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Very Important News regarding Dr Myhill and the GMC

Discussion in 'Action Alerts and Advocacy' started by Supporters of Dr Myhill, Sep 15, 2010.

  1. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    Dear All,

    Here is a letter from Sarah.

    Please read, act and post as much as you can.

    Thanks for your continuing support!



    =========================================================================


    Dr Sarah Myhill MB BS, Upper Weston, Llangunllo, Knighton, Powys, Wales, UK LD7 1SL
    Tel: 01547550331 Fax: 01547550339 E-mail: office@doctormyhill.co.uk Website: www.drmyhill.co.uk

    Newsletter 14 September 2010
    Dear All,

    I have just received a further summons from the General Medical Council for a further Interim Orders Panel Hearing to be held at the GMC, 350 Euston Road, London on Thursday 7th October at 9.30a.m. The GMC have sent me 3,718 pages most of which are your wonderful letters and a full print out of the on-line petition.

    There is only one new piece of evidence which is a GMC commissioned Expert Witness report into the website complaint. It appears the B12 complaint (from the Partners Practice) has not been investigated further as there are no witness statements nor Expert Witness reports. My aim at this hearing will be to have all the charges against me thrown out. So what are my chances?

    In my favour
    The GMC commissioned an Expert Witness report into my website in which the Expert Witness concludes:

    For all the reasons given above, in producing her website and giving information and opinion I consider that overall Doctor Myhills actions are appropriate and of a reasonably competent standard. In my opinion it is difficult to clarify the role Doctor Myhill has. She is not acting as a GP in producing her website. In my opinion it is fair to say that on the evidence available Doctor Myhill is acting as a reasonably competent doctor providing free advice and opinion.

    With respect to the Partners complaint where I recommended B12 injections I have demonstrated to the GMC the following:
    1. The Partners Practice has told lies. This I pointed out to the GMC at my first IOP Hearing but they chose to ignore it.
    2. The GMC themselves misconstrued the evidence and got their facts wrong. As a result of a Data Protection Act search I find that my case was drawn up by a member of the GMC legal team who, in the letter of instruction to the GMC Expert Witness Professor Bouloux, described me in the male gender and as a consultant anaesthetic (sic). It is difficult to imagine how one can make four mistakes in three words but this has been achieved with merit! The rest of the account of my dealings with the Partners practice together with my past history with the GMC is similarly flawed and shot through with inaccuracies.
    3. The Expert Witness report by Professor Bouloux is entirely based on the GMCs version of events. He simply copied and pasted this account. In failing to check the GMCs version of events from the original source information, by failing to be an expert in the subjects on which he opines and by rushing through his report at the last minute, this report is similarly flawed.
    4. GMC sanctions are without logic or consistency. Because I recommended a B12 injection, my rights to prescribe all medication from British National Formulae were lifted. This is in contrast to the Jane Barton case (29.1.10) who was found guilty of professional misconduct for the death of 12 patients by morphine. She was investigated by police for the deaths of 92 patients. She simply lost her rights to prescribe morphia drugs for three years. http://www.dailymail.co.uk/news/art...lly-hazardous-levels-drugs.html#ixzz0mkkazWwi As one of my colleagues commented lucky she did not inject B12!

    I have taken the following actions:

    5. I have reported the Partners practice to the GMC for investigation of dishonesty, I have reported the GMC legal to the GMC Complaints Department and also to the Bar Counsel for incompetence, I have also reported Professor Bouloux to the GMC for failing to act competently as an expert witness.
    6. The GMC continue to take patients notes without their knowledge or permission. I have reported their actions to the Information Commissioner.
    7. I now have three letters of apology from the GMC for withholding information from me and not meeting deadlines with respect to the Data Protection Act. I have reported the GMC to the Information Commissioner for these breaches.
    8. I have written at length to the GMC with many of the above concerns and others with specific detailed questions. The majority of these questions have been ignored but I shall be raising them at my IOP Hearing.

    What problems I face from the GMC
    A GMC IOP Hearing is not interested in facts nor the veracity of facts. They appear to be able to act on suspicion.
    The GMC have not, as I can see it, made any investigation for themselves with respect to the veracity of facts.
    The GMC can award themselves up to eighteen months to consider a case before calling a Fitness to Practise Hearing without apparently giving any reason.
    There appears to be nobody to whom I can appeal with respect to GMC actions.
    It is clear that many other doctors have received similar treatment at the hands of the GMC they too have been subject to sanctions which lack any logic or consistency.
    The GMC have complete control over the activities of the IOP so for example I have requested that the Partners practice attend my Hearing, as should Mr S Jones who complained about my website, as should Professor Bouloux together with various officials from the GMC. My guess is that the GMC will refuse these requests.

    I expect to be strung up again by the GMC at this next IOP Hearing but I shall put up a good defence!

    What I shall be doing between now and my Hearing
    I intend to publish my defence before the Hearing and I shall make this defence available online.
    I shall not be represented but I shall conduct my own defence.
    I am not making any plans for a demonstration outside the GMC. I was so grateful that people came to support me in April, but very aware that it was a very difficult day for many sick patients because the GMC would not admit them into their foyer and they had to sit outside in the cold being poisoned by traffic fumes of the Euston Road! I really do not want a repeat of that.

    What you can do
    I would be so grateful if you would again write to the GMC by letter or email. The GMC were rocked by the broadside of letters sent in response to my first IOP Hearing. Please send to:
    Mr Paul Bridge, General Medical Council, Regents Place, 350 Euston Road, London, NW1 3JN
    PBridge@gmc-uk.org

    Please tell your story, and my story, to the Press. The GMC were very concerned about Press interest at my April Hearing.

    Keep updated on http://www.supportdrmyhill.co.uk/

    I would like to thank all those kind people who have donated generously to my defence. I have used this money to pay for a student to collate all the wonderful letters that you have sent which illustrate patient counter examples ie examples of patients failed by NICE guidelines and who have benefited from advice on the website. I have also paid for a researcher to extend the references that underpin my website opinions.

    Many many thanks to you all for your generous support and all the lovely letters and cards you have sent me they have been a source of inspiration and encouragement, all much needed and appreciated!

    Very best wishes Sarah
  2. pollycbr125

    pollycbr125 Senior Member

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    yorkshire
    I think Sarahs case is looking promising , the GMC certainly seem very out of touch with the varying sanctions they put in place , ludicrous .

    this bit made me smile lol As a result of a Data Protection Act search I find that my case was drawn up by a member of the GMC legal team who, in the letter of instruction to the GMC Expert Witness Professor Bouloux, described me in the male gender and as a consultant anaesthetic (sic). It is difficult to imagine how one can make four mistakes in three words but this has been achieved with merit! ha ha just shows what a farce the GMC are ;)
  3. ukme

    ukme Senior Member

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    Will do what I can, best to Dr M.
  4. justy

    justy Senior Member

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    U.K
    Thanks for keeping us informed. In the absence of any other support from the NHS being forthcoming foe my illness, i have relied on Dr.Myhill's website and testing to a large degree. I would still not have had a diagnosis -after 15 years of illness if it had not been for her.
  5. floydguy

    floydguy Senior Member

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    Sorry don't know what's going on with Dr. Myhill. But I do find what happens in the UK a bit scary. Is she really being investigated for B12 injections?
  6. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    Hi floydguy

    see the thread here called Dr Myhiil's Licence in Jeopardy for the full story or go to Dr Myhill's website and follow links for GMC Hearing or search SupportDrMyhill for a dedicated website.

    Hope this helps,
  7. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    Sarah is asking you all to email or write to the GMC again and also to get any press coverage you can.

    Many thanks.
  8. Min

    Min Senior Member

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    UK
    thank you
  9. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    Hi All,

    Thanks so much for all the emails that have come in ALREADY!

    Great Effort!

    Keep them coming please!
  10. taniaaust1

    taniaaust1 Senior Member

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    Sth Australia
    Yes floydguy... she was calling for those who had found B12 had helped them.. to send letters in for her defence in using this for CFS/ME. Still probably helpful.

    http://www.supportdrmyhill.co.uk/your_letters.html
  11. Cloud

    Cloud Guest

    I'm not in the UK and don't know much about the differences with their medical practices laws, but it seems crazy to use the prescribing of B12 as a justification for these actions because it only exposes their own corrupt nature and motives. B12 is just a vitamin and so what if it's given parenteral route, it's still just a vitamin, not a dangerous drug. And as far as I know, there is no such thing as B12 toxicity.....it's a very safe supplement.
    I'm so glad to see her fighting back and getting some upper hand in this. I'm glad to see her filing suits against those contributing to this witch hunt. The use of IM B12 is fairly common with the ME/CFS doctors here.....but will letters from the USA on the use of B12 be helpful?
  12. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    Yes please!

    Letters from the US, as from anywhere, will be very helpful ----as they were for the first Interim Orders Panel (IOP).

    The website complaint in particular is a world wide issue.

    Thanks for your support.

    The emails of support are coming at an increasing rate - keep them coming. I am sure we can beat 1000 this time.

    Thanks.
  13. leela

    leela Slow But Hopeful

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    Couchland, USA
    I have a quick question--not knowing anything about the UK judicial system, I am wondering why Dr M is representing herself
    rather than having a solicitor represent her? Is this too personal a question?
  14. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    Hi Leela

    Not too personal at all.

