lesser sanctions are not 

sufficient. 
 
 
 
“Not fundamentally incompatible with continuing to be a registered doctor.” 
 
 
 
We do not allege that what is proved is fundamentally incompatible with Dr Cosgrove 
 
continuing to be registered.   
 

“No evidence of harmful, deep-seated personality or attitudinal problems.” 
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We submit there is evidence of deep-seated attitudinal problems here.   
 
 
 
“No evidence of repetition of behaviour since incident. 
 
 
 
There is some evidence of repetition. 
 

“Committee satisfied that doctor has insight and does not pose a significant risk of 
 
repeating the failure.” 
 
 
 
That might be a matter of some concern to the light of what I have had to say. 
 
 
 
“Patient interests are sufficiently respected.” 
 

You may think they would be sufficiently respected.  You may conclude from that in the 
 
way we put this case, sir, that we would contend that this case does fall within the 
 
Indicative Sanctions Guidance for suspension. 
 
 
 
Erasure on page 12. 
 
 
“This sanction is likely to be appropriate when behaviour is fundamentally 

incompatible with being a doctor and involves any of the following:” 
 
  
 
I have already submitted that you may think the behaviour is not fundamentally 
 
incompatible with being a doctor.   
 
 
 
“Does it involve any of the following: 
 

Serious departure from the relevant standards as set out in ‘Good Medical 
 
Practice.’” 
 
 
 
You may think that “serious” is reserved for cases that are more serious than this. 
 
 
“Doing serious harm to others.” 
 
 

The doctor has not done that. 
 
 
 
“Abuse of position of trust or violation of the rights of patients.” 
 
 
 
The doctor has not done that. 
 

“Offences of a sexual or violent nature.” 
 
 
 
The doctor has not done that. 
 
 
 
“Dishonesty.” 
 
 
The doctor has not done that. 

 
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“Persistent lack of insight into seriousness of actions or consequences.2 
 
 
 
There may be some lack of insight there, you may think.  Clearly erasure is the most 
 
serious of the sanctions and you will have in mind all the evidence in the case, both for 
 
and against the doctor, and the issue of proportionality.   
 
 
Finally, if you were minded to suspend the doctor’s registration, we would encourage you 

to do so on terms that there was a resumed hearing before the doctor practises again, so 
 
that the Committee has an opportunity to assess what has happened in the meantime, both 
 
in terms of the doctor’s conduct and practice.  Unless I can assist further, those are my 
 
submissions. 
 
 
 
THE CHAIRMAN:  Thank you.  Before turning to Mr Morris, I think it is important, and 
I am sure it is your wish that, although you submitted document C15 indicating that Dr 

Cosgrove was seeking to have his name removed from the register, we should not be 
 
influenced by this document if we come to the stage where we are considering any 
 
sanction that we might impose. 
 
 
 
MR PEARCE:  Do I take that to mean that you are asking me whether you should not 
 
assume from that document that his registration will cease in any event, so that it may 
make little difference to what action you take? 

 
 
THE CHAIRMAN:  Yes. 
 
 
 
MR PEARCE:  We would submit, yes, you should pay no regard to this.  You should 
 
make the determination that is right on the evidence and your assessment of the evidence. 
 
This is a separate issue to any sanction you may impose.  Precisely so, sir. 
 

THE CHAIRMAN:  Mr Morris. 
 
 
 
MR MORRIS:  Sir, I agree with that last exchange in relation to the significance of that 
 
matter.  Paragraph 4 of the Indicative Sanctions says, 
 
 
“Doctors practise medicine in order to serve the interests of the patients.” 
 
 

I hope by the time I have finished and you have seen the additional evidence I seek to put 
 
before you that your Committee will be able to accept that this doctor, in practising as he 
 
did and making the errors that he has, which have been admitted or found proved, did so 
 
out of an overriding, albeit as you have found in some respects misguided intention to 
 
serve the interests of his patients, and that his errors do not arise out of any sense of 
malice or an attempt to seek personal advantage, whether financial or otherwise. 

 
 
Furthermore, over reaching this case is my submission that there is no evidence, and 
 
indeed it is not put forward by the Council, that any of the patients whose care appears 
 
within these heads of charge actually suffered any harm.  Indeed, the evidence will be, 
 
and is already, from the patient him or herself or from the patients’ parents or from the 
 
clinical records you have before you that Dr Cosgrove treatment of these patients 
transformed their lives for the better in many respects.   

 
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Sir, may I hand in at this stage a bundle of testimonials?  (Same handed
 
 
 
THE CHAIRMAN:  This bundle will be D36. 
 
 
 
MR MORRIS:  I also have a small bundle of miscellaneous documents, which I think is 
 
the safest way to describe them at this stage. 
 

THE CHAIRMAN:  The second bundle will be D37. 
 
 
 
MR MORRIS:  In addressing you on the gravity of the errors that have been found 
 
proved, in my submission they fall into two categories, namely, the errors in the 
 
monitoring/giving of advice to colleague clinicians in relation to the monitoring of 
 
medication on the one hand, and the letters of complaint sent to patient GPs with copies 
to the clinician being complained about and to the patients. 

 
 
Dealing first with the findings that you have made in relation to monitoring deficiencies 
 
and advice deficiencies, I hope that I can fairly categorise them as in all the circumstances 
 
not being very serious deficiencies.  May I first of all run briefly through the findings that 
 
you have made in relation assessment of weight, height, blood pressure and other 
 
monitoring aspects, just to hopefully put the findings into context. 
 

In relation to patient A, whatever his failings in relation to that patient, the undisputed 
 
fact of the matter is that Dr Holme, a paediatrician, did throughout the period exercise a 
 
monitoring function specifically in relation to the Ritalin medication, which I would 
 
submit puts into context the finding in relation to the failure to make an adequate 
 
assessment of the patient’s weight and the failure to advise the patient’s general 
 
practitioner to monitor the patient, as recommended in the above heads of charges. 
 

In relation to the failure to warn the patient’s mother about Clonidine and the deleterious 
 
effect that that might have if sudden withdrawal occurs, again can I seek to put that into 
 
context by citing to you what Professor Taylor had to say about that?  I do not ask you to 
 
turn it up.  It is day 9 of the transcripts at 28H to 29A.  Talking about the hypertensive 
 
rebound if Clonidine is stopped, he said this: 
 
 
“It is a concern, not an established fact, that fluctuations in blood pressure on 

Clonidine have not been charted specifically.  The reason for the recommendation 
 
of steady dose is from the point of view of avoidance of hazard rather than a 
 
hazard that has actually happened.” 
 
 
 
Sir, moving on under this head of “monitoring/advice” and going to patient C, the failure 
found there is the fact that the letter sent to the general practitioner did not contain any 

advice about the appropriate monitoring of Master C.  Again the fact of the matter is that 
 
on the undisputed evidence of Mrs C, Dr Rackham, the patient’s GP, did indeed monitor 
 
the patient’s blood pressure, height and weight.   
 
