Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

The Director of Proceedings charged Dr Wiles with disgraceful conduct in that he had an intimate and sexual relationship with his patient or former patient.

Background: 

There was no dispute that the patient had been Dr Wiles' patient, and that they went on to have an intimate and sexual relationship. Dr Wiles contested that the circumstances did not amount to a disciplinary offence.

The course of events could be divided into three phases. First, a period of several years during which the patient consulted Dr Wiles as a patient without any other dimension to the relationship. Second, a period of some months during which the patient did not consult Dr Wiles as a medical practitioner. At this time the patient worked in a building that Dr Wiles frequently attended. During this phase the patient and Dr Wiles had a friendship that involved day to day contact. The third phase was from the commencement of the sexual relationship to its conclusion, and subsequent events.

First Phase:

The patient first consulted Dr Wiles in the latter part of the 1980s. The matters the patient considered particularly significant included:

• Dr Wiles was the lead maternity caregiver during her pregnancy in the late 1980s and delivered her first child,
• During and after the pregnancy there were frequent consultations regarding the patient's health, and her child's health,
• Following the birth of her first child, the patient was very "stressed and depressed",
• In the mid 1990s the patient had a pregnancy that resulted in a miscarriage in circumstances that caused the patient a great deal of distress and anguish.
• the patient referred to a number of events both of a medical nature, and other things that made her vulnerable during the years she consulted Dr Wiles. The patient detailed employment stresses, various minor health issues, post-natal depression, colposcopy, a health problem her child suffered from, difficulties in her relationship with her husband, her feelings about the miscarriage, difficulties with an employee, and coping with young children.

Second Phase:

At the last medical consultation the patient had with Dr Wiles, she presented with a relatively minor medical problem. In evidence Dr Wiles described a discussion that took place at the end of that consultation which led to the professional services practice in which the patient worked moving to a building that Dr Wiles frequently attended.

From this point the relationship between the patient and Dr Wiles developed in multiple ways. The first was day to day contact that arose from the relocation of the practice in which the patient worked which led to virtually daily social contact. The patient also provided professional services to the Medical Centre in which Dr Wiles practised. This occurred soon after the last medical consultation.

During this time the patient had contemplated continuing to have her children treated at the Medical Centre in which Dr Wiles practised, and finding another doctor to treat her. The Tribunal considered that the patient never fully resolved the issue in her own mind.

The relationship between Dr Wiles and the patient changed from social friendship to an intimate friendship on about 76 days after the last medical consultation. On or about that day there was a conversation in which each indicated to the other possible interest in an intimate relationship. There is considerable conflict in the evidence about the details of how the relationship developed, and particularly the timing of various events.

The Tribunal was satisfied that Dr Wiles and the patient entered into an intimate relationship about 76 days after the last medical consultation, and that sexual intercourse took place at some point between 5 weeks and 3 months after the relationship first became intimate. The Tribunal was also satisfied that in the interval there was intimate sexual contact.

Third phase:

After sexual intercourse first took place, Dr Wiles and the patient had an ongoing sexual relationship that continued for about a year. They continued to see each other most days during that year. The relationship was clandestine, as the patient and Dr Wiles were still living with their respective spouses, who were not aware of the relationship between the patient and Dr Wiles.

The relationship ceased to be secret due to a development at a social function which Dr Wiles and the patient attended. Dr Wiles separated from his wife some two weeks after the fact of his relationship with the patient became open, and Dr Wiles wished to commit himself to the relationship with the patient. The patient however ultimately committed herself to her marriage, and rejected the relationship with Dr Wiles.

Finding:

A majority of the Tribunal concluded that the conduct of Dr Wiles did not reach the threshold for disciplinary action. The Tribunal did not do so without hesitation, and not without concluding that Dr Wiles' pursuance of his relationship with the patient was unwise in the extreme, but in the judgment of the majority of the Tribunal it fell short of the threshold for disciplinary action.

The minority member of the Tribunal considered that Dr Wiles was guilty of conduct unbecoming a medical practitioner and that conduct reflected adversely on his fitness to practise medicine.

The Tribunal was very conscious in this case that it needed to consider both the ethical standards of the profession, and also the need to set standards having regard to patient interests and community expectations.

There were certain matters that were not part of the facts in this case, and the Tribunal emphasised that had they been present there can be no doubt that a disciplinary offence would have been established. It emphasised that it specifically found:

• There is no evidence that either Dr Wiles or the patient initiated any sexual, or romantic contact in the clinical setting.
• There was no doctor/patient consultation after Dr Wiles and the patient became involved in a romantic relationship.
• Dr Wiles never treated the patient for a psychiatric condition, or provided psychotherapy, or provided formal counselling. Dr Wiles did discuss and advise on personal difficulties.

The majority of the Tribunal was satisfied after considering the evidence given by the patient and Dr Wiles that the issues of power in the doctor/patient relationship had at least been substantially dissipated by the intervention of the friendship that had developed. It was satisfied that by the time the relationship first became intimate, the patient had ceased to regard Dr Wiles as her doctor, and Dr Wiles had ceased to regard the patient as his patient. Accordingly, the Tribunal found Dr Wiles could not exert any influence as a doctor, whatever he said or did was as a friend by this time.

The majority of the Tribunal was satisfied on the evidence that had the patient been located where she saw Dr Wiles on a day to day basis, without having formerly been a patient of Dr Wiles, exactly the same outcome would, or could, have occurred after they began to spend time together.

The Tribunal considered despite the fact the facts of this case fell short of justifying disciplinary action, Dr Wiles' actions were most unwise, and indeed fell just short of the disciplinary threshold. Its criticism was because at the point where the relationship became sexualised, Dr Wiles could have acted in a way that would have protected him and the patient.

The Tribunal considered that when Dr Wiles and the patient recognised that there was a mutual interest in pursuing a romantic relationship, Dr Wiles should have frankly told the patient that the fact they had been doctor/patient was an issue he had a professional obligation to face. To an extent Dr Wiles did that by discussing, and effecting the transfer of medical records of the patient and her children. However, that was not the issue, while there were no ongoing consultations the transfer of records did not "wipe the slate clean". At that point the patient should at least have been advised of the issue regarding possible harm to her from a relationship with her former doctor. The Tribunal was very conscious that where there is a sexual relationship with a doctor and a former patient, where the doctor/patient relationship has been a significant one, it is very common indeed for the former patient to be badly harmed emotionally in the relationship.

In this case the majority of the Tribunal considered that Dr Wiles' actions did not reach the threshold for disciplinary action, because the particular relationship Dr Wiles and the patient developed from the last medical consultation to the time the relationship became intimate placed sufficient distance between the doctor/patient and the sexual relationship. The majority of the Tribunal concluded that there was sufficient distance between the doctor/patient relationship and the intimate and sexual relationship to fall short of a disciplinary offence.

Appeal:

The Director of Proceedings appealed the majority Decision of the Tribunal to the District Court.  The appeal was dismissed (DP v Wiles (District Court, Wellington, MA 69/01, 26 January 2003, Lee DCJ)).  The Director of Proceedings appealed the District Court Decision.  The High Court dismissed the appeal (DP v Dr Wiles (High Court, Wellington, AP 33/02, 24 November 2002, France J)).