Estimated reading time at 200 wpm: 26 minutes

1. Introduction

This article demonstrates my dislike of publishing in journals: no journal will allow such a deep dive into a single case. Is it necessary? Well, put yourself in Dr Garrard’s shoes and think again. You get sacked for two similar incidents with months between them in the absence of any hard evidence. The balance of probability means you did it – you’re sacked! This article may at first glance seem like nothing to do with psychiatry. Some want the words ‘mental illness’ to instantly leap from the page. To understand the relevance one needs to read the article carefully. Psychiatrists are doctors and some of them may wish to learn how the system can take them into hell! Oh and you’re not allowed to write like that in a journal – oooo.. woooh.. that sensationalistic writing! Journal papers must be free of emotional expression. One must appear to be a robot. Tough – not for me.

So – if you got past my ‘issues’ then flip to 3.2 to see how ‘correlation’ means guilt!

1.1 The unusual procedural journey of a single case

Few fitness-to-practise cases travel quite the route taken by the allegations against Dr Neill Garrard. What began as two separate complaints of sexually motivated misconduct in A&E settings in 2021 ended up spanning more than four years, two full Medical Practitioners Tribunal hearings, a successful appeal to the High Court, a remittal, and a fresh determination in January 2026. Alongside that Dr Garrard successfully sued his employers for unfair dismissal.

The Professional Standards Authority appealed the first tribunal’s decision not because new facts had emerged, but because it argued the original panel had misdirected itself on a point of law: how evidence from one patient could properly support the credibility of the other’s account. The High Court agreed, quashed the 2023 findings, and sent the matter back for reconsideration by a differently constituted tribunal. That second hearing, conducted largely on the papers using transcripts from the first, reached the same ultimate conclusion—no facts proved—despite applying the corrected legal approach the judge had demanded.

The protracted timeline is itself noteworthy. Complainants who once gave live evidence found their accounts presented in written and transcribed form years later; the doctor faced a second public airing of the same serious allegations; and the GMC, having lost on the facts once, was required to prove its case afresh under stricter evidential guidance.

From the first allegation in March 2021 to final closure in January 2026 spans nearly five full years. During that stretch Dr Garrard faced:

• police interview under caution (no charges)
• Trust dismissal following internal investigation
• self-reporting to the GMC
• two separate full fitness-to-practise hearings, each involving public scrutiny of deeply personal allegations
• an interim order restricting his registration for much of the period
• the emotional and financial burden of repeated legal representation across criminal, employment, and regulatory arenas

Even though both tribunals ultimately found no facts proved, the machinery of regulation—appeal, quashing, remittal, fresh panel—ensured the matter remained live long after the events themselves. The delay was not caused by new evidence emerging or shifting facts; it stemmed from a legal error in the first tribunal’s directions, which the High Court quite properly corrected, but at the price of restarting much of the fact-finding exercise.

For any professional, especially one working locum shifts in high-pressure A&E departments, the cumulative impact is obvious: reputational stain, restricted practice, lost income, and the constant weight of unresolved accusation. The system delivered procedural accuracy in the end, yet the human and economic cost of getting there was undeniably steep.

Relevant sources of information

MPTS 2026, High Court – Between Professional Standards Authority for Health and Social Care and GMC and Dr Garrard 2025. Good reading is the Employment Tribunal Decision Case Number: 2300995/2023 (para 105 to 125 especially).

1.2 Why this matter matters beyond one doctor

At first glance the case might appear to concern only the credibility of two vulnerable patients and one doctor’s conduct during night shifts in overstretched emergency departments. Several broader questions emerge that reach well beyond the individuals involved.

How reliably can tribunals distinguish between genuine recollection and medication-induced false memory when psychotropic drugs—pregabalin, diazepam, sertraline—are in play? What weight should cross-admissibility carry when the core accounts already face serious plausibility challenges? And does the current standard of proof on the balance of probabilities, combined with the absence of CCTV or independent witnesses in closed consultation rooms, set an attainable threshold for proving sexually motivated misconduct in acute clinical settings?

The repeated failure to find facts proved, even after judicial correction of the first tribunal’s legal error, invites reflection on these systemic points without needing to second-guess whether the original complaints were well founded. The case illustrates both the protective mechanisms built into professional regulation and the practical limits those mechanisms can encounter when dealing with complainants in acute mental-health or neurological distress.