 
 
In relation to patient D, the failure to make proper arrangements for monitoring the 
 
effects of the treatment that Dr Cosgrove provided for that patient, you will recall that the 
doctor was unable to continue telephone monitoring after July 1996 because he did not 

have the new telephone number for this patient or the patient’s mother, and the 
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responsibility for prescribing and monitoring the medication thereafter went solely into 
 
the hands of  
 
Dr Spence, as was confirmed by Mrs D when she gave evidence to you. 
 
 
 
Specifically in relation to Risperidone, it is perhaps significant to point out that in his 
 
second letter of 17 July – again I do not ask you to turn it up but it is in divider 6 of C8 at 
pages 5 and 6 – he pointed out to the patient’s then general practitioner, Dr Taylor, which 

was shortly before the transfer to Dr Spence, the fact that the Risperidone had side 
 
effects. 
 
 
 
Finally, the remaining defect as found in relation to monitoring and advice relates to 
 
patient G, where it has been found that he did not make an adequate assessment of the 
 
patient’s weight and did not monitor the patient’s growth.  What is clear is that the 
mother was alert to the loss of weight of her son of one kilogram since the beginning of 

medication in February, running up to May.  Indeed, you have in D37 at pages 4 and 5 a 
 
commentary from the mother about Dr Cosgrove’s practice, care and treatment, where 
 
she describes her struggle in relation to getting treatment for her son’s behaviour.  At the 
 
bottom of that page she says this: 
 
 
 
“I do not blame Dr Cosgrove for my son’s weight loss.  This is a known side 
effect of Ritalin.  Had his weight dropped to what I felt to be unacceptable, I am 

more than capable of expressing my opinion and would have asked Dr Cosgrove 
 
to adjust the dosage.” 
 
 
 
Sir, again putting the finding into context, this was a patient whose mother was fully 
 
aware of the possible consequences and known side effects of the medication that  
 
Dr Cosgrove was putting her son on. 
 

Sir, may I make two further general remarks about the defects in monitoring and giving 
 
advice?  Concern was expressed by Professor Taylor that some of these patients, it would 
 
appear, were being monitored without any direct receipt of documentation from the 
 
schools and that the reports from schools were being filtered back through the parents, 
 
with the twofold risk that the school might not give a fully balanced picture in relation to 
the child for the understandable purposes of encouraging the parents and, secondly, that 
 
the parent in relating the material on to Dr Cosgrove might be influenced by what the 

parent had observed at home, and that this was particularly important in the context that 
 
whereas a certain level of medication might be appropriate in order to control behaviour, 
 
there may be grounds for thinking that a different level of medication might have to be 
 
balanced against that in order to secure continuing attention and cognitive function at 
 
school. 
 

I hope that when you have had a chance to look at the testimonials that have been put 
 
before you, you will see in many cases parents speaking of not only a marked 
 
improvement in behaviour but also of academic performance at school, which would tend 
 
to suggest that the medication was not hindering on that front.  Indeed, you have the 
 
specific evidence of Mrs C that from her perspective she felt that the introduction of 
 
medication kept her son in mainstream schooling when otherwise he would have gone up 
a different and more depressing cul-de-sac. 

 
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Secondly, and perhaps most importantly of all, and particularly in terms of the concerns 
 
expressed by Mr Pearce on behalf of the Council of a deep-seated attitudinal problem by 
 
the doctor, I submit that whereas there may well be grounds for saying that in relation to 
 
his attitude to his fellow clinicians and their approach to the diagnosis and treatment of 
 
ADHD, it does not apply in this context of the monitoring of patients.  I say that because 
 
of patient A and his response to the problems that patient A met or underwent. 
 

Sir, at page 68 of C12, the doctor wrote to Dr Holme in July 1999.  You will recall the 
 
evidence that this letter was written after Dr Holme had written about his concern about 
 
the very high level of medication and the tachycardia that he had detected, and had not 
 
only copied that letter to him but had also telephoned the doctor to discuss the matter with 
 
him.  That letter of 3 July, in my submission, is important in the context of what I am 
 
saying.  In my submission, it clearly shows that when Dr Holme made contact with him 
and expressed his concerns, the doctor did not pooh-pooh them.  He did not take a 

rejectionist attitude but he listened to the concerns and acted on them.   
 
 
 
First and foremost, he ensured that the patient and mother came to see him.  He confirmed 
 
the high blood pressure that the doctor had found and conceded that his figures clearly 
 
corroborated the 120-minute figure that Dr Holme had obtained.  He acknowledged that 
 
the probable cause from his perspective for the tachycardia was the Ritalin or 
Methylphenidate, and he acknowledged that it could not be ignored and told the mother 

such.  Notwithstanding that a previous reduction in medication had led to deteriorating 
 
behaviour, he took the view that the level of medication had to be reduced and indeed 
 
asked her to reduce it to 100mg per day.   
 
 
 
In that context, it is perhaps noteworthy that some years later when this patient was sent 
 
to Professor Taylor for a second opinion, the advice coming from the Maudsley in 
relation to that was that the medication was appropriate up to a level of 90mg per day.  

Furthermore, in specific terms of monitoring, he acknowledged the need for closer 
 
monitoring of the pulse rate and made arrangements for the patient’s godmother, a 
 
nursing sister, to do that, together with giving the advice that, in order to have 
 
corroboration of those figures, the family should get the pulse rate readings checked at 
 
the surgery.  Therefore, this is a doctor who, when concerns are put to him and discussed 
with him reasonably, responds reasonably to those concerns and takes action and 
 
increases the level of monitoring. 

 
 
Sir, can I now turn to the second band of findings that you have to deal with, which are 
 
the complaint letters that he wrote to colleague professionals?  Obviously, one has to 
 
accept that there were far better ways of seeking to put over his opinion that the treatment 
 
that his patients had received prior to coming to see him was poor and that, arising out of 
a lack of information or knowledge about the condition and the benefits of medication, 

those concerns could have been communicated in a much more effective and less harmful 
 
way. 
 
 
 
Can I again seek to put in context what was going on here, not as an attempt to excuse his 
 
conduct but as an attempt to explain it?  Professor Taylor readily accepted that  
 
Dr Cosgrove was a pioneer in the development of the broader application of medication 
to this condition both in children and particularly in adults. 

 
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He agreed that the doctor had in the past suffered both media and professional hostility 
 
even though the treatment that he was promulgating was well-founded scientifically, and 
 
the reference for that is Day 9, Page 20 at Letter C. 
 
  
 
He also said that it would be fair to say that there would be a large number of clinicians 
 
still in the late 1990s who were adopting the restrictive approach to the treatment of 
ADHD by medication which was not really justified by the evidence, and it would appear 

that that reluctance by large numbers of his fellow clinicians still persists to this day 
 
notwithstanding the considerable growth of ADHD Clinics that Professor Taylor talked 
 
about. 
 