    Here is an extract from an earlier update newsletter from the Support Dr MYhill website:

    Firstly a big thank you to all who have supported and continue to support me in my fight
    against the GMC. It has become clear to me that to be legally represented will be unaffordable.
    Since my first GMC investigation I have been unable to obtain medical indemnity cover for
    GMC Hearings so I am forced to fund my own defence. Thank you to those many generous
    people who have already sent me money! Because the GMC is a charity I have applied to them
    for charitable funds to assist me in view of the fact that, by their own actions, I can no longer
    get medical indemnity cover for GMC Hearings.

    see http://www.supportdrmyhill.co.uk/files/newsupdatetoallpatientsjuly20102.pdf

    Dr Myhill has a team around her of people who are working very hard to produce an impressive set of defence papers.

    For example, I qualified as Chartered Accountant but I had a special interest in legal matters within Price Waterhouse, as was. In addition I was a senior manager within a regulatory body of Chartered Accountants and so have experience in these matters. Other members of the team have other but equally important life experiences that they bring to the defence.

    The full defence papers will be made available online and I think they do credit both to Dr Myhill and also to all your fantastic supporters out there.
  15. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    VERY IMPORTANT DISCLOSURE

    Dr Myhill has today issued a new letter to her patients and supporters together with the publication of her Defence Document for the forthcoming IOP Hearing on 7th October.

    Full details of the newsletter and Defence Document can be viewed at www.supportdrmyhill.co.uk

    If you wish to receive information as it received please subscribe to the mailing list by following the link on the support website home page.Dr Myhill has today issued a new letter to her patients and supporters together with the publication of her Defence Document for the forthcoming IOP Hearing on 7th October.

    Full details of the newsletter and Defence Document can be viewed at www.supportdrmyhill.co.uk

    If you wish to receive information as it received please subscribe to the mailing list by following the link on the support website home page.

    Many thanks,
  16. Supporters of Dr Myhill

    Supporters of Dr Myhill Guest

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    I am trying to post the entire Defence Document for you all here. Well worth a read.

    DR SARAH MYHILL MB BS

    Upper Weston, Llangunllo, Knighton, Powys, Wales. LD7 1SL

    Tel: 01547 550 331

    Email: office@doctormyhill.co.uk

    DEFENCE DOCUMENT

    IOP HEARING 29th April 2010

    GMC CASE REFERENCE: 2734668

    CONTENTS:

    1.BACKGROUND
    1.1 The Complaints
    2.INTRODUCTION
    2.1 Purpose of this Document
    2.2 Structure of this Document
    2.3 Division of evidence in section 3
    3. THE DEFENCE ARGUMENTS
    3.1 Procedural defence points
    3.2 Evidential defence points
    3.3 Conclusion
    4. APPENDICES
    4.1 Letter from Rebecca Townsley (GMC) dated 7 April 2010, and supporting
    documentation, detailing the nature of the complaints against Dr Myhill.
    4.2 IOP Determination
    4.3 Letter from Julian Graves (GMC) dated 26 April 2010 concerning missing letters from
    SM’s GMC data record.
    4.4 Letter from Dr Myhill to Elizabeth Hiley (GMC) dated 17 July 2010 concerning the
    vexatious nature of the website complaint
    4.4A Vexatious Allegations Guidance on the Application of Rule 4(3)( c) of the GMC
    (Fitness to Practise) Rules 2004
    4.5 Letter of complaint by Dr Y of the Partners dated 18th June 2009
    4.6 Letter from Patient X’s medical notes dated 4th March 2009
    4.7 GMC (Fitness to Practise ) Rules 2004 Rules
    4.8 Email dated 8th April 2010 from Dr Myhill to GMC appealing the notice period of one
    day for her original IOP Hearing date
    4.9 Email dated 9th April 2010 from Neil Allwood (GMC) to Dr Myhill granting a
    postponement of her IOP Hearing until 29th April 2010
    4.10 Letter dated 26th April 2010 accompanying Expert Witness report from Professor
    Bouloux
    4.11 Presentation given at Hearing on behalf of GMC by Mr Gary Summers QC.
    4.12 GMC Imposing Interim Orders: Guidance for the Interim Orders Panel and Fitness to
    Practise Panel April 2008 Annex 9
    4.13 Professor Bouloux’s Expert Witness report
    4.14 GMC case notes dated 16th February 2010 - advice from GP expert concerning the
    selection of an expert witness
    4.15 GMC case notes regarding the basis against which Dr Myhill should be judged
    4.15A Expert Witness Reports authored by Dr David Freed, Professor Martin Pall and Dr
    Norman Booth.
    4.16 Letter dated 7th August from Neil Jinks (GMC) to Dr Myhill
    4.17 Letter to Adam Elliot (GMC) dated 15th May 2010
    4.18 Letter from Dr Y of the Partners to Mr Bridge (GMC) dated 1st September 2009
    4.19 http://ohpa.org.uk/
    4.20 Internal GMC dated 10th February 2006
    4.21 Email from Dr Myhill to Paul Bridge (GMC) dated 21st April 2010
    4.22 GMC records of attendees at the IOP Hearing
    4.23 List of GMC cases demonstrating the inconsistency of the IOP prescription sanction
    against Dr Myhill
    4.24 Case History as produced by John Macdonald QC
    4.25 Letter from Teresa Birch, NICE, to Pat Endicott
    4.26 Letter from Kay Ellis, Department of Health Officer, to Invest in ME charity dated 28
    May 2010
    4.27 BMJ paper, dated March 2010, on breast screening in Denmark
    4.28 Letter from SM to Ms TS dated 14 August 2010
    4.29 Letter, dated 17 July 2010, from SM to Stephen Farnworth, Investigation Manger at
    the GMC, complaining about the dishonest behaviour of the Partners in this respect and
    requesting a GMC investigation of this matter.
    4.30 Further letter from SM to Stephen Farnworth, dated 1 September 2010, making
    further legal points on the definition of dishonesty.
    4.31 Email from Neil Marshall, GMC, dated 5 September 2010
    4.32 Letter from SM to Scott Geddes, Head of Investigation GMC dated 1 September 2010
    asking for Professor Bouloux to be investigated by the GMC for not following Expert
    Witness report guidance.
    4.33 GMC Guidance on the production of Expert Witness reports
    4.34 Letter dated 15 September 2010 from SM to Adam Elliot
    4.35 Correspondence exchanges regarding the attendances of witnesses for cross
    examination
    4.36 – Publishable Minutes of Fitness to Practise Panel concerning Dr Asim Raza Zaidi
    which includes the GMC accepted definition of dishonest behaviour.
    4.37 – Summary of the decided cases H (a Health Care Worker) v Associated Newspapers
    Ltd and H (a Health Care Worker) v N (a Health Authority) in which the duty of care of
    anonymity to patients suffering from rare disorders is defined
    5. SELECTED CORRESPONDENCE
    5.1 Dr Myhill letter to GMC dated 5 May 2010
    5.2 Dr Myhill letter to GMC dated 8 May 2010
    5.3 Dr Myhill letter to GMC dated 26 May 2010
    5.4 GMC letter to Dr Myhill dated 27 May 2010
    5.5 Dr Myhill letter to GMC dated 1 June 2010
    5.6 GMC letter to Dr Myhill dated 16 June 2010
    5.7 Dr Myhill letter to GMC dated 17 June 2010
    5.8 Dr Myhill letter to GMC dated 30 June 2010
    5.9 Dr Myhill letter to GMC dated 12 July 2010

    SECTION 1 - BACKGROUND

    1.BACKGROUND
    Since 2001 Dr Sarah Myhill (‘SM’) has faced the prospect of six GMC Fitness to Practise
    Hearings. No complaint ever came from a patient, all emanating instead from doctors or
    from the GMC itself. During those investigations SM’s website was extensively examined
    by the GMC, including the use of a commissioned Expert Witness report, and was not
    found wanting then. All allegations were dropped with no case to answer and no
    sanctions were placed on her practice. GMC Counsel Mr Tom Kark stated:
    “No-one can seriously doubt Dr Myhill’s good intentions”
    SM wishes to practise medicine unencumbered by spurious GMC investigations and with
    this in mind she commissioned an independent QC, Mr John Macdonald, with the remit of
    reviewing her case history (appended – see section 4.24)for discussion with the GMC. This
    resulted in a meeting with Head of Investigations Jackie Smith on 12th August 2009. Ms
    Smith refused to sign minutes of that meeting and has refused all communication with Dr
    Myhill since.
    1.1 The Complaints
    On 8 April 2010, SM received a letter from Rebecca Townsley, Assistant Registrar at the
    General Medical Council (‘GMC’), stating that two complaints about her medical practice
    had been received by the GMC. The GMC considered that these complaints suggested that
    SM’s fitness to practise may be impaired and so instigated an Interim Orders Panel ‘(IOP’)
    Hearing. The said letter and supporting documentation are attached at Appendix 4.1
    Briefly, these complaints were as follows:
     The ‘B12 Complaint’ – This concerned a practice of 8 GPs, Dr H L Moss and Partners
    (the ‘Partners’), who complained about SM’s advice that they prescribe B12 and
    magnesium sulphate injections to a patient at their practice who suffered from
    Batten’s Disease. This patient shall be referred to as Patient X.
     The ‘Website Complaint’ – This concerned a complainant, described as a clinical
    scientist, who considered that SM’s website represented a risk to public safety.
    This complainant was effectively anonymous, although named as Stuart Jones.
    The details of these complaints and their validity are obviously the subject of much of the
    discussion in this document but for background purposes only they are documented
    above as they were presented to SM.
    These complaints were heard at an IOP Hearing held on 29th April 2010.