2. The Original Allegations

2.1 Patient A – Royal Hampshire County Hospital, March 2021

Patient A, a woman in her thirties suffering from functional neurological disorder and chronic migraines, arrived by ambulance at the Accident and Emergency department of Royal Hampshire County Hospital, Winchester, late on 26 March 2021. She had experienced a severe headache accompanied by two witnessed episodes of loss of consciousness. Her regular medication included pregabalin, co-codamol, duloxetine, and diazepam.

She was triaged and placed in Bay 13, where Dr Garrard, then working as a locum registrar, saw her shortly after midnight on 27 March. The GMC alleged that, during several visits to her bedside over the early hours, Dr Garrard:

• dug his fingers into her shoulder
• squeezed her fingers
• touched her breasts on one or more occasions
• squeezed her nipple on more than one occasion
• chanted to her in a “hypnotic” manner while breathing heavily
• told her words to the effect of “you will lust for me” and “you will want to kiss me”

These acts, it was said, were carried out without consent and were sexually motivated.

Patient A made an immediate complaint to nursing staff and telephoned the police from her bed. A healthcare assistant overheard the call and escalated the matter. Her husband submitted an online referral to the GMC the following day. Hampshire Police interviewed her under video on 1 April 2021 but later decided no further action was warranted. Dr Garrard was interviewed under caution; no criminal charges followed.

2.2 Patient B – Lewisham Hospital, December 2021

Patient B, also a woman in her thirties, attended the Urgent Care Centre at Lewisham Hospital on the evening of 27 December 2021. She had been experiencing worsening anxiety, loss of balance, elevated heart rate, and episodes of sleepwalking since a recent COVID booster vaccination. She was taking sertraline and had contacted NHS 111 earlier that day; the call handler arranged an in-person assessment to exclude serotonin syndrome.

Dr Garrard saw her after she was brought from the waiting area. The GMC alleged that, during the consultation, he:

• asked her on multiple occasions to remove her vest and bra, and later her trousers and underwear, when not clinically indicated
• told her to go to a nearby garage to buy water for herself and coffee for him
• said her boyfriend was causing her sleepwalking and anxiety, that she should not trust him or her parents, and that only he understood her symptoms
• instructed her to wait at the bus stop after discharge so he could drive her home after his shift
• spoke to her on one or more occasions in a “hypnotic” manner (though she later clarified in interview that she did not believe he had hypnotised her)

These actions, again, were alleged to lack consent and to be sexually motivated.

Patient B emailed a complaint to the hospital’s Patient Advice and Liaison Service the following evening. She discussed the matter with her GP two days later and participated in a Trust investigation. She chose not to involve the police, satisfied that the hospital was handling the issue. Dr Garrard self-reported the allegation to the GMC.

2.3 Common threads and points of difference

Both patients were vulnerable women presenting alone to A&E with acute neurological or mental-health symptoms during night shifts. Each alleged that Dr Garrard spoke in an unusual, repetitive or soothing tone (variously described as chanting, hypnotic, or weird), asked them to undress to an inappropriate degree (breasts for Patient A; full upper and lower body for Patient B), and exhibited controlling or sexually suggestive behaviour. Neither patient knew the other, ruling out direct collusion.

Differences were also marked. Patient A described overtly sexual remarks and physical touching of breasts and nipple; Patient B described no physical contact but alleged psychological manipulation concerning her relationships and an offer of a lift home. The “hypnotic” element featured in both accounts yet was described differently: heavy breathing and explicit sexual chanting for Patient A, soothing tone and finger-clicking for Patient B. Medication regimes diverged—polypharmacy including pregabalin and diazepam for Patient A, sertraline monotherapy for Patient B—with correspondingly different expert evidence on potential side-effects.

These overlaps and distinctions became central to the tribunals’ analysis of whether the similarities were sufficient to rebut coincidence or whether independent explanations (principally medication-related perceptual disturbances) remained plausible.

3. The First Tribunal (November–December 2023)

3.1 Key evidence considered

The Medical Practitioners Tribunal heard live evidence over several days in late 2023. Patient A and Patient B both gave oral evidence, describing their encounters in detail. Dr Garrard also gave evidence, denying all allegations and pointing to plausible clinical explanations for his actions.

Expert witnesses addressed clinical justification and pharmacology. For Patient A, the GMC expert considered whether the alleged touching could form part of a legitimate neurological examination; the defence highlighted potential effects of pregabalin and diazepam on perception and memory. For Patient B, duelling experts debated whether sertraline (possibly exacerbated by her recent COVID booster) could produce vivid dreams, auditory hallucinations, or serotonin-syndrome-like states capable of generating false recollections.

