​The sentencing of GP Manish Shah

In the famous Court Number 1 at the Old Bailey yesterday, former Romford doctor, Manish Shah, was sentenced to three life sentences for sexually assaulting 24 patients at the Mawney Medical Centre; he must serve a minimum term of 15 years in prison before he can apply for parole.
 
Attending the sentencing hearing on behalf of my client (who was a complainant in the first of two trials of Shah), it was clear that this sentence in no way overstated the gravity of his offending.
 
It was impossible not to feel appalled as the judge summarised the details of the awful experiences Shah had put his victims through: unnecessary breast, vaginal and rectal examinations, which he had persuaded them to undergo by a combination of preying on their fears and reassuring them that they were getting the best care.  The judge told Shah that his offending had been planned: he had deliberately targeted women who were young or otherwise vulnerable, for example, because they had just had a baby or a close relative who had been diagnosed with cancer.  He had access to this information through his position as their GP.  He had manipulated patients, on some occasions also their parents and his professional partners at the surgery.  His motivation had been mainly sexual but was also driven by his desire to control and on occasions to humiliate women.
 
The 90 offences spanned a period of time of 4 years from 2009 to 2013; there was absolutely no doubt that Shah was a predatory and prolific offender who would doubtless have continued his pattern of behaviour had it not been for the brave actions of those who eventually raised a complaint.
 
Shah did not admit to any of the complaints and made his victims endure a lengthy criminal trial process and the ordeal of having to give evidence.
 
This week has also seen the publication of the report of the Paterson Inquiry into the behaviour of the disgraced breast surgeon who performed inadequate or unnecessary operations on patients in the West Midlands, with a motivation being his personal financial gain.
 
The Paterson Inquiry looked at the circumstances and practices surrounding Ian Paterson and, whilst the Inquiry found things have improved, there remained concern that the systems in place today would still not be able to identify and stop another Paterson at an early stage.
 
It is clear from these cases, and others in which I have been involved, that, whilst the great majority of healthcare professionals are dedicated to the wellbeing of their patients, there will be a few who do not put patient safety and care first.
 
Robust – and, crucially, effective - supervision and monitoring is vital.  Whilst Anne Molyneux QC described Shah as a “master of deception”, I think it will be important to review whether there were any warning signs in his case, which were missed.  My experience in other cases where there has been sexual abuse by healthcare professionals is that there have been patient concerns or complaints but the response to them has been inadequate.  Or colleagues have had concerns but have felt inhibited in raising them, perhaps out of concern about the repercussions if they should do so or because the subject of the concern has been able to normalise their behaviour as ‘just the way they do things’ (i.e. “hiding in plain sight”).  This is where recognition that medical guidelines should not be flouted (however senior or experienced the clinician appears to be) is vital. 
 
Everyone working in a healthcare setting should be supported to speak up if they suspect abuse – I believe this should be a mandatory legal requirement as well as a professional duty.
 
It is really important that support and counselling is made available to those affected – as the psychological impact of the enormous breach of trust involved in these cases can be very great.  This should be independent as requiring someone to go back to the relevant organisation to get support can result in further traumatisation.
 
In summary, this case was a horrible breach of trust and many people will feel that it is almost unique.  However, as Bishop Graham James observed in his opening statement to the Paterson Inquiry, “It is wishful thinking that this could not happen again”.  The checks and balances that were in place should be reviewed to make sure that they were really functioning and effective.  And the needs of the victims going forward should not be lost sight of – it was very clear, sitting in Court today, that many of those who experienced Shah’s abuse and had to go through this process to see him convicted will need a lot of support in order fully to heal.