    SECTION 2 - INTRODUCTION
    2. INTRODUCTION
    2.1 PURPOSE OF THIS DOCUMENT
    The purpose of this document is to present the arguments, and supporting evidence, in
    defence of SM with regards to the IOP Hearing of 29th April 2010 (the ‘Hearing’), the full
    decision of which is included in the appendices (section 4.2). The decision by the Interim
    Orders Panel (the ‘Panel’) of that Hearing was that SM had her prescribing rights removed
    and certain pages of her website were ordered to be taken down. Other restrictions as
    detailed in section 4.2 were also imposed.
    This document is intended as a summary document, but one which contains enough
    evidence to substantiate, prima facie, the defence arguments being made. Very many
    correspondences on these issues have taken place and these need to be taken into
    account when formulating a full opinion. However, to include all such documentation here
    would be self-defeating in a document intended to be a summary.
    The arguments contained herein, it is contended, are sufficient to render the said decision
    wrong procedurally, evidentially and legally.
    2.2 LAYOUT OF THIS DOCUMENT
    This document is laid out as follows, referenced with capital Roman numerals as below:
     (I)---A procedural or evidential point is presented
     (II)---The effect of this point on the IOP decision is detailed and any action required
    to be taken by the GMC is also listed.
     (III)--A reference to any relevant evidential documentation is made to appendices
    found in section 4.
    2.3 DIVISION OF EVIDENCE IN SECTION 2
    The arguments and evidence contained in section 3 are divided into two broad areas:
    procedural and evidential.
    Procedural points are those where the GMC has not complied with its own internal
    procedures or where other ‘points of order’ are made.
    Evidential points are those where the evidence used at the Hearing is either
     Insufficient – key points of evidence having been omitted or not considered fully
    by the Panel. This category includes examples where submitted evidence has not
    been sufficiently verified by the GMC.
     Incorrect – key points of evidence used in the Hearing are wrong on point of fact.
    Clearly there is overlap between these two general forms of evidence and this is dealt
    with on a case by case basis throughout the document. Generally, the view has been
    taken that each point should be placed in the section to which there is the most serious
    error or omission in the GMC prosecution.
    For example, the vexatious nature of the B12 complaint represents a procedural piece of
    evidence. However, this complaint is vexatious because the actual details of it are
    incorrectly stated by the Partners who told an untruth when bringing this complaint. This
    untruth represents an evidential argument and in this case the evidential argument is
    considered stronger than the procedural point and therefore the vexatious nature of the
    B12 complaint is included in section 3.2 Evidential Defence Points rather than section 3.1
    Procedural Defence Points.

    SECTION 3 – THE DEFENCE ARGUMENTS

    3. THE DEFENCE ARGUMENTS

    3.1 PROCEDURAL DEFENCE POINTS
    3.1.1 Letters essential to the defence of SM were filleted from the official record
    (I) As a result of Data Protection Act (DPA) searches made by SM it became clear that
    nearly all the letters which SM had written to the GMC were missing from the official GMC
    data record on SM. In total there were 45 missing. SM complained about this and on the
    morning of the Hearing received a letter from Julian Graves of the GMC dated 26 April
    2010 delivering all those letters to SM’s office. Mr Graves lists 38 as not having been
    previously disclosed, 5 letters as having been previously disclosed and 2 letters as having
    not been found.
    (II) It is a procedural requirement of GMC Hearings that the relevant past GMC record of
    the defendant has to be considered in the determinations of the Panel overseeing the
    hearing. These letters are, by their nature clearly relevant, to the Hearing evidence.
    Clearly, in all probability, this did not happen at the Hearing of SM given that so much
    evidence relevant to the case in hand was missing from the official GMC record. As well
    as a procedural point, this is also evidential because the Panel, and indeed GMC
    investigation Officers, could not avail themselves of the full facts and history of the case
    against SM. The fact that crucial evidence appears to have been missing from that
    presented to Panel members has the effect that the IOP decision should be set aside until
    and unless evidence can be brought forward by the GMC that these letters were available
    to GMC investigation Officers and Panel members. It is therefore required that each
    member of the Panel produces a signed affidavit to the effect that they had sight of all
    these said letters.
    (III) There are many letters on SM’s own GMC file which she holds herself concerning this
    issue. The key letter, admitting the error by the GMC, was the said letter from Julian
    Graves and this is located at section 4.3 in the appendices. Should it be necessary, copies
    of all 45 letters can be produced for the purposes of ascertaining their relevance.
    3.1.2 The GMC did not follow its own guidelines on vexatious complaints.
    (I) The Website Complaint is vexatious as defined by GMC Rules. Criteria 8 of ‘Vexatious
    Allegations Guidance on the Application of Rule 4(3)( c) of the GMC (Fitness to Practise)
    Rules 2004’ states that:
    8. Broadly, a complaint can be vexatious within rule 4(3)(c) in either its intrinsic nature or in the
    manner in which it is brought and/or pursued: that is, if there are reasonable grounds to believe that
    one or more of three criteria apply:
    A. The complaint’s primary purpose and/or effect is to disturb, disrupt and pressurise the doctor,
    the GMC and/or another organisation and/or individual.
    B. The primary purpose and/or effect of the manner in which the complaint is brought is to
    disturb, disrupt and/or pressurise the doctor, the GMC and/or another organisation and/or
    individual.
    C. The complaint is otherwise manifestly unreasonable.
    The anonymous website complainant was motivated by his own personal belief systems
    rather than any evidence based scientific concerns. The complainant is a regular and
    frequent blogger on the web forum Badscience. He consistently takes a negative view of
    any medical practices which operate outwith National Guidelines and considers all such
    practice dangerous. There are examples of abuse on that web blog. In addition, very many
    repeat and trivial allegations have been brought in a short time period by this one
    complainant. Indeed he is flippant about the whole affair, stating that
    "I actually find this quite funny as my initial contact with the GMC was just a speculative
    email to the general enquiries email asking whether it would actually be worth submitting
    another complaint given the failure of the previous 6 efforts. This was written with some
    haste during a coffee break and hence contained a few typo’s. Amusingly, after submitting my
    full complaint the GMC decided to use this email to front the complaint to Myhill *sigh*."
    Detailed arguments as to why this complaint is vexatious are detailed in the appendix
    noted below. It is concluded there that all three thresholds noted in Criterion 8 above
    were met by this complaint.
    (II) Given that this complaint was vexatious, as defined by the GMC’s own guidelines, it
    should be set aside, in accordance with GMC procedures, for the purposes of the
    determination by the IOP.
    (III) Once again, many letters have been sent to the GMC concerning this matter but for
    illustrative purposes, section 4.4 contains a letter dated 19 July 2010 from SM to Elizabeth
    Hiley, Information Access Officer at the GMC, and this correspondence provides a
    detailed summary of the arguments in this context. Section 4.4 A is also included being
    the Guidance notes on the Application of Rule 4(3) ( c).
    3.1.3 The GMC did not follow its own guidelines on vexatious complaints.
    (I) The GMC has been unable to provide evidence that its Case Officer even considered the
    vexatious nature of both complaints (see 3.1.2 and also 3.2.1). It is a requirement that
    such consideration must be made by the GMC before bringing forward any Hearings.
    (II) Due to this procedural lapse, the decision by the IOP should be set aside until such
    time as a detailed account of what the GMC has done in order to determine the vexatious
    nature or otherwise of these two complaints has been made.
    (III) The necessary evidence for this point is contained in:
     Section 4.4 Letter from Dr Myhill to Elizabeth Hiley (GMC) dated 17 July 2010
    concerning the vexatious nature of the website complaint
     Section 4.5 Letter of complaint by Dr Y of the Partners dated 18th June 2009
     Section 4.6 Letter from Patient X’s medical notes dated 4th March 2009
    3.1.4 Independence of the Panel
    (I) Dr Lewis Morrison was a member of the Panel in this case. Dr Morrison works for
    Lothian NHS and is involved in the provision of stroke services in Scotland (reference:
    http://docs.google.com/viewer?a=v&q cache:hhx4RUVYasoJ:www.lothianstrokemcn.sco
    t.nhs.uk/network). In January 2006, Dr Charles Swainson Medical Director of Lothian NHS
    and also involved in the provision of stroke services in Scotland complained about SM to
    the GMC. In addition, Ms Angela MacPherson, also a Panel member, has spent many years
    as a senior figure on the Scottish Executive Health Department and may well be known by,
    or to, either of Drs Morrison or Swainson. Obviously this raises the possibility that Dr
    Morrison or Ms Angela MacPherson, or indeed both, had prior knowledge of SM’s
    previous cases and were therefore in some way prejudiced. This point has been raised
    with the GMC (see section 5.1) and Neil Marshall, Assistant Director, GMC Investigations,
    responded in his letter of 27 May 2010 (see section 5.4) stating that he had contacted Dr
    Morrison, who had confirmed that he had no knowledge of SM’s previous cases, and also
    that Dr Morrison had not informed the GMC of any potential conflicts of interest prior to
    the Hearing.
    (II) The independence of the Panel has not been demonstrated in a transparent and
    accountable manner. For the avoidance of doubt, and for the record, it is required that Dr
    Morrison, Ms Angela MacPherson and Dr Swainson produce signed affidavits to the effect
    that discussions concerning SM’s previous GMC cases had not taken place between them,
    or indeed via third parties, either prior to or after the Hearing. Until and unless these
    affidavits are forthcoming, the IOP decision should be set aside on the basis that it has not
    been openly demonstrated that the Panel was independent.
    (III) Sections 5.1 and 5.4 along with the web address noted above contain the evidence
    base for this procedural point.
    3.1.5 Discussion of the IOP sentence before the hearing of evidence
    (I) Discussions of the restrictions to practise to be placed upon SM took place prior to SM
    giving her statement. This gives the clear impression that the IOP had decided upon the
    outcome of the case before all evidence had been submitted to the Panel. Whilst the
    Panel did have written evidence concerning the B12 complaint, there was neither such
    written evidence nor even an expert witness report about the website complaint.
    (II) Even if it is accepted that the Panel could come to a fair decision regarding the B12
    complaint without SM’s statement , which in itself seems to run against Natural Justice,
    SM not having had a chance to put her case first, there can be no acceptance that such a
    decision regarding the website complaint is justified given the complete lack of
    documentary evidence available to the IOP on this complaint. Given the lack of proper
    procedures regarding the order of the tabling of evidence, the IOP decision should be set
    aside until and unless it can be demonstrated that the discussions regarding restrictions
    before SM’s giving of evidence were only preliminary in nature and were indeed capable
    of being reversed after the submission by SM. Once again, signed affidavits from each
    Panel member confirming this are required.
    (III) Appendices found at sections 5.1 and 5.3 first raised this procedural point.
  17. Supporters of Dr Myhill