Contemporaneous records played a central role: Patient A’s immediate police call and husband’s GMC referral; Patient B’s texts to her friend and boyfriend, her PALS email the next day, and GP entries noting vivid dreams and possible hallucinations. Nursing notes and Trust investigation documents were also before the panel.

3.2 The tribunal’s approach to cross-admissibility

The GMC invited the tribunal to treat the two patients’ accounts as cross-admissible on the basis that independent complainants making similar allegations of sexually motivated misconduct were unlikely to do so by coincidence. The Legally Qualified Chair directed the panel by reference to R v BQC and R v Freeman, setting out both propensity and coincidence routes.

In closing submissions the GMC emphasised the coincidence basis, arguing that the defence case invited a finding of pure chance and that the improbability of two unrelated patients fabricating comparable accounts strengthened each complaint. The direction given, however, covered both bases and stressed that propensity required proof of one allegation before it could support another. The panel was told it could consider evidence holistically but must decide each particular separately.

3.3 Outcome: no facts proved

On 13 December 2023 the tribunal delivered its written determination. It found none of the allegations proved on the balance of probabilities.

The panel dealt with each patient’s account separately before addressing cross-admissibility at the end. It concluded that the similarities were not sufficiently strong or distinctive to establish a pattern. Differences in the alleged speech (sexual chanting versus soothing instructions about relationships), the absence of proven hypnotic chanting in either case, and credible expert evidence on medication side-effects undermined the GMC’s case.

The tribunal considered coincidence possible, noting that both patients presented with conditions and treatments that could plausibly produce distorted perceptions or false memories. Dr Garrard’s denials were consistent and supported by the absence of independent corroboration in closed clinical settings. Fitness to practise was therefore not impaired.

4. The PSA Appeal to the High Court

4.1 Grounds of appeal

The Professional Standards Authority for Health and Social Care exercised its statutory power under s.29 of the National Health Service Reform and Health Care Professions Act 2002 to appeal the 2023 tribunal’s decision. The PSA advanced two closely related grounds, both centring on the tribunal’s treatment of cross-admissibility:

• The tribunal misdirected itself on the correct legal test for when evidence relating to one patient could be used in respect of allegations concerning the other.
• Even if the direction was sound in principle, the tribunal misinterpreted or misapplied that test in its reasoning.

The appeal did not challenge the tribunal’s factual findings as such, nor did it introduce fresh evidence. Instead, it contended that errors of law in the approach to cross-admissibility infected the entire fact-finding exercise.

4.2 Mr Justice MacDonald’s ruling ([2025] EWHC 318 (Admin))

The appeal was heard on 28 January 2025 before Mr Justice MacDonald in the Administrative Court. Judgment was handed down remotely on 14 February 2025. The GMC did not appear or make submissions, in line with convention. Dr Garrard, represented by Mr Michael Rawlinson, opposed the appeal.

The judge allowed the appeal on both grounds and quashed the tribunal’s determination in its entirety.

4.3 Core errors identified

On the first ground, the court held that the Legally Qualified Chair’s direction, recited in the tribunal’s reasons, conflated the two recognised bases for cross-admissibility—propensity and rebuttal of coincidence—without tailoring the guidance to the GMC’s case. The GMC had relied squarely on coincidence: the unlikelihood that two independent complainants would make similar but false allegations of sexually motivated misconduct absent collusion.

The direction emphasised that propensity required proof of one allegation to the required standard before it could support another, and failed clearly to articulate the distinct principles applicable to coincidence reasoning. Those principles, drawn from authorities such as R v Freeman [2008] EWCA Crim 1863, R v Adams [2019] EWCA Crim 1363, and R v H [2011] EWCA Crim 2344, include:

• No prior finding of fact on one allegation is needed before considering its evidence in relation to the other.
• Collusion or contamination must first be excluded.
• If excluded, the fact of two independent similar complaints reduces the probability of innocent coincidence.
• The tribunal must assess the evidence holistically rather than sequentially.

The direction given risked confusion and did not reflect the circumstances of the case.

On the second ground, the court found that the tribunal had wrongly elevated the threshold for similarity. It required a “pattern” or something “sufficiently distinctive to link” the allegations, rather than asking simply whether there was a sufficient connection and similarity between the facts to render one patient’s evidence relevant to the other (per Chopra [2006] EWCA Crim 2133). The tribunal’s focus on differences in the precise nature of the “hypnotic” speech, while noting broad similarities (vulnerable female patients, undressing requests, controlling/sexualised behaviour in a clinical setting), led it to discount cross-admissibility prematurely. Had proper principles been applied, the judge observed, it was difficult to see how the tribunal could have concluded otherwise than that the evidence was cross-admissible on the coincidence basis.