  
 
The reason I make that submission is the extraordinary divergence between practice in 
 
the United Kingdom and practice in the US which Professor Taylor discussed at Day 9, 
Page 19, Letters D to E.  He said that since the '90s there had been a change and rates of 

prescription have been rising substantially since 1995 and so there is probably now 
 
something like a one-third of one per cent chance of receiving the medication.  However 
 
he acknowledged that that was a very much lower figure than the figure in the US, which 
 
he put at something in the order of five to seven per cent, and therefore the use of 
 
medication in the US was 20 times as common as the use of medication in this country. 
 
  
That reluctance of approach by his fellow clinicians, bordering on hostility on occasions, 

raises its head I suggest in respect of some of the clinicians he had to deal with, or 
 
directly deal with, in particular cases that you have before you today. 
 
  
 
You will recall a letter in C12 at Page 89, and again I do not ask you to turn it up, from 
 
Dr Vereker to Mrs A, where it was clear from that letter that Mrs A had perceived rightly 
 
or wrongly that there was bad feeling on the part of Dr Vereker, the previous treating 
psychiatrist, at the transfer of the patient's care to Dr Cosgrove. 

  
 
Also in C12, at Page 42, there is a letter written by the Consultant Paediatrician, Dr Lwin, 
 
on 5 July 2000 to Dr Barnes, another consultant paediatrician within the hospital, where 
 
he says: 
 
  
"I understand that Dr Holme referred Patient A to you before he 
 
left.  A's adopted mother is aware of this and has already received 

correspondence ... [please] could you offer A an appointment, 
 
please", 
 
  
 
and there is a handwritten response to that on that letter, from I would submit clearly Dr 
 
Barnes, in which he says: 
  

"I do not see children being treated by Dr Cosgrove", 
 
  
 
and a double exclamation mark. 
 
   
 
Now in discussing Patient C Professor Taylor said that, and I think this was of general 
 
application, there was a need to attempt to get a shared care arrangement so that both 
behavioural training and with psychological input could be combined with treatment by 

medication, and that that ought to be feasible and that no Trust would be so obdurate as to 
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stand in the way of that. 
 
  
 
Well again on the ground I submit that things are a little more difficult than that, because 
 
you have at D37 a letter at Page 2 from Dr Moses to the GP, Dr Rackham, dated 1 July 
 
1999.  Now that was written before the diatribe letter, if I can put it like that, of the 7th or 
 
9th July from Dr Cosgrove to her, and so she had not received that letter yet, and she was 
talking about what had happened when the patient's mother had taken the patient to see 

Dr Cosgrove.  The penultimate paragraph: 
 
  
 
"Unfortunately, when C's mother took his to see Dr Cosgrove, 
 
staff felt that their behavioural management of C and entirely 
 
undermined.  I could only agree with this, in particular as C's 
 
response on the morning after he had seen Dr Cosgrove was to 
explain the piece of aggressive behaviour by saying that he had 

ADHD, as if this excused him from any responsibility for his 
 
behaviour. 
 
  
 
C was thus discharged from Pollards Well prematurely, in that we 
 
were expecting to work with him until the end of the summer 
 
holiday". 
  

So, summarily discharged from further behavioural therapy and no attempt to see if it 
 
could be combined with Dr Cosgrove's treatment, and so these were the problems and 
 
obstacles that were being put in Dr Cosgrove's path when he treated patients with 
 
medication. 
 
  
 
It goes on, because you will recall the history in relation to Patient D.  After 1996, when 
care was exclusively confined to Scotland and Dr Spence, none of the clinicians in 

Scotland who all knew that Dr Cosgrove had initiated the treatment with medication 
 
sought to make contact with him to discuss the problems that Dr Spence was having.  Dr 
 
Spence himself, without reference to Dr Cosgrove, increased the dosage up to 60 mgs a 
 
day from the final dose that Dr Cosgrove had established at 35, had tried Clonidine 
 
instead of Risperidone, had reinstated Risperidone when Clonidine did not appear to 
work at an increased dosage of 4 mgs a day and even noted in his notes what to do, and 
 
went on to substitute Dexamphetamine for Ritalin again with no positive results.  No 

attempt to communicate with the doctor to seek his advice on medication in a field at 
 
which it was acknowledged he would have had a lot of experience. 
 
  
 
And in relation to Patient H, Dr Dover, the consultant in child and adolescent psychiatry, 
 
and this is particularly germane in  the context of Professor Taylor talking about the need 
if only to try and persuade existing clinicians about the desirability of a trial of 

medication.  At Pages 6 to 8 you have an extract from that patient's notes, and on 26 June 
 
2002 the Community Psychiatric Nurse had written to the patient's GP, Dr Patel, 
 
informing him of the current situation in relation to the boy and this was before Dr 
 
Cosgrove came on the scene: 
 
  
 
"In brief you are fully aware of our ongoing involvement with 
this family over a period of time.  Family/parent appointments 

were recommended and have been ongoing intermittently 
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following our detailed assessment ... 
 
  
 
Unfortunately Mr H is not at present accepting of the above and 
 
has 'demanded a trial of Ritalin tablets for his son'.  Such has been 
 
discussed with Dr Dover, Consultant ... who does not believe that 
 
there is sufficient evidence to warrant the prescription of 
medication". 

  
 
Dr Patel then writes on Page 7 to Dr Dover saying that: 
 
  
 
"H's parents are concerned again.  Come to see me for lots of 
 
problems at home and school of overactive interest in adult life, 
 
sexuality, naughty behaviour, and intolerable habits ... I should 
write to you to take this matter somewhat differently and more 

seriously ..." 
 
  
 
And then Dr Dover responds to that on 15 July on Page 8 saying: 
 
  
 
"I have already met with the family personally and they have 
 
been assessed in detail by a number of different professionals 
within our team ... At present it is not appropriate for me to offer 

H an appointment with myself as there is no role for medical 
 
treatment in his behaviour problems". 
 
  
 
So, a professed reluctance from Dr Dover even to consider a trial of medication at the 
 
request of parents who clearly are having an extremely difficult time with their child. 
 
  
That is the background as Dr Cosgrove sits in his clinic in Bristol and receives a constant 

flow of patients from all across the country, coming in to his clinic displaying distressing 
 
symptoms which have been graphically highlighted in evidence before you both by Mrs 
 
D, and you will recall her description of her son jumping on the furniture, and Mrs C who 
 
gives a description of during the consultation with Dr Cosgrove of her son kicking, 
 
thumping, pulling her hair and pulling the blinds in the surgery down.  All coming to him 
for what is acknowledged is appropriate treatment at his hands, when they could ill afford 
 
the journey and the fee that he had to charge, and this was going on year after year and 

one can perhaps understand the sense of frustration he felt that good scientific evidence 
 
was being ignored by a large number of consulting psychiatrists in this country which 
 
effectively should have put him out of a job. 
 
   
 
And so one has a background that in his mind the clinicians who had been dealing with 
patients who subsequently came to him were unwilling or unable to take on board the 

new reality and the new evidence and to adjust their practice accordingly, and it is in that 
 
context that he writes these unacceptable letters to them. 
 