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    3.1.6 Lack of fair notice period accorded by GMC to SM
    (I) Initially SM was given one full working day’s notice period of the IOP Hearing. This
    notice was received in a letter dated 7th April 2010 (see section 4.1) requiring SM to attend
    a Hearing on 12th April 2010. GMC (Fitness to Practise) Rules 2004 state that at Rule 11:
    “In practice, doctors will normally receive at least 7 days’ notice of the hearing, but in
    exceptional urgency the period of notice may be shorter.”
    (see section 4.7). Furthermore, a subsequent telephone call between SM and Mr Paul
    Bridge (GMC) revealed that GMC policy is to reserve periods of notice of just one day
    normally to cases of suspicion of murder and rape. SM appealed the one day notice
    period, a course of action only open to her because she happened to be in her office that
    day. Had SM not opened her mail until the next day then she would have had no chance
    to appeal this notice period at all. SM appealed in an email of 8th April 2010 (see section
    4.8) and received notice that her appeal had been successful in an email of 9th April 2010
    from Neil Allwood (GMC) (see section 4.9). This postponed the Hearing until 29th April
    2010.
    Whilst sufficient notice was, eventually, granted to SM for the IOP, no such notice was
    granted with respect to her ability to review the Expert Witness report submitted by
    Professor Bouloux. After the postponement in the initial IOP Hearing date was granted,
    SM received said Expert Witness report on 26th April 2010 (see section 4.10). This gave SM
    just 3 days to formulate a rebuttal to this report and effectively no time to commission an
    Expert Witness to be briefed on her behalf.
    The GMC had 10 months in which to investigate the B12 complaint and 14 weeks to
    investigate the website complaint. There was therefore a significant asymmetry in the
    time allowed to prepare prosecution and defence papers. By contrast Harold Shipman was
    given one full month to prepare his defence papers for a GMC Hearing, even after he had
    been found guilty of murder.
    (II) There has been no explanation by the GMC of the reason for the late arrival of the
    Expert Witness report. It is a basic tenet of English Law that Natural Justice should prevail.
    SM did not have sufficient time to prepare her defence against the Expert Witness Report
    and coupled with the original notice period of just one day for the initial date of the
    Hearing, there is sufficient evidence to conclude that the GMC did not take SM’s rights as
    a defendant seriously. Moreover, having given no reason at to why her case was originally
    designated ‘exceptional urgency’, it is concluded that the sum of all these factors leads to
    the conclusion that the IOP decision should be set aside on the grounds that it was not
    fair. SM should be given the time necessary to prepare a full defence and must have sight
    of all the evidence that the GMC intend to produce in support of their case in good time
    before such hearing.
    (III) As noted above evidence for these points is contained in the following sections:
     Section 4.1 Letter from Rebecca Townsley (GMC) dated 7 April 2010 requiring SM
    attendance at initially scheduled IOP Hearing for 12th April 2010
     Section 4.7 IOP Rules
     Section 4.8 Email date 8th April 2010 from SM to GMC appealing the notice period
    of one day for her original IOP Hearing date
     Section 4.9 Email dated 9th April 2010 from Neil Allwood (GMC) to SM granting a
    postponement of her IOP Hearing until 29th April 2010
     Section 4.10 Letter dated 26th April 2010 accompanying Expert Witness report from
    Professor Bouloux
    3.1.7 GMC Counsel revealed the identities of the Partners and also of Patient X during the
    course of his public presentation.
    (I) Mr. Gary Summers, Counsel for the GMC, presented his case in such a way as to reveal
    the identities of both the Partners and Patient X to a determined observer. This
    knowledge is now public. The most relevant paragraph in Mr Summers’ presentation is
    reproduced below but there are other examples within his presentation where basic
    errors in the protection of the Partners’ and Patient X’s identities were made.
    “In short, the case was brought to the attention of the GMC by eight GPs in that Yorkshire
    practice in the letter of 18 June 2009. The mother of the patient had self-referred to Dr
    Myhill after discovering her website on the web, as a result of which Dr Myhill requested a
    blood sample in respect of her son, an adult.
    Following analysis of the blood sample Dr Myhill wrote to the patient’s mother outlining
    various theories and treatments for chronic fatigue syndrome. In particular, she advised that
    he be administered B12 and magnesium sulphate injections. Dr Woods advised the mother
    that he would not be able to prescribe these drugs, being unsure why the patient should be
    prescribed the drugs in the first place. In particular, the patient was a known suffer of – and I
    am going to use the letter “B” – of juvenile [B’s] disease.”
    (II) The effect on the IOP decision is that the GMC has broken its duty of care to patients
    and complainants in preserving their public anonymity. Mr. Gary Summers’ presentation
    is in the public domain. There is little that can now be done to undo this breach of trust by
    the GMC in terms of the position of the Partners and Patient X but this cavalier approach
    by the GMC to its general duties of care do cast doubt on how seriously the GMC takes its
    other more specific duties such as the conducting of thorough and fair investigations. It is
    concluded that when the weight of evidence of other points contained herein is
    considered, this lack of exercising by the GMC of its duty of care in this instance should be
    taken into account.
    (III) Evidential documentation attached at section 4.11 is a copy of Mr. Gary Summers’
    presentation. In addition the decided cases of H (a Health Care Worker) v Associated
    Newspapers Ltd and H (a Health Care Worker) v N (a Health Authority) came to the
    conclusion that:
    ‘Where information can identify a particular patient because their symptoms are very rare or
    the patient is one of a very small community, an obligation of confidence would be owed.’
    This case applies directly to Patient X and so confidentiality was both owed to Patient X
    and also not granted by GMC Legal Counsel. It can be concluded that Mr Gary Summers
    did break his duty of care of anonymity to Patient X. A summary of this case is included at
    section 4.37.
    3.1.8 Full consideration by the Panel of the level of support for SM was not given
    (I) SM submitted thousands of emails, letters and online petition comments in her support
    to be used as evidence by the Panel. In her letter to the GMC of 5th May 2010 (section 5.1)
    SM asked for confirmation that the Panel had had sufficient time to read and digest these
    many comments from patients and members of the general public alike. SM also asked
    when Panel members first saw these letters, emails and petition comments and when
    they were read – see section 5.3. In response, Neil Marshall, in his letter of 27th May 2010
    – see section 5.4 – responded that:
    “I can also confirm that we did include, in the information put before the Panel, all letters
    received by us (in good time before the hearing) in support of your case.”
    It will be noted that Mr. Marshall has not fully answered the question. There has been no
    confirmation by the GMC that these letters were full taken into account by the IOP in its
    deliberations and indeed this seems highly unlikely in view of the volume of comments
    made and the speed with which a decision was arrived at.
    (II) Without these letters, emails and petition comments of support having been properly
    read and digested, SM did not receive a fair Hearing. Unless and until receipt of signed
    affidavits from each member of the Panel that they had read, digested and taken into
    account these thousands of comments of support is received, the IOP decision should be
    set aside. In this context, also, full consideration of the Patient Experiences Document
    should be given, where not only letters of support are included but also details from
    patients and the general public alike of the adverse effects on their health that have
    resulted from the restrictions placed on SM’s medical practice by the IOP decision.
    (III) The online petition can be found at:
    http://www.ipetitions.com/petition/witchhuntofdrsarahmyhill/signatures
    and a copy of all the letters and emails of support can be provided if necessary. The
    Support Dr Sarah Myhill facebook group can be viewed at
    http://www.facebook.com/home.php?#!/group.php?gid=108048875899603&ref=ts
    See also sections 5.1, 5.3 and 5.4 for correspondence on these issues.
    3.1.9 SM has the right to be judged by her peers
    (I) SM has a right to be judged by her peers. Professor Bouloux, by his own admission, has
    no expertise in the diagnosis and treatment of either chronic fatigue syndromes or
    mitochondrial disorders. Indeed he states that he refers this group of patients to
    specialists rather than treat them himself. Within the GMC case notes on SM there is a
    piece of advice dated 16th February 2010 from an expert GP witness which states that:
    “..did not have sufficient knowledge of CFS to be in a position to answer questions posed and
    that in view of Dr Myhill’s background he feels that the GMC should instruct an expert not
    just with mainstream knowledge of CFS but an expert with a special knowledge or interest in
    CFS”
    By instructing Profesor Bouloux who is neither expert in nor has a special interest in CFS,
    the GMC has ignored its own expert advice. Indeed the GMC are confused about the
    manner in which SM should be assessed and the standard against which she should be
    judged. In his case notes, the relevant Case Examiner states that:
    “Dr Myhill has provided opinions which would not be supported by the wider medical
    profession.”
    This is not the standard against which SM should be judged. It is a defence in law that if a
    doctor practises a technique which is generally accepted by his peers, then that is
    sufficient. ‘Peers’ are defined not by reference to the ‘wider medical profession’, as the
    GMC has done so but rather by reference to ‘a responsible body of medical opinion’ as
    defined by the Bolam principle. The Bolam principle is laid out below:
    Bolam v Friern Hospital Management Committee [1957] 1 WLR 583 is an English tort law
    case that lays down the typical rule for assessing the appropriate standard of reasonable
    care in negligence cases involving skilled professionals (e.g. doctors): the "Bolam test".
    Where the defendant has represented him or herself as having more than average skills
    and abilities, this test expects standards which must be in accordance with a responsible
    body of opinion, even if others differ in opinion. In other words, Bolam test states that "If
    a doctor reaches the standard of a responsible body of medical opinion, he is not
    negligent"
    This test is passed even in the presence of others who ‘differ in opinion’. SM’s peers are
    the group of doctors involved in the practice of allergy, environmental and nutritional
    medicine. It is from within this group of doctors that the GMC should have sought expert
    witness reports. These doctors certainly represent a responsible body of medical opinion
    and are best placed to judge SM’s practicing of medicine.
    (II) The GMC has made two crucial errors in its assessment of SM by the expert witness
    report of Professor Bouloux:
    1---It has not followed its own received expert advice that the assessment should be made
    by a doctor expert in the field of CFS
    2--- It has not followed the Bolam Principle in determining whether SM’s practice is
    negligent by making that assessment against the ‘wider medical profession’ rather than
    against ‘a responsible body of medical opinion’.
    The effect of these errors is to render the expert witness report by Professor Bouloux
    inadmissible and so this report should be set aside. This in turn has the effect of rendering
    the GMC case effectively without corroborative evidence (as noted in section 3.2.2). This
    has the direct corollary that the IOP decision should be set aside both because of the
    procedural errors made by the GMC in its obtaining of expert witness evidence and also
    because of the impact this has on the corroborative evidence base for the case against SM
    – that is to say, such evidence base is effectively withdrawn.
    (III) The evidence base for this point is:
     4.13 Professor Bouloux’s Expert Witness report
