In Martindale v Derbyshire Healthcare NHS Foundation Trust, a claim was brought against Derbyshire Healthcare NHS Foundation Trust for negligent management of a doctor’s psychotherapy and aftermath, all of which impacted her medical career and future earnings as a doctor. Iain O’Donnell, instructed by Melanie Isherwood of Weightmans Solicitors, represented the Trust in this complex claim with what amounted to 49 discrete alleged breaches of duty and a claim of over £1m in damages.

 Alleged negligence:

Overall, the judge found that the psychodynamic psychotherapy provided to the Claimant met accepted standards and was not negligent. The judge did find that there was a lack of senior supervision available to her psychotherapist to assist with the attachment formed by the claimant, but this point was successfully defeated on causation grounds.

There were no breaches of duty by her psychotherapist, although patient confidentiality was breached when the letter to her GP was also sent to her original therapist. This point was also defeated on causation grounds.

There was no breach in duty made by the Trust at the end of her therapy or in any further post-termination allegations of their interference with her complaints.

Causation and loss:

The judge dismissed the Claimant’s claim for loss of earnings related to her lost career as a medical doctor.

Before her therapy began, Dr. Martindale had expressed her decision to change her career to become a veterinary surgeon as she struggled to work with people, partially due to her mental health conditions.

The Judge found that there was no record of her deciding to continue her medical career instead of becoming a vet and that it was unlikely her treatment would have enabled her to continue working with people as a doctor.

Judgment available here.

Background:

Dr. Martindale had a history of psychological problems and was diagnosed as Borderline Personality Disorder (BPD). Whilst working as a locum doctor, she decided that changing her career to a veterinary surgeon would be more suitable. She had found working with people difficult, both as a junior doctor in a hospital and locum, partially due to her mental health issues. Shortly after her decision, a Health & Safety investigation was launched after one of her tenants in Derbyshire died of carbon monoxide poisoning from a faulty boiler, which was the Claimant’s responsibility.

She sought help for her mental health problems via ‘Doctors for Doctors’ and received therapy. She decided to move back to Derbyshire and was referred to the Derbyshire Healthcare NHS Foundation Trust’s psychotherapy department.  Dr. Martindale became deeply attached to her therapist despite his professional distance. Concurrently, there was an inquest into the death of her tenant, with her therapist giving evidence to the Coroner as to her mental state. The Health and Safety Executive (HSE) decided to prosecute, which ultimately led to her  being convicted of health and safety offences relating to the death of her tenant, for which she received a suspended prison sentence. Her mental health subsequently deteriorated despite progress in her therapy sessions.

Dr. Martindale voiced concerns over her therapist leaving her and being sectioned during this time. Shortly after this, her therapist found out he had been offered a job in Lincolnshire and arranged for his patients to transfer to a colleague at the end of his four month notice period.  Dr. Martindale was angry about his departure and, despite letters encouraging her to return, she did not return to therapy until her final appointment. Her request to see her therapist privately, or by any other means, was denied. She refused to see the new therapist, requested to be discharged and made a complaint of malpractice to the Trust.

The Claimant’s therapist informed both her GP and her original London therapist about the termination of her therapy and concerns over her mental health. She continued to insist on seeing him, despite both his and the Trust’s assessment that this was not appropriate, and rejected all offers of appointments with the new therapist. Dr. Martindale sought referrals into other areas and briefly saw a therapist at the Nottingham Psychotherapy Unit, who voiced his concerns about her safety to the police. She contacted Improving Access to Psychological Therapies (IAPT), who felt her case was more complex than their services were intended to support. Complaints regarding breach of duty and confidentiality were made and investigated by the Caldicott Guardian, UK Council of Psychotherapy (UKCP) and the Health Ombudsman, which were not upheld.

Her behaviour escalated as she was made the subject of a Restraining Order, both in relation to her therapist and premises where he worked. She erected signs and started an online petition calling for his resignation and also that of another senior clinician who had represented the Trust at previous meetings. She was convicted of harassment which placed her in breach of a suspended prison sentence for the HSE offences. She was made the subject of a further Restraining Order.

The Trust met again with her to offer help outside for Derbyshire and were concerned enough to contact the police for a ‘safe and well’ visit to Dr. Martindale’s home. This led to allegations of harassment and allegations of the Trust offering money and to drop charges if she dropped the petition and complaints, all of which were expressly denied by the Trust. Dr. Martindale viewed the trust as preventing future care, suppressing her complaints and negligently treating her.

She brought a claim against the Trust that but for the mismanagement of her therapy and after-effects, she would have recovered to continue her medical career. Her subsequent criminal behaviour was acknowledged to be inexcusable, but she claimed that had she been properly treated she would not have behaved in this way and avoided the offences now prohibiting her from a career in medicine.

Her multiple claims were all dismissed after a fully contested trial at the Nottingham District Registry.