  
 
Can I turn to what harm was caused by the sending of those letters.  There is no evidence, 
 
in my submission, that those letters caused any disruption to the treatment patterns 
 
available to the children or patients concerned.  There is no suggestion that, but for the 
sending of that letter, the patient would have been treated differently.  You will recall, for 

example, the fact that Dr Moses says that Patient C was discharged from Pollards Well 
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before the letter was written. 
 
  
 
It is acknowledged, and was accepted, that those letters raised the likelihood of the reader 
 
doubting the knowledge and skills of the clinician.  All those patients and those patients' 
 
parents had already, you may think, been disillusioned with the standards of care that they 
 
or their children or child had received before they first consulted Dr Cosgrove and before 
the letter was written. 

  
 
Certainly it caused embarrassment and difficulty to the clinicians concerned to have his 
 
comments communicated not only to the clinician but to the patient's General Practitioner 
 
and the parents themselves and that cannot be excused but, on the other hand, it did not in 
 
my submission impact or give rise to any risk in my submission that it would impact on 
 
the actual care of that patient. 
  

Sir, can I then turn to the Indicative Sanctions Guidance, which obviously you have to 
 
bear in mind when formulating what to do with the doctor, and by way of preamble 
 
perhaps in Paragraph 13 there is some guidance as to how to approach the mitigation and 
 
material that is before you at this stage in relation to serious professional misconduct and 
 
sanction.   
 
 
You will see there that the Committee, it is said, will need to consider any mitigation in 

relation to the seriousness of the behaviour in question and the extent to which mitigation 
 
should influence judgment on a finding of SPM and then on sanction.  That is a reflection 
 
of the rules, clearly, because your decision on SPM is only taken after you have heard all 
 
the mitigation.  That was reinforced by the Privy Case in the case of Silver, where they 
 
said that it is axiomatic that after the findings of fact all the relevant circumstances must 
 
be considered before a finding of serious misconduct can be arrived at.   
 

Turning to sanctions, the purpose of sanctions, as my learned friend has alluded to, is set 
 
out in paragraphs 10 onwards, the protection of patients and the public interest.  If I can 
 
go to the headings that my learned friend visited under the heading of “Suspension” 
 
which he sought to discuss with you and address to you, he did not characterise on the 
 
behalf of the Council that this was a serious incidence of misconduct in the particular 
context of that list of factors.  He did not contest that the doctor’s behaviour was 
 
fundamentally incompatible with continuing to be a registered doctor.  He suggested 

there was evidence of deep-seated personality or attitudinal problems.   
 
 
 
It is clear from everything you have read and seen that the doctor, in relation to his fellow 
 
clinicians, has taken a firm and unyielding line in relation to their conduct as he sees it.  
 
He has taken that line from a deeply held belief that they have got it wrong and, by 
getting it wrong, they have caused many patients and many patients’ families many years 

of misery.  I have no doubt that were he here today he would plead guilty to that.  As I 
 
have hopefully set out in my submissions, I question to what extent that approach has 
 
caused harm to patient care.   
 
 
 
In relation to insight, it may be said that he does not have insight in relation to that 
 
particular problem, but it cannot be said, in my submission, that he does not have insight 
and is unable to respond to concerns about monitoring and the giving of advice.  Again, I 

cite his response to Dr Holmes’ letter when Patient A was developing a tachycardia 
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problem. 
 
 
 
In particular, the last entry under “Suspension”, 
 
 
 
“Patients’ interests sufficiently respected.” 
 
 
Dr Cosgrove clearly has sought always to respect his patients’ interests to the best of his 

ability.  In so doing, you may think he has overstepped the mark in his dealings with 
 
other clinicians.   
 
 
 
Sir, can I finally turn to the testimonials themselves that really speak more eloquently 
 
than I ever could?  I ask you to look carefully at all of them when you go into camera, but 
 
can I just flag a few up with you particularly.  The first one at pages 1 and 2 is from Dr 
Hartman, a Pathologist, who had recently become a patient of the doctor in 2004, this 

year.  Clearly, he is a clinically well educated person in the context of the condition itself, 
 
about which he has clearly read widely.  He points out at the end of the first paragraph, 
 
 
 
“There is an enormous evidence base for these consequences…” 
 
 
 
that is to say the consequences of not treating this condition by medication, 
 

“…and these form the foundation of the NICE and SIGN guidelines for the use of 
 
methylphenidate in childhood.  An active public and professional education 
 
campaign is starting to occur in the United States of America, but has yet to occur 
 
in the United Kingdom.  I attempted to find a healthcare professional in the United 
 
Kingdom with experience and expertise in diagnosing and managing adult 
 
ADHD.  I was able to find the names of only two such physicians, one of whom is 
Dr Cosgrove.  This demonstrated to me that Dr Cosgrove is one of two doctors 

currently able to provide a service for an estimated 250,000 adults with this 
 
condition in the UK.” 
 
 
 
He goes on to say, 
 
 
“My inability to pay was no impediment to my seeing Dr Cosgrove as a patient.  
 
Dr Cosgrove spent more time with me than I had ever been granted by any 

healthcare professional previously and drew up a targeted treatment plan at the 
 
end of the appointment with clear telephonic follow up appointments.” 
 
 
 
In the subsequent paragraph he talked of an extremely thorough telephone interview 
 
which lasted for close to an hour, again highly targeted, before issuing him with a follow 
up prescription.  He concedes that, after initially being somewhat sceptical about 

telephonic follow up, 
 
 
 
“I was left in no doubt that such a means of follow-up is an extremely useful 
 
means of patient follow-up and indeed, it must surely be necessary given the 
 
number of patients which Dr Cosgrove must care for.” 
 
 
He came to the conclusion, from the perspective of a patient and a medical doctor, that 

there was no doubt that patient welfare is Dr Cosgrove’s foremost priority and that Dr 
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Cosgrove has no mercenary or self-aggrandising motives that he was able to discern.  
 
Although he had not seen the content of the letters that had been written by Dr Cosgrove 
 
to colleagues, he firmly believed that any letters written would have been written because 
 
he cares passionately for his patients and would be trying to educate other healthcare 
 
professionals, patients and their families and it would not be for personal gain.   
 
 
I missed out a passage at the end of the second paragraph on the first page, a little 

incident that happened on the Friday evening of his consultation, when he asked Dr 
 
Cosgrove why he was not preparing to leave, he told him he had another patient and their 
 
family who were travelling from Scotland.  When he looked surprised he was willing to 
 
see a patient so late on a Friday evening, Dr Cosgrove simply said, “I cannot see any 
 
patient suffer.”  That Dr Hartman found profoundly moving. 
 