     4.14 GMC case notes dated 16th February 2010- advice from GP expert concerning
    the selection of an expert witnes
     4.15 GMC case notes regarding the basis against which SM should be judged
     4.15A Expert Witness Reports authored by Dr David Freed, Professor Martin Pall
    and Dr Norman Booth.
    In addition, these points are discussed at length in the correspondences at sections 5.1,
    5.2, 5.3, 5.5, 5.6, 5.7 and 5.9.
    3.1.10 Underlying Principles of GMC’s extent of jurisdiction.
    (I) The complaints against SM arise from the belief that her treatments do not conform to
    National Guidelines, in the case of the website complaint, and that SM’s recommended
    treatments in the case of the B12 complaint were off licence and therefore in some way
    not generally recommended. In a letter to SM, dated 7th August 2006, Neil Jinks, then
    GMC Assistant Registrar, stated that:
    “It is not the place of the GMC to take a position on the correctness or otherwise of generally
    recommended or of possible ‘cutting edge’ treatment…...”
    Professor Wendy Savage, erstwhile elected member of the GMC Council from 1989 to
    2005, wrote a book concerning her experiences with the GMC principles regarding the
    above point. In that book, ‘A Savage Enquiry’ she states that:
    “One of the most important principles of the practice of medicine is that of clinical
    autonomy, which allows a fully trained doctor the responsibility for deciding which mode of
    treatment is best for his or her patients. In practice clinical autonomy means that
    consultants and GPs are of equal status, are responsible for their own clinical decisions and
    should not be criticised by their colleagues as long as those decisions are within the ‘broad
    limits of acceptable medical practice’. The GMC’s handbook also states that the deprecation
    of a doctor of the professional skill, knowledge, qualifications or services of another doctor
    could amount to serious professional misconduct.”
    This was followed up in April 1987 by the following comment made by Sir Donald Irvine in
    the Blue Book on the issue of the disparaging of professional colleagues:
    `"65. It is improper for a doctor to disparage, whether directly or by implication, the
    professional skill, knowledge, qualifications or services of any other doctor, irrespective of
    whether this may result in his own professional advantage, and such disparagement may
    raise a question of serious professional misconduct.”
    The Blue Book 1990 included an identically worded section.
    (II) The GMC is acting outwith its capacity of jurisdiction. These complaints are based on
    disagreements with SM about the correctness or otherwise of ‘generally recommended or
    of possible cutting edge treatment’ and judgement on this is not within the remit of the
    GMC as evidenced above. Given that the GMC is acting outwith its capacity, the IOP
    decision should be set aside in its entirety.
    (III) The evidence base for this point is contained within:
     Section 4.16 Letter dated 7th August from Neil Jinks (GMC) to SM
     Copies of the Blue Book or Wendy Savage’s book will be made available should this
    be necessary.
     Section 4.17 Letter to Adam Elliot (GMC) dated 15th May 2010
    In addition see correspondences at sections 5.3 and 5.9.
    3.1.11 Patient X’s notes were taken without their permission or knowledge
    (I) A number of issues have arisen concerning this point.
     (a) The GMC has not disputed that it has taken Patient X’s medical notes without
    their permission. Instead the GMC has argued that this practice is in no way
    improper. Indeed, in his letter of 27th May 2010 (see section 5.4), Neil Marshall
    comments that:
    “The Medical Act gives us powers to obtain and use information as is necessary to ensure the
    public interest is protected.’
    Mr Marshall continues in his letter of 16th June 2010 (see section 5.6) with the comment
    that:
    “..the GMC can require a doctor or any other person to supply information, or disclose
    documents which appear relevant to the carrying out of our fitness to practise function.’
    Notwithstanding for the time being whether the GMC is correct in its assertion, the
    manner in which this access of information was carried out did not even comply with
    internal GMC Disclosure requirements. In a letter from Dr Y of the Partners to Mr Bridge
    (GMC) dated 1st September 2009 the following point was made:
    “I enclose the completed Disclosure Consent Form. You will see that I have not completed
    sections (6) and (7). The patient is not capable of understanding the matter, and his mother
    has not expressed dissatisfaction with Dr Myhill. We understand we have a professional
    obligation to bring the matter to your attention nonetheless, however unpleasant that
    action may seem to us. As requested I enclose anonymised copies of the medial records, and
    of all other documentation”.
    Dr. Y filled in the GMC Disclosure Consent Form improperly. Dr. Y failed to complete
    paragraph 6 or 7. He has failed to get the approval of the patient’s mother. She had no
    idea the GP was complaining, she had no idea that her son’s private and confidential
    medical records were being sent to the GMC. Furthermore, there is no letter of consent
    from the patient’s mother. So, even if the GMC argument regarding the justification for
    the removal of Patient X’s notes without their permission is correct, the internal GMC
    procedures for doing this were not properly followed.
     (b) Putting aside for the time being the correctness or otherwise of the GMC action
    in this context, the fact that the GMC used Patient X’s notes in its prosecution
    raises a further issue of the unfairness of the trial. SM asked permission quite
    properly and correctly to use her own private medical notes on Patient X for her
    defence case. This permission was denied on the grounds that the patient’s mother
    did not want her son’s identity potentially to be compromised. At this time, the
    patient’s mother did not realise that the GMC had already taken her son’s notes
    without any permission, knowledge or without even having followed their own
    internal procedures properly. This meant that there was an asymmetry in the
    evidence available to the GMC and that available to SM at the Hearing. This
    compromised SM’s defence because she could not repudiate claims made
    concerning Patient X’s medical notes as this would have meant her going against
    the wishes of her patient and his mother. This is manifestly unfair and contrary to
    Natural Justice.
     (c) Returning now to the correctness of the GMC assertion that it can access notes
    in this way under provisions in the Medical Act 1983 (the ‘Medical Act’). The fact
    that the Medical Act is contrary to certain subsequent legislations is well
    documented. Indeed, Mr Marshall states in his letter of 16th June 2010 (see section
    5.6) that
    “..it would be open to any party offended by our use of personal information in our fitness to
    practise procedures to make a case before the Courts…”
    As Mr Marshall knows full well, this would be a line open only to those with very deep
    pockets, which SM does not have. However, further to the general point, there are two
    issues which should be considered. The taking of confidential medical notes in this way is
    almost certainly contrary to the Data Protection Act and likewise almost certainly
    breached Patient X’s rights under Human Rights legislation. It is neither within the remit
    of this case nor within the power of SM to challenge such wide-ranging issues but these
    factors should be taken into account ‘in the round’. The fact that the Office of Health
    Professions Adjudicator (‘OHPA’) has been set up (see http://ohpa.org.uk/) is further
    evidence of these issues with the Medical Act. OHPA will have the function of being
    responsible for taking decisions on fitness to practise cases brought by the GMC, amongst
    others. This is a direct response to the fact that the provisions under the Medical Act
    breach Human Rights legislation in that a defendant is prosecuted, judged and sentenced
    by the same agency, namely in this case, the GMC.
    (II) Taking each point in turn:
    (a) The GMC has not properly followed its internal procedures for the use of confidential
    patient notes and so the use of these notes in this Hearing should not have happened.
    Striking these notes and the use they were put to from the evidence submitted by the
    GMC in its prosecution renders the GMC case regarding the B12 complaint untenable.
    Therefore the B12 complaint should be set aside.
    (b) The unfairness in the utilisation of Patient X’s private medical notes renders the
    Hearing unfair to the extent of the B12 Complaint. Therefore the B12 complaint should be
    set aside.
    (c) Note should be taken of the possible illegality of GMC actions with regard to Data
    Protection and Human Right legislation. It is not possible for SM to contest this but this
    point is one which should be taken into account, particularly with respect to comments
    made in section 3.3.
    (III) The evidence base for these points is as follows:
     Section 4.18 Letter from Dr Y of the Partners to Mr Bridge (GMC) dated 1st
    September 2009
     Section 4.19 http://ohpa.org.uk/
    In addition, see correspondences at sections 5.1, 5.2, 5.3, 5.4, 5.5, 5.6 and 5.7
    3.1.12 Hearing Proceedings were flawed and unfair in that neither cross examination nor
    the calling of witnesses was permitted.
    (I) No partner from the Partners, and in particular Dr Y (see section 3.2.1), was present at
    the Hearing for cross examination. Professor Bouloux was not present for cross
    examination of his flawed Expert Witness report. Of course, the website complainant,
    being anonymous, was not present for cross examination. SM asked for Dr Y to be
    subpoenaed to attend the Hearing but this request was denied. SM asked for Professor
    Bouloux to be present at the Hearing and this again was denied. Many requests were
    made for persons relevant to the Hearing to be present, for example an email from SM to
    Mr Paul Bridge (GMC) dated 21st April 2010 requested the presence of Dr Woods. This
    again was refused and SM was told that only the GMC could subpoena witnesses.
    (II) The lack of relevant witnesses being available for cross examination renders the
    Hearing unfair. Evidence used by the prosecution for its case was not capable of being
    challenged in any meaningful way and evidence vital for SM’s defence could not be
    adequately presented without the presence of key witnesses. In addition, the asymmetry
    in the power of the GMC to subpoena witnesses juxtaposed with SM’s inability to do so
    renders the Hearing procedurally unfair. As a consequence of this unfairness, the IOP
    decision should be set aside in its entirety.
    (III) The evidence base for this point is as follows:
     Section 5.3 L and M
     Section 4.21 Email from SM to Paul Bridge (GMC) dated 21st April 2010
     Section 4.22 GMC records of attendees at the IOP Hearing
    In addition a detailed appendix of the requests for attendance and the denials received or
    otherwise is included at section 4.35-- Correspondence exchanges regarding the
    attendances of witnesses for cross examination
    3.1.13 The prescription only medicine restriction placed on SM by the IOP is illogical and
    disproportionate.
    (I) Whilst disagreeing with the procedures followed and evidence based used in arriving at
    its conclusions, the IOP requirement for SM to take down certain web pages is at least
    logical and proportionate to the complaint made, even though it has been shown that this
    complaint should be set aside. However, the restriction that SM should not prescribe
    prescription only medicine, as detailed in the British National Formulary (BNF), is wholly
    illogical and totally disproportionate. The concerns, even if taken to be true, raised by the
    complainants do not involve SM inappropriately prescribing medicines from the BNF. The
    web pages complained about and the B12 complaint do not implicate SM at all in the
    wrongful prescribing of prescription only medicines.
    (II) The illogical and disproportionate nature of the restriction on SM from prescribing
    prescription only medicine is such that this restriction should be lifted.
    (III) The evidence base for this point is as follows:
     Section 4.1 Letter from Rebecca Townsley (GMC) dated 7 April 2010, and
    supporting documentation, detailing the nature of the complaints against Dr
    Myhill
     See also sections 5.1, 5.2, 5.3 and 5.5 where this point is repeatedly raised
     Section 4.23 List of GMC cases demonstrating the inconsistency of the IOP
    prescription sanction against SM
  18. Supporters of Dr Myhill