 
Miss Roue wrote in defence of Dr Cosgrove at pages 3 to 5.  She talks in the third 

paragraph of her son’s physical development being monitored by both themselves and his 
 
GP.  His growth and weight were carefully watched.  His blood pressure was checked 
 
regularly.  She talks of the considerable time he spent discussing the prescription of 
 
Risperidone for the child in a subsequent paragraph.  Over the page she says in the third 
 
paragraph down, 
 
 
“My son is a shining example of how a child with ADHD can be a high achiever 

and with the right care can cope with his condition and succeed.  He has been 
 
treated by Dr Cosgrove since starting school and our son has just this week 
 
managed to pass his 11+ exam.  He passed within the top 90.  He is a happy child 
 
with high self-esteem.  He is top of his class and with the medication is able to 
 
concentrate on his written work which he needs to produce to demonstrate his 
 
intelligence.  Without medication he cannot do this.” 
 

Carrying on on the academic school front, she goes on to talk about two godsons who 
 
also had ADHD.  Within two weeks of starting medication their schools were reporting a 
 
huge improvement in course work.  She goes on to say at the bottom of the page, 
 
 
 
“I am not some deluded individual who has in any way been hoodwinked by some 
devious doctor.  I am an intelligent and rational person who has researched my 
 
son’s condition widely.” 

 
 
Can I take you on to page 20, which is a statement from Musa Idris?  In the middle of the 
 
page, 
 
 
 
“Telephone appointments are always extremely in depth – concerning weight, 
eating and sleeping patterns, diet and current medication dosage.  In fact, on one 

occasion when Musa missed an appointment, Dr Cosgrove refused to send a 
 
repeat prescription until a follow-up appointment had been made.” 
 
 
 
So the monitoring process was a real process.  If it did not proceed, it meant that Dr 
 
Cosgrove would not prescribe.   
 
 
On page 22 there is a letter from Anna Richardson.  She talks about the problems her 

child was having.  In the second paragraph, 
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“Eventually I took my son to see an NHS Consultant who told me that there was 
 
no treatment available other than behaviour therapy (that I had been doing 
 
anyway).  This Consultant frightened me into believing that prescription 
 
treatments for this condition would leave my son ‘doped’ and in danger, he 
 
recounted horror stories in the USA and worried me.” 
 

That is another illustration of the hostility that still persists in parts of the profession. 
 
 
 
At page 37 there is a note from Venetia Hill.   
 
 
 
“I am very grateful for Dr Cosgrove’s practice, care and treatment because no 
 
other psychiatrist has given me such confidence.  I was very frightened of putting 
my son on medication and effectively resisted for 14 years, but at a terrible price 

with my son becoming violent and the police having to be called sometimes.  No 
 
amount of behaviour therapy has had the same effect of helping my son 
 
concentrate as the medication.” 
 
 
 
The patients and parents of patients who are coming to Dr Cosgrove are not coming out 
 
of a sense of “Medication is the answer.  It gets us off the hook as responsible parents.  
We are not to blame”, and leaping at the prospect.  Patients and parents have been deeply 

sceptical about the use of medication in the treatment of their children.   
 
 
 
Sir, Dr Cosgrove, in my submission, clearly cared, perhaps not wisely but too well for his 
 
patients, but over the years he has done a great service to a large swathe of sufferers from 
 
this syndrome who have been deprived of appropriate care, notwithstanding the proper 
 
evidence base on which he was acting.  In my submission, there remains a continuing 
place in medicine for this doctor. 

 
 
THE CHAIRMAN:  Thank you very much.  At this point I will turn to the Legal 
 
Assessor. 
 
 
 
THE LEGAL ASSESSOR:  Once again, I have prepared a written advice which I propose 
to read into the record.  I am grateful to both Counsel for their comprehensive addresses, 
 
because it has reduced what I have to say to the Committee.   

 
 
These proceedings have now reached the point where the Committee has to determine 
 
whether the proved and admitted facts, taken with the evidence adduced by the parties 
 
under rule 28 is such that they find Dr Cosgrove guilty of serious professional 
 
misconduct.  I repeat part of my earlier advice as to what constitutes serious professional 
misconduct.  It is conduct which has a link with the practice of medicine and which, in 

the circumstances of the case, represents a serious – and I stress that word – breach, 
 
whether by omission or commission, of the rules and standards, written and unwritten, 
 
ordinarily required to be followed by a registered medical practitioner.  
 
 
 
The Committee is charged with whether they find Dr Cosgrove guilty of such conduct.  I 
 
advise that if, after anxious consideration of the proved and admitted facts of the charge, 
and what I shall call compendiously the rule 28 evidence, they are left in any real doubt 

as to whether Dr Cosgrove is guilty of serious professional misconduct, then he should 
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have the benefit of that doubt. 
 
 
 
In the event that Dr Cosgrove is found guilty of serious professional misconduct, the 
 
question of sanction by means of a direction concerning his registration then falls to be 
 
considered.  The way in which the Committee approaches this is governed by law.  The 
 
applicable law is to be found in the Statutory Instrument SI 1988 12255, more commonly 
known as the Professional Conduct Committee Rules.  It has the force of law and the 

authority of Parliament.  The relevant law is to be found in rules 30 and 31.   
 
 
 
The Indicative Sanctions Guidance is a highly relevant document.  Its provisions may 
 
properly be referred to and given great weight by the Committee, but it is guidance and 
 
not law.  This has two consequences.  The first is the one that whilst the guidance must be 
 
taken into account, Dr Cosgrove’s case must be considered on its own particular facts and 
the appropriate decision reached on those facts. 

 
 
Secondly, if there is a conflict between the procedure laid down by Parliament in rule 30 
 
and rule 31 and the Indicative Sanctions Guidance, it is the rules that must be given 
 
preference. 
 
 
 
With this in mind I advise the Committee that they should try, if at all possible, to reach a 
decision suited to the facts of this case which is both in accordance with the rules and in 

harmony with the Indicative Sanctions Guidance. 
 
 
 
Rule 30(1) requires the Committee to consider whether they should postpone the 
 
determination or whether to make a direction.  If the Committee do not consider that this 
 
is necessary, then it has to consider whether it is sufficient to make no direction.  
 
Although this is not named in the rules, this course amounts to a reprimand.  If a 
reprimand is not sufficient, then the Committee must consider whether the imposition of 

conditions on the practitioner’s registration lasting for not more than three years for the 
 
purpose of protecting members of the public, which of course includes patients, or for his 
 
own interests, is sufficient.  If and only if the Committee consider that the imposition of 
 
conditions is insufficient will the Committee go on to consider whether they should 
 
exercise their powers to suspend Dr Cosgrove’s registration for a period of up to 12 
months.  Lastly, I repeat and emphasise that if and only if suspension is considered to be 
 
insufficient should the Committee exercise their power to erase.  This is the scheme of the 

imposition of sanctions laid down by Rule 31.   
 
 
 
It may be fairly asked what is meant by the word “sufficient”.  My advice is that it means 
 
“proportionate”.  A sanction will be proportionate if it is no more than is necessary to 
 
achieve one or more of the following objectives:  the protection of the public, again of 
course including patients; maintaining public confidence in the maintenance of proper 

professional standards by the self-regulation of the medical profession; and the interests 
 
of the practitioner himself.  This list is not exhaustive. 
 
 
 
A number of specific points need to be made about the application to the doctor of 
 
proportionality.  First, it is not legitimate to impose a sanction merely to punish a 
 
practitioner.  A sanction may be imposed for a legitimate purpose, the inevitable 
consequence of which may well have a punitive effect – for example, loss of employment 

on erasure or suspension – but in such a case the Committee must be satisfied that such an 
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erasure or sanction is no more than necessary to protect the public or to achieve some 
 
other legitimate purpose. 
 
 
 
Secondly, maintaining the reputation of the medical profession is frequently said to be 
 
such a legitimate objective, and indeed it is.  However, this does not mean simply the 
 
standing of the profession in the eyes of the public considered in isolation.  The legitimate 
objective to be pursued is rather that the profession’s reputation is truly maintained, in the 

sense that an informed public perceives and is both reassured by and justifiably confident 
 
of the fair, transparent and effective regulation that the medical profession operates to 
 
ensure that it can truly be said that both the public and the public interests are protected 
 
by it. 
 
 
 
Lastly, my statutory remit is to advise the Committee on points of law.  The Committee 
are not obliged to follow my advice.  Should they decline to do so, I advise that it be 

stated expressly in their determination that they decline to do so and the law that they do 
 
in fact apply.  The reason for this is so that Dr Cosgrove and anyone advising him can 
 
then be certain of what law was applied in his case. 
 
 
 
That is my advice. 
 
 
THE CHAIRMAN:  Can I seek clarification of one point that you made?  I may have 

picked it up incorrectly, but I thought I heard you say that if the panel found the doctor 
 
guilty of serious professional misconduct and were minded to take no action against his 
 
registration, this was a reprimand.  My understanding is that the panel can take no action 
 
against the doctor’s registration or offer a reprimand.  I thought that was what you had 
 
said, Mr Pearce. 
 
THE LEGAL ASSESSOR:  Sir, just to reply to that, I may very well be in error.  I 
thought that if no action was taken, that constituted a reprimand.  I would be grateful for 

any guidance that counsel can give me on that. 
 
 
 
MR PEARCE:  I think the Indicative Sanctions Guidance suggests that there are two 
 
different things involved here.   
 
 
THE CHAIRMAN:  I would refer you to paragraph 8. 
 
 

MR PEARCE:  Paragraphs 8 and 15.  Paragraph 8 makes the point that the Procedure 
 
Rules do not require the Committee to impose a sanction, so it is thus open to the 
 
Committee to conclude the case without a reprimand, namely, the lowest level of 
 
sanction.  That paragraph therefore suggests that one can have no action, which is as it 
 
were resolved on a reprimand.  Paragraph 15 states that where the Committee decide that 
it is not sufficient to conclude a case of serious professional misconduct or conviction 

with no action, a reprimand is the lowest sanction that can be applied.  It goes on to make 
 
the point that a reprimand does not actually appear in the terms of the legislation but that 
 
it is open to the Committee to express an opinion.  So I think we can read it in more than 
 
one way. 
 
 
 
THE LEGAL ASSESSOR:  My approach is that I do not think the word “reprimand” is 
actually mentioned in the rules, but it seems to have acquired an existence of its own 

before this Committee.  I stand corrected in that sense and I would alter my advice.  It 
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appears to be a course open to the Committee to take no action and, if that is not 
 
sufficient, they can go on to reprimand, in which case my advice is that you should 
 
simply insert “no action” into the scheme of ascending actions that may be taken by the 
 
Committee in response to a finding of serious professional misconduct.  However, I stress 
 
that the first stage is to consider whether you find Dr Cosgrove guilty of serious 
 
professional misconduct.  I am grateful to the Chairman for drawing that to my attention. 
 

THE CHAIRMAN:  Mr Morris, do you have any view on what has been discussed? 
 
 
 
MR MORRIS:  Sir, no.  I respectfully agree that there are two aspects to conclude the 
 
matter.  If one goes back to the statute, Rule 30(2) states that if the Committee decide that 
 
no such postponement, that is, where the option of postponement is considered, is 
 
necessary, they should consider and determine whether it shall be sufficient to make no 
direction and conclude the case and that, if they so determine, the Chairman should 

announce that determination.  Rule 31 goes on to set out various directions, which, of 
 
course, start with conditions and go on up the ladder.  It would therefore appear that the 
 
practice that has arisen of either taking no action or issuing a reprimand both fall within 
 
Rule 30(2). 
 
 
 
THE LEGAL ASSESSOR:  In my advice I said that although it is not named in the rules, 
the reprimand does not exist.  I am frequently accused of being perhaps a trifle over-

legalistic, and I think it would not be correct for me to argue that the reprimand simply 
 
does not exist because it is not mentioned in the rules, but if perhaps I can just clarify it, 
 
the ascending order will then be:  no direction; reprimand; conditions; suspension; 
 
erasure. 
 
 
 
THE CHAIRMAN:  I think we are all agreed on that. 
 

THE LEGAL ASSESSOR:  I am grateful. 
 
 
 
THE CHAIRMAN:  The Committee will now go into camera. 
 
 
 
STRANGERS THEN, BY DIRECTION FROM THE CHAIR, WITHDREW AND THE 
COMMITTEE DELIBERATED IN CAMERA 
 
 

STRANGERS HAVING BEEN READMITTED
 
 
 
THE CHAIRMAN:  Mr Morris, at all material times, Dr Cosgrove was practising as a 
 
Consultant Child and Adolescent Psychiatrist working in private practice at the Bristol 
 
Priority Clinic.  The Committee have considered the cases of a number of patients seen 
by Dr Cosgrove between May 1996 and January 2003.  These patients were both adults 

and children and were diagnosed as suffering from Attention Deficit Hyperactivity 
 
Disorder (ADHD).  Dr Cosgrove prescribed drugs to these patients but did not take 
 
appropriate steps to monitor the patients whilst they were taking the drugs prescribed and 
 
as such acted irresponsibly and not in the best interests of the patients. 
 
 
 
The Committee have further found proved that on a number of occasions Dr Cosgrove 
sent letters to other practitioners who were involved in the care of the patients he had seen 

and copied these letters to the patients or their parents.  In those letters he made 
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comments which were unprofessional, unsustainable and likely to cause the reader to 
 
doubt the knowledge and skills of the practitioners referred to within the letters. 
 