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    3.1.14 The letter of instruction from Ms TS, GMC Legal Department to Professor Bouloux is
    littered with factual inaccuracies.
    (i) The said letter of instruction contained so many errors as to make it inadmissible. The
    full detail of the errors is laid out in the letter referenced in the evidence section below.
    However, by way of example as to how poor the construction of this document was, the
    following comment was made by Ms TS to Professor Bouloux:
    “In this letter I set out some instructions for you to provide your opinion on whether the
    doctor’s actions and treatment fell short of what could be expected of a reasonably
    competent Consultant Anaesthetic and if so in what ways and to what extent” (sic).
    and also
    “........if the facts alleged against Dr Myhill are proved, his fitness to practise is impaired to a
    degree that would justify action on his registration.......
    Dr Myhill is described as a male consultant anaesthetic. This may seem laughable but
    when taken with all the other factual errors listed in the evidence letter, it becomes
    apparent that the letter of instruction for Professor Bouloux was wholly inadequate.
    (ii) Given the level of factual errors in Ms TS’s letter of instruction, Professor Bouloux’s
    Expert Witness should be set aside and given that this is the only evidence produced by
    the prosecution team regarding the B12 complaint, that complaint also should be set
    aside.
    (iii) The evidence base is:
     Section 4.28 Letter from SM to Ms TS dated 14 August 2010
    In addition a complaint has been made by SM to the Bar Council concerning Ms TS’s
    conduct in this matter. At present this matter is under investigation. Any developments
    will be presented to the IOP as and when they arise.
    3.1.15 Professor Bouloux’s Expert Witness report does not follow GMC guidance on Expert
    Witness Reports
    (i) Professor Bouloux has broken virtually every one of the guidelines contained within the
    GMC document ‘Guidance on acting as an Expert Witness’. This breaching of the guidance
    is laid out in detail in the letter from SM to Scott Geddes, Head of Investigations GMC,
    noted below as section 4.32. SM has asked the GMC to investigate Professor Bouloux’s
    actions in this respect. In addition, it reflects poorly on the GMC that they accepted this
    Expert Witness report given its lack of compliance with its own guidance document.
    Professor Bouloux’s only defence would be that the letter of instruction from Ms TS, GMC
    legal department, was so poor (see section 3.1.14) that he was ill-instructed and acted
    accordingly.
    (ii) Given that the Expert Witness report from Professor Bouloux does not conform to
    GMC guidance on such matters, it should be set aside. Given further that this report is the
    only evidence base for the B12 complaint, this complaint also should be set aside.
    (iii) The evidence base is contained in
     Section 4.32 Letter from SM to Scott Geddes, Head of Investigation GMC dated 1
    September 2010 asking for Professor Bouloux to be investigated by the GMC for
    not following Expert Witness report guidance.
     Section 4.33 GMC Guidance on the production of Expert Witness reports
    3.2 EVIDENTIAL DEFENCE POINTS
    3.2.1 The B12 complaint is based on an untruth
    (I) In his letter of complaint to the GMC of 18th June 2009 Dr Y of the Partners states that:
    “On 24th March 2009 I had a further telephone conversation with the mother. I reiterated
    that we had not agreed to administer, or train her to administer the injections.”
    However, in Patient X’s medical notes there is a letter dated 4th March 2009 from Dr P of
    the Partners to the district nurse at K Road Health Centre stating that:
    “Dear Colleague, Please can Patient X’s mum be taught how to administer B12 injections.
    Yours sincerely, Dr P.”
    It is clear then that the Partners’ B12 complaint is based on an untruth about the actual
    facts of the complaint. Making an untrue complaint is also vexatious as detailed in the
    GMC rules noted at section 3.1.2 above and so the GMC has also broken its own rules on
    vexatious complaints by even accepting to investigate this complaint meaning that this
    point is a procedural defence as well as evidential.
    (II) This complaint should be set aside because at its core there is an untruth which has
    been absolutely proven. This untruth is not a matter of opinion; it is a bald fact.
    (III) As evidence of this point the relevant letters noted above are included as
     section 4.5 – letter of complaint by Dr Y of the Partners dated 18th June 2009
     section 4.6 – letter from Patient X’s medical notes dated 4th March 2009
    Further letters have been exchanged between SM and the GMC on this point and these
    are included here for the sake of completeness
     Section 4.29 Letter, dated 17 July 2010, from SM to Stephen Farnworth,
    Investigation Manger at the GMC, complaining about the dishonest behaviour of
    the Partners in this respect and requesting a GMC investigation of this matter.
     Section 4.30 Further letter from SM to Stephen Farnworth, dated 1 September
    2010, making further legal points on the definition of dishonesty.
     Section 4.31 Email from Neil Marshall, GMC, dated 5 September 2010 which
    incredulously makes the following statement:
    ‘…it is not my intention to engage in any further semantic debate about the meaning of the
    word ‘dishonesty’
    The definition of dishonesty is key to this complaint and for Mr Marshall to refuse to
    discuss it seems rather churlish.
    The full arguments with respect to this point are summarised in the most recent letter by
    SM to Adam Elliot, GMC, dated 15 September 2010 and this is attached as further
    evidence:
     Section 4.34 Letter dated 15 September 2010 from SM to Adam Elliot
    The definition which Mr Marshall was not prepared to discuss the semantics of is as
    follows and is taken from the decided case, R v Ghosh (1982) 75 CR App. R. 154, which is
    considered the defining case law on the definition of dishonesty in English Criminal Law:
    • "Were the person's actions honest according to the standards of reasonable and
    honest people?" If a jury decides that they were, then the defendant's claim to be
    honest will be credible. But, if the court decides that the actions were dishonest, the
    further question is:
    • "Did the person concerned believe that what he did was dishonest at the time?"
    Sections 4.30 and 4.34, as noted above, show how the Partners pass both of these tests.
    Moreover, this definition of dishonesty is accepted by the GMC, despite Mr Marshall’s
    protestations. Here is an excerpt from the Publishable Minutes of the FITNESS TO
    PRACTISE PANEL dated 9-11 June 2010 concerning Dr Asim Raza Zaidi in which the
    following definition of dishonesty was used:
    The Panel has accepted the advice given by the Legal Assessor with regard to the definition
    of misleading and the test for dishonesty. The Legal Assessor advised the Panel that, when
    considering the issue of dishonesty, the Panel should apply the following two stage test:
    1. Was what the doctor did dishonest by the ordinary standards of reasonable and
    honest people?
    2. Did the doctor realise what he was doing was dishonest by those standards?
    It can be seen that this is exactly the test that has been applied by SM to the Partners. The
    full text of these minutes is included at section 4.36.
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    AND ALSO

    3.2.2 The GMC did not obtain either adequate corroborative evidence for, or confirm the
    credibility of, the complaints nor did they ascertain the credibility of the website
    complainant himself.
    (I) Under GMC Imposing Interim Orders: Guidance for the Interim Orders Panel and Fitness
    to Practise Panel April 2008 Annex 9 (see section 4.12) it is stated that:
    “The Interim Orders Panel will make no finding of fact but the complaint must be credible
    and backed by corroborative evidence.”
    Regarding the B12 complaint, the actual veracity of the complaint is refuted in section
    3.2.1 indicating that there must be a lack of valid corroborative evidence. In addition
    Professor Bouloux’s Expert Witness report (see section 4.13), which was used as
    corroborative evidence, is discussed at length in section 3.1.9 above and has been shown
    to be inadequate for this purpose. Furthermore, the GMC has not responded adequately
    to requests by SM for details as to how it confirmed the identity of the website
    complainant – see sections 5.1, 5.3 and 5.4 for SM’s question and the lack of an
    appropriate answer from the GMC. In addition, the GMC has refused to obtain a
    Declaration of Interest from the website complainant on the basis of confidentiality - see
    section 5.3. The combination of no evidence from the GMC confirming this complainant’s
    actual identity coupled with the lack of a Declaration of Interest renders this complainant
    not credible. This is because neither his credentials nor his motivation for the complaint
    have been established. This is discussed in more detail in section 4.4, where it is argued
    that the fact that it is not known whether the website complainant is complaining in his
    own right or on behalf of a third party adds to the sense that this is a vexatious complaint
    – see section 3.1.2. The motivation for a complainant is a significant factor in his credibility
    and therefore the credibility of the complaint itself. The GMC has not performed sufficient
    checks to determine either the motivation of the Partners, in submitting a complaint
    which has an untruth at its core, or of the website complainant as already discussed and
    pointed out at length in section 4.4.
    (II) The B12 complaint is not credible, primarily because it has at its core an untruth. The
    website complaint is not credible because the credentials and motivation of the
    complainant have not been established by the GMC despite repeated requests by SM. In
    addition, the corroborative evidence in the form of Professor Bouloux’s report has been
    shown to be inadequate. Therefore, the IOP should not have been called because the
    GMC did not follow its own internal procedures in the context of Annex 9 above. In these
    circumstances the IOP decision should be set aside. In this context, also, full consideration
    should be given to the Medical Reports Document, where a full scientific evidence base
    supporting SM’s medical practice has been accumulated.
    (III) The evidence base for this conclusion can be found at
     section 4.4 Letter from SM to Elizabeth Hiley (GMC) dated 17 July 2010 concerning
    the vexatious nature of the website complaint
     section 4.12 GMC Imposing Interim Orders: Guidance for the Interim Orders Panel
    and Fitness to Practise Panel April 2008 Annex 9
     section 4.13 Professor Bouloux’s Expert Witness report
    and also in sections 5.1, 5.3 and 5.4.
    3.2.3 GMC records of previous failed cases against SM contain many factual errors.
    (I) The full list of these factual errors can be found at sections 5.7 A, B and C and 5.8 B.
    (II) The existence of these evidential errors means that the Panel based its decision and
    findings on an inaccurate evidence base. These records are relevant to the case before SM
    for the same reasons as expounded in section 3.1.1 and so if they were not presented to
    the Panel then that in itself would constitute a procedural error, also. This has the effect
    that either the IOP decision should be set aside, if these records were presented to the
    Panel, because the data record which the Panel based its decision on was inaccurate, or
    that the IOP decision should be set aside, if these records were not presented to the
    Panel, because the proper procedures of presenting a full GMC past history to the Panel
    had not therefore been followed. It should be noted that in the latter case, that of nondisclosure
    to the Panel, it is not just a case of the GMC having not followed proper
    procedures but also that vital positive evidence in SM’s favour was thereby denied to the
    Panel. For example the following quote is from Mr Tom Kark GMC legal adviser on
    previous cases:
    “No-one can seriously doubt Dr Myhill’s good intentions’
    In addition, in an internal GMC memo dated 10th February 2006, it is stated that:
    “My main concerns with all the Myhill files are that all of the patients appear to be
    improving and none of them are likely to give WS (witness statements) or have complained
    about their treatment.”
    There are many more such positive comments on these previous case files which are very
    relevant to the Panel’s understanding of the history of SM’s involvement with the GMC
    Investigations Department. Further examples can be produced if required.
    (III) The evidence base for this point is as follows:
     Section 5.7 and section 5.8 B. References to other documents within these two
    sections are made and should the production of these other documents so
    mentioned be required then this shall also be done and will in this case represent a
    second layer of evidence base.
     Section 4.20 Internal GMC memo dated 10th February 2006
     In addition, other evidence of positive supportive comments within these previous
    cases date records can be produced if so required.
    3.2.4 GMC records of the current case against SM contain many factual errors.
    (I) The full list of these factual errors can be found at sections 5.7 D and 5.8 A and D
    (II) The existence of these evidential errors means that the Panel based its decision and
    findings on an inaccurate evidence base. These records are relevant to the case before SM
    for the same reasons as expounded in section 3.1.1 and so if they were not presented to
    the Panel then that in itself would constitute a procedural error, also. This has the effect
    that either the IOP decision should be set aside, if these records were presented to the
    Panel, because the data record which the Panel based its decision on was inaccurate, or
    that the IOP decision should be set aside, if these records were not presented to the
    Panel, because the proper procedures of presenting a full GMC past history to the Panel
    had not therefore been followed.
    (III) The evidence base for this point is as follows:
     Section 5.7 D and section 5.8 A and D. References to other documents within these
    two sections are made and should the production of these other documents so
    mentioned be required then this shall also be done and will in this case represent a
    second layer of evidence base.
    3.2.5 The Website complaint is based on a false assumption
    (i) As noted in section 3.1.2, the website complaint is based on a personal belief system.
    This complainant believes that NICE guidelines are in some way mandatory and that
    doctors who do not abide by them should be investigated for malpractice. This is not the
    case. Letters have been received from both NICE and the Department of Health stating
    that NICE guidelines are guidance only. In particular the letter received from NICE states
    that:
    ‘NICE clinical guidelines are recommendations about the treatment and care of people with
    specific diseases and conditions in the NHS in England and Wales. Clinical
    guidelines represent the view of NICE, and are arrived at after careful consideration of the
    evidence available. Healthcare professionals are expected to take it fully into account when
    exercising their clinical judgement. However, the guidance does not override the individual
    responsibility of healthcare professionals to make decisions appropriate to the circumstances
    of the individual patient, in consultation with the patient and/or guardian or carer, and
    informed by the summary of product characteristics of any drugs they are considering.’
    And the letter from the Department of Health states that:
    ‘It is important to emphasise that the National Institute for Health and Clinical Excellence
    (NICE) clinical guidelines are just that – guidelines for healthcare professionals. The
    guideline emphasises a collaborative relationship between clinician and patient and
    recognises there is no one form of treatment to suit every patient but that what is needed is
    a personalised, holistic approach.’
    (ii) The website complaint is based on a false assumption and should be set aside.
    (iii) Evidence is contained in
     Section 4.25 – Letter from Teresa Birch, NICE, to Pat Endicott.
     Section 4.26 – letter from Kay Ellis, Department of Health Officer, to Invest in ME
    charity dated 28 May 2010
    3.2.6 Concerns regarding the website are medically out of date
    (i) The website complainant made complaints about many pages of the website.
    Notwithstanding the comments made in section 3.2.5 above, these complaints can be
    shown to be medically out of date. For example regarding the complaint about breast
    cancer screening contained in the website, the following was reported in the Belfast
    Telegraph on 4 August 2010:
    ‘Breast screening harms as many as it saves: report
    Wednesday, 4 August 2010
    o The UK’s national breast screening programme is harming almost as many
    women as it helps and must be urgently re-evaluated, a review in England has
    claimed.
    The benefits of breast screening — early detection of cancer followed by rapid treatment —
    are finely balanced against the harms of over-diagnosis followed by unnecessary treatment
    and suffering, the review says.
    Breast screening has divided the medical establishment for more than 20 years.
    The central drawback of screening is that in some cases the cancer (or other disease)
    detected does not need treating, either because it is a false alarm, because it resolves
    naturally or because it is very slow growing (so you die of something else).
    Supporters say it prevents an estimated 1,400 deaths a year. They claim that breast
    screening saves two women's lives for every one who gets unnecessary treatment.
    Critics dispute these figures, claiming that for every woman saved, as many as 10 undergo
    unnecessary treatment.
    Last March, the British Medical Journal (BMJ) published a paper on breast screening in
    Denmark which showed that deaths had fallen faster in areas without screening.
    Researchers were accused of “undermining trust”.
    Fi Godlee, editor of the BMJ, asked Professor Klim McPherson, public health epidemiologist
    of Oxford University, to review the evidence, and the results are published in the BMJ's
    current issue.
    Prof McPherson, citing US evidence, says breast screening reduces the death rate by 14% in
    the under-60s — “marginal statistical significance” — and by 32% in under-70s. But this is a
    small benefit because at age 60 the risk of death from breast cancer over the next 15 years is
    just 1.2% — 259 women in the UK would have to be screened to avoid one death.
    He calls for a “full examination of all the data” and more honesty from the NHS about the
    scientific uncertainties. ‘
    (ii) Claims made by the website complainant were lacking in foundation in the first place
    given the comments made in section 3.2.5 but in addition, even if these claims were
    accepted as justified complaints to be made, they are medically out of date and so should
    be set aside. This has the effect that the website complaint itself should be set aside.
    (iii) Evidence base for this is contained within
     http://www.belfasttelegraph.co.uk/news/health/breast-screening-harms-as-manyas-
    it-saves-report-14897265.html
     Section 4.27 BMJ paper, dated March 2010, on breast screening in Denmark
    3.3 CONCLUSION
    3.3.1 General
    Each of the individual points above come to their own separate conclusions ranging from
    setting aside the IOP decision in its totality through to setting aside one or other of the
    complaints subject to the submission of various required documentation through to the
    required receipt of certain reassurances from the GMC. Whether or not any or all of these
    points are considered valid, there is one further point to be made. The summation of so
    many procedural and evidential points, even if not absolute evidence in their own
    individual right, indicates that this IOP Hearing was poorly run, with GMC internal
    procedures not followed, that good practice in general was not followed, that there was a
    very poor evidential base and that possible issues with Data Protection and Human Rights
    legislation exist. In this context alone, the IOP decision should be set aside on the basis of
    unfairness to SM.
    3.3.2 Special Relevance of section 3.2.3 and 3.2.4 to an Appeal Hearing.
    All of the above procedural and evidential points are relevant both to the overturning of
    the IOP decision as it stands but also to any future Appeals. In particular, it is essential
    that the errors noted in section 3.2.3 and 3.2.4 are corrected before any future Hearings
    because it is absolutely necessary that the data record which forms the foundation of the
    evidence base upon which the Panel will base future decisions is accurate.