 
 
The Committee have also found that in or around August 2000, Oxfordshire Mental 
 
Healthcare NHS Trust carried out an investigation into a number of features of the 
 
treatment of a patient of the Trust, Patient E.  On 29 September 2000, Miss Wendy  
Samways, Complaints Manager at the Oxfordshire Mental Healthcare NHS Trust, wrote 

to Dr Cosgrove requesting copies of his clinical notes concerning Patient E and enclosed 
 
signed authorisation for the release of the records.  Dr Cosgrove replied to this request by 
 
letter dated 3 October 2000, stating that he would not supply the medical records.  The 
 
Committee have heard that Dr Cosgrove and Mrs E came to a shared agreement that the 
 
records should not be disclosed and for that reason the Committee did not find that his 
 
failure to supply the medical records was inappropriate or unprofessional.  Nonetheless, 
the Committee found that Dr Cosgrove acted unprofessionally and made unsustainable 

comments in his letter dated 3 October 2000 to Oxfordshire Mental Healthcare NHS 
 
Trust.  These comments were likely the cause the reader of the letter to doubt the 
 
knowledge or skills of the employees of the Trust who treated Patient E. 
 
 
 
The Committee acknowledge that throughout the course of this inquiry there has been no 
 
criticism of Dr Cosgrove’s prescribing practice to those patients whom he diagnosed as 
suffering from ADHD.  Instead, this case has been centred around Dr Cosgrove’s 

monitoring of those patients whom he diagnosed as suffering from ADHD and the letters 
 
he subsequently sent to other practitioners involved in the care of those patients.  The 
 
Committee are concerned about the evidence adduced in relation to Dr Cosgrove’s 
 
management of patients to whom he had prescribed drugs.   
 
 
 
Professor Taylor, a Child and Adolescent Psychiatrist, attended to give his expert opinion 
on these matters.  He has told the Committee that it is necessary to undertake a physical 

examination, including height, weight and blood pressure of patients who are taking 
 
Ritalin and Risperidone, in order to determine whether continued prescribing is 
 
appropriate.   
 
 
 
The Committee have had regard to the European Child and Adolescent Psychiatry 
Clinical Guidelines for Hyperkinetic Disorder, 1998 on monitoring patients to whom 
 
Ritalin is prescribed and to Professor Taylor’s protocol for the monitoring of patients to 

whom Ritalin in doses of up to 60 mg per day is prescribed.  They have found that  
 
Dr Cosgrove’s monitoring of patients over the telephone was not sufficient to obtain 
 
relevant information for the monitoring of patients and prescribing of Ritalin and fell 
 
short of the standards of monitoring which both the European Guidelines and Professor 
 
Taylor’s own protocol recommend.  
 

The Committee have heard that an initial consultation was carried out on a face-to-face 
 
basis and that Dr Cosgrove usually undertook follow-up consultations over the telephone. 
 
 Whilst some information can be obtained by means of a telephone conversation, this is 
 
inadequate for the totality of monitoring which was required for these patients.  The 
 
Committee acknowledges that whilst some of the patients’ GPs were undertaking some 
 
monitoring, this was not undertaken to its fullest extent, nor did Dr Cosgrove give explicit 
instructions for the monitoring of these patients.  The Committee note that Dr Cosgrove 

also made informal arrangements for the parents to undertake some monitoring of their 
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child.  However, the Committee consider that those arrangements were inadequate and 
 
unacceptable.  The Committee consider that Dr Cosgrove was the prescribing practitioner 
 
and as such was responsible for the proper monitoring of his patients.  In not doing so, he 
 
failed to discharge his duties in being responsible for those patients.   
 
 
 
The Committee have also heard evidence from a number of witnesses with regard to 
certain of the correspondence that Dr Cosgrove sent to other medical practitioners, 

patients or their parents.   The Committee have found that the nature of this 
 
correspondence goes far beyond what amounts to robust criticism and that he acted in a 
 
wholly unprofessional manner in sending those letters.  The Committee consider that he 
 
was not in possession of all of the facts pertaining to the issues dealt with in the letters 
 
when he made his judgments and as a consequence he persistently undermined the 
 
opinions provided by and the standing of other practitioners involved in the care of the 
patients for whom he prescribed.   Furthermore, in copying those letters to the patients or 

their parents and GPs of patients, he undermined future patient/doctor relationships and 
 
the further proper medical care of these patients. 
 
 
 
The Committee consider that in sending those letters, that Dr Cosgrove breached the 
 
principles contained with the GMC publication “Good Medical Practice”.  The October 
 
1995 and July 1998 editions state: 
 

“You must not make any patient doubt a colleague’s knowledge or skills by 
 
making unnecessary or unsustainable comments about them”’; 
 
 
 
and, in similar terms, the May 2001 edition states: 
 
 
 
“You must not undermine patients’ trust in the care or treatment they receive, or 
in the judgment of those treating them, by making malicious or unfounded 

criticisms of colleagues”. 
 
  
 
The Committee have considered all the submissions made on behalf of Dr Cosgrove, 
 
including those of Mrs C and Mrs E, who attended the hearing.  It has been submitted that 
 
Dr Cosgrove in treating his patients considered that he was acting only in their best 
interests.  It has further been submitted that Dr Cosgrove did not act out of malice or to 
 
gain personal advantage.  There has been no evidence before the Committee that suggests 

that any patients suffered harm as a result of Dr Cosgrove’s actions. 
 
The Committee have also read and carefully considered the many testimonials which 
 
demonstrate that Dr Cosgrove is well respected and held in high regard by his patients.  
 
There is no doubt that Dr Cosgrove considered that he had the best interests of his 
 
patients at the forefront of his mind.   
 

Whilst the Committee acknowledge the difficulties that Dr Cosgrove faced within the 
 
profession with the regard to the recognition of ADHD and its treatment with medication, 
 
this cannot justify his failure to discharge his duties as a treating consultant and cannot be 
 
used as an excuse for his lack of patient monitoring and attitude towards colleagues.   
 
 
 
Dr Cosgrove as a consultant should have working to the highest standards and should 
have demonstrated good standards of care.  All patients are entitled to receive good 

standards of practice and care from their doctors and the practice of medicine involves 
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teamwork at all levels.  Patients and colleagues are entitled to be treated properly and 
 
considerately.  Dr Cosgrove did not demonstrate this consideration.  The Committee have 
 
found that he repeatedly, through correspondence, made unsustainable criticisms against 
 
other medical practitioners and cast doubts on their clinical competence. 
 
 
 
The Committee have considered all the matters and judge Dr Cosgrove’s behaviour to be 
a serious departure from the standards of care and conduct expected of a registered 

medical practitioner.  The Committee find Dr Cosgrove guilty of serious professional 
 
misconduct.   
 
 
 
The Committee have noted the letter from Dr Cosgrove dated 16 March 2004, in which 
 
he states that he has now retired from medical practice.  Despite this, the Committee note 
 
that Dr Cosgrove remains on the Medical Register as a fully registered medical 
practitioner.  The Committee are therefore bound to decide what action to take, if any, 

concerning his future registration with the GMC. 
 
 
 
In doing so they have carefully considered the issue of proportionality.  It is the duty of 
 
this Committee to protect patients and maintain public confidence in the medical 
 
profession.  It is the Committee’s duty to ensure that the public continues to have 
 
confidence in self-regulation of the medical profession and that the reputation of the 
profession is upheld.  

 
 
The Committee have considered the range of sanctions available and have also taken 
 
account of the advice provided in the Indicative Sanctions Guidance published by the 
 
GMC and have followed the advice tendered by the Legal Assessor. 
 