    SECTION 4 – APPENDICES
    Section 4.23 List of GMC cases demonstrating the inconsistency of the IOP prescription
    sanction against SM
    DR JANE BARTON
    BRIEF SUMMARY – Dr Barton was investigated over 12 years for the deaths of 92 patients
    in her care of which 5 were clearly shown to be due to morphine overdose. At her Hearing
    on 29th January 2010, she lost her rights to prescribe opiates for the next three years,
    whilst ALL other drug prescribing was permitted. This shows just how draconian and
    inconsistent the decision to lift all of SM’s prescribing rights is, in a situation where no
    harm to patients, let alone death, has been proven against SM.
    [GMC CASE REFERENCE- 1587920]
    DR STUART RUTHVEN
    BRIEF SUMMARY –In 2003, the then Royal Navy surgeon was convicted of making
    indecent photographs of children. He was sentenced to an 18-month community
    rehabilitation order and made to sign the Sex Offenders Register for five years. A review
    panel of the General Medical Council (GMC) ruled that Dr Ruthven could continue to
    practise, with the condition he did not treat under-16s. But in December 2008 that
    condition was revoked, meaning that he can now work with children.He has since worked
    at Alder Hey Children’s Hospital. Children’s charity Kidscape says they have grave concerns
    about the medic’s freedom to practise. Director Claude Knights said: “The possession of
    indecent images of children represents a vile crime, which is even more despicable when
    the perpetrator is a doctor. The downloading of indecent images of children is never a
    victimless crime and encourages this deplorable trade. Some people would question
    whether this doctor's sentence reflects fully the horror of his crimes.”
    DR MICHAEL ORMISTON
    BRIEF SUMMARY - A Dr Ormiston performed a botched operation which resulted in the
    death of 27 year old Louise Field. However, Dr Ormiston walked away from a General
    Medical Council hearing. Ms Field died two days after vascular surgeon Dr Michael
    Ormiston accidentally punctured her lung and pumped gas into her stomach at the BUPA
    Hospital, Harpenden, Herts. Dr Ormiston admitted making inaccurate records after the
    operation and the GMC panel noted that he had committed “significant departures from
    good medical practice”. The panel cleared him, however, of serious misconduct and found
    that his fitness to practise was not impaired. The panel also decided against issuing the
    surgeon with a warning.
    DR SINHA
    BRIEF SUMMARY – Dr Suman Sinha, who admitted making mistakes after a feeding tube
    was accidentally inserted into a man's lung instead of his stomach, was cleared of
    misconduct by the GMC .Dr Suman Sinha failed to spot the tube was in the wrong place
    when she checked Benjamin Richards' X-ray. Mr Richards, 48, started coughing, but nurses
    continued with the feed for two hours until the error was discovered. He was transferred
    to the high dependency unit at the now closed Oldchurch Hospital, but died of severe
    pneumonia several days later. The General Medical Council heard Dr Sinha made the
    decision to begin feeding after checking an X-ray on October 26, 2004. She then wrote in
    the notes: "The naso-gastric tube is in the correct position. It's a little high and needs to be
    pushed down a little further."
    Dr Freddy Patel
    Newspaper Seller Ian Tomlinson, Deadly Police Battering
    (Caption & Pic Courtesy Of One Click)
    The Home Office pathologist criticised for suggesting the newspaper seller Ian Tomlinson died of a
    heart attack during the G20 protests in 2009 has been suspended from practice for three months.
    The disciplinary ruling imposed by the General Medical Council on Dr Freddy Patel came after he was
    found guilty of misconduct or "deficient professional performance" in three earlier autopsy cases.
    The Crown Prosecution Service subsequently announced that its lawyer reviewing evidence in the
    Tomlinson case would now "consider the GMC's findings". Tomlinson died after being struck and
    shoved to the ground by riot police during protests in the City of London in April 2009. Patel was the
    first pathologist to examine his body. Patel said Tomlinson died of a heart attack, implying that his
    death was due to natural causes. A second examination contradicted that finding, suggesting instead
    that the newspaper vendor had died from internal bleedi ng. In July Keir Starmer QC, the director of
    public prosecutions, announced that no charges would be brought against any police officers. The
    latest CPS move stops short of suggesting it will reopen the whole file into Tomlinson's death.
    Owen Bowcott, The Guardian

    SECTION 5 – SELECTED CORRESPONDENCE
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    section 4 and 5 will not be posted here for the time being.

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