 
 
The Committee first considered whether to conclude this case by taking no action or by 
issuing a reprimand.  The findings against Dr Cosgrove represent a serious breach of the 

principles of Good Medical Practice and the standards of care and conduct which the 
 
public is entitled to receive from registered medical practitioners.  Furthermore, the 
 
Committee note that further similar incidents occurred after 2002 despite Dr Cosgrove 
 
being notified of these matters by the GMC in 2002.  The Committee found that 
 
Dr Cosgrove did not demonstrate insight into his failings, he has not expressed any 
remorse or regret for his actions and there is no evidence that he has taken rehabilitative 
 
steps to remedy the matters which have brought this case before the Council.    

 
 
They have therefore determined that to conclude this case with a reprimand would not 
 
sufficiently reflect the seriousness of the case.   
 
 
 
The Committee have carefully considered whether to impose conditions on 
Dr Cosgrove’s registration.  They consider that any conditions should be appropriate, 

proportionate, workable and measurable.  The persistent nature of his inappropriate and 
 
unprofessional conduct from 1996 to 2003, which included a period after which he 
 
became aware that his conduct was under review by the GMC, provided evidence of the 
 
presence of attitudinal difficulties.  The Committee have had no indication of his 
 
willingness to respond positively to re-training and coupled with the difficulty in 
 
formulating practical conditions for the type of work that Dr Cosgrove undertook, the 
Committee have determined that any conditions would be an insufficient response to the 

finding of serious professional misconduct.   
 
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The Committee consider that Dr Cosgrove has not demonstrated any remorse or insight 
 
into his behaviour.  The matters under consideration by this Committee have occurred 
 
over a significant period of time in particular in 2003, by which time he was aware of the 
 
investigations being carried out by the GMC.  The Committee have come to the 
 
conclusion, having taken into consideration his significant departure from Good Medical 
Practice in several areas that it is in the public interest and to protect members of the 

public and the reputation of the medical profession, that Dr Cosgrove’s registration 
 
should be suspended for a period of 12 months. 
 
 
 
The effect of the foregoing direction is that, unless Dr Cosgrove exercises his right of 
 
appeal, his registration will be suspended for a period of 12 months beginning 28 days 
 
from the date that proper notice is deemed to have been served on him. 
 

The Committee will resume consideration of his case at a meeting to be held before the 
 
end of the period of 12 months. At that hearing the Committee will expect to receive 
 
evidence that Dr Cosgrove has addressed the problems identified throughout this 
 
determination including: 
 
 

 
  Evidence as to how he would improve his practice towards monitoring patients 
whom he may treat or for whom he may be responsible; 

•  Evidence that he has improved his communication skills;  
 
•  Evidence that he has addressed his attitudinal difficulties. 
 
 
 
The Committee will consider whether to take further action in relation to Dr Cosgrove’s 
 
registration. He will be informed of the date of that meeting which he will be expected to 
 
attend. 

 
Shortly before the resumed hearing he will be asked to furnish the General Medical 
 
Council with the names and addresses of professional colleagues and persons of standing 
 
to whom the Council may apply for information as to his conduct since the hearing of Dr 
 
Cosgrove’s case.  
 
 
 
The Committee are minded to consider the issue of making an order for the immediate 
suspension of Dr Cosgrove’s registration and would wish Counsel to address the 

Committee on those issues. 
 
 
 
 
Thank you very much, Mr Morris. 
 
  
MR PEARCE:   Sir, for our part we would say that the matter of immediate suspension is 

one that lies very much in your domain to determine, save and except that those matters 
 
which lie behind your decision to make an order of suspension on the doctor's registration 
 
might themselves be taken as grounds upon which you think an order for immediate 
 
suspension is appropriate.  Unless I can assist further, I have nothing to add? 
 
  
THE CHAIRMAN:   No, thank you. 
 
  

Mr Morris? 
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MR MORRIS:   Sir, I would submit it is not necessary for the protection of members of 
 
the public, or would be in the best interests of the practitioner to order immediate 
 
suspension in the light of his letter of 16 March 2004 which establishes that he has retired 
 
from medical practice, the clinic from which he has practised and which is the source of 
 
the actions the subject of this Committee's determination this afternoon has ceased to 
exist and immediate suspension is not necessary. 

  
 
THE CHAIRMAN:   Thank you.  Does any Member of the Panel wish to raise anything 
 
with Counsel? 
 
  
 
Legal Assessor, is there anything that you want to say? 
 
  
THE LEGAL ASSESSOR:   No, thank you. 

  
 
THE CHAIRMAN:   We will now go into camera again. 
 
  
 
STRANGERS THEN, BY DIRECTION FROM THE CHAIR, WITHDREW 
 
AND THE COMMITTEE DELIBERATED IN CAMERA 
 
  
STRANGERS HAVING BEEN READMITTED 

  
 
THE CHAIRMAN:   Mr Morris: 
 
  
 
The Committee have considered your submissions.  The Committee have been mindful of 
 
Dr Cosgrove's letter of 16 March 2004 in which he states that he has retired from medical 
 
practice, however, the Committee remain of the view that he remains on the Medical 
Register as a fully registered medical practitioner and would therefore be able to return to 

medical practice in the intervening period should he so decide. 
 
  
 
The Committee have determined that in accordance with Rule 32 of the Procedure Rules, 
 
Dr Cosgrove's registration shall be suspended forthwith.  The reason for so doing is for 
 
the protection of members of the public. 
  
 
The effect of this direction is that Dr Cosgrove's registration will be suspended from the 

date on which notice of the direction  is deemed to have been served upon him. 
 
  
 
The substantive period of suspension for 12 months, as already announced, will then take 
 
effect 28 days from the date on which notice of the direction is deemed to have been 
 
served upon him, unless he lodges an appeal in the interim. 
  

The order for immediate suspension will remain in force until the substantive order for 
 
suspension takes effect. 
 
  
 
That concludes the case.  Thank you very much.  I am sorry, it does not quite conclude 
 
the case.  I should have asked the Legal Assessor to repeat a bit of advice he gave us 
 
while in camera and so I will get him to repeat that advice now.  I am sorry about that. 
  

THE LEGAL ASSESSOR:   Yes.  Well, I referred the Committee to Section 38 of the 
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Medical Act 1983.  The part that was read to the Committee related to the basis on which 
 
the immediate suspension could be made.  I referred them to the words which said: 
 
  
 
"... if satisfied that to do so is necessary for the protection of 
 
members of the public or would be in the best interests of that 
 
person, may order that his registration be suspended forthwith ..." 
  

The simple point was to make it clear that the Committee had the power to suspend 
 
forthwith, either on the basis of protecting the public, or in the interests of the 
 
practitioner. 
 
  
 
THE CHAIRMAN:   It was a simple reading of the appropriate point in the legislation. 
 
  
So, that concludes the case now.  Thank you. 

  
 
  
 
  
 
  
 
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