The errors were material: correct direction and application might have led to a different outcome on the facts.

4.4 Consequence: quashing and remittal

The decision of 13 December 2023 was quashed. The matter was remitted to a freshly constituted Medical Practitioners Tribunal with a direction to reach a fresh determination applying the correct approach to cross-admissibility. No findings were made on the underlying merits; the High Court confined itself to the legal errors identified.

5. Procedural Steps After the Appeal

5.1 The February 2025 High Court directions hearing

Following the principal judgment of 14 February 2025, the parties returned to the High Court on 25 February 2025 to settle the terms of the remittal. A key dispute arose over evidence format: the GMC proposed that the case could proceed “on the papers” using the transcripts and documents already before the 2023 tribunal, arguing that re-calling witnesses would cause unnecessary delay and distress.

Dr Garrard’s representatives contended that fairness required fresh oral evidence, particularly from Patient A (who remained willing and available) and Patient B, to allow the new panel to assess credibility directly. Mr Justice MacDonald declined to resolve the point himself. Instead, he directed that a differently constituted Medical Practitioners Tribunal should decide whether live evidence was necessary or whether the 2023 material sufficed. The judge emphasised that the remitted tribunal must have discretion to ensure a fair rehearing while avoiding disproportionate re-traumatisation of complainants.

5.2 The November 2025 case-management decision on evidence format

On 19 November 2025 a case-management hearing took place before a Medical Practitioners Tribunal. Both parties made submissions on the evidential approach. Patient A confirmed she was available and prepared to give live evidence again if required. Patient B indicated a strong preference against re-attending, citing the emotional toll of the first hearing.

The tribunal ruled that, notwithstanding Patient A’s availability, it was appropriate and fair for the remitted hearing to proceed without fresh oral evidence from either patient. The 2023 transcripts of their evidence (both witness statements and cross-examination), together with all other documentary and expert material from the original hearing, would stand as the factual record. The panel reasoned that:

• The original evidence had been tested thoroughly under oath.
• Requiring live evidence risked re-opening old wounds for vulnerable complainants without clear probative gain.
• Dr Garrard would still give live evidence, allowing the new tribunal to observe him directly.
• The binding nature of prior procedural rulings under Rule 30 of the GMC (Fitness to Practise) Rules 2004 supported continuity unless material circumstances had changed.

No party sought to challenge this determination thereafter.

5.3 Use of 2023 transcripts instead of live evidence

The practical consequence was that the remitted hearing in January 2026 relied heavily on hearsay in respect of the complainants. Their 2023 oral evidence was admitted not as fresh evidence but as preserved records, subject to the tribunal’s careful assessment of weight.

The panel received explicit legal advice on treating such material: it must consider why the witnesses were absent (understandable distress and prior full participation), the GMC’s reasons for not calling them afresh, and the overall fairness of proceeding without cross-examination before the new members. The tribunal was invited to draw on principles akin to s.4 of the Civil Evidence Act 1995 when weighing reliability, while recognising that MPT proceedings operate under distinct rules.

This approach balanced procedural economy, complainant welfare, and the doctor’s right to a fair rehearing. It also meant the new panel could not pose its own clarifying questions directly to Patient A or Patient B—something it later noted would have been helpful on certain points of detail.

6. The Remitted Tribunal (January 2026)

6.1 Corrected legal directions on cross-admissibility

The freshly constituted tribunal, sitting from 7 to 23 January 2026, received precise legal advice tailored to the High Court’s criticisms. The Legally Qualified Chair directed the panel that the GMC relied on cross-admissibility solely to rebut coincidence, not to establish propensity.

The panel was instructed to ask first whether sufficient connection and similarity existed between the facts alleged for Patient A and Patient B to render one account relevant to the other. If yes, it must then:

• exclude collusion or contamination (plainly absent, as the patients were unconnected and presented at different hospitals nine months apart);
• consider the evidence holistically, recognising that independent similar complaints from two complainants reduce the likelihood of innocent explanation;
• attach weight without first proving one allegation to the civil standard;
• weigh any defence explanation for coincidence—in this case, medication-induced perceptual distortions or false memories.

The direction drew directly from Freeman, Adams, and Chopra, avoiding the conflation that had flawed the 2023 hearing.

6.2 Re-evaluation of patient reliability and medication effects

Despite the corrected framework, the tribunal found the broad similarities (vulnerable lone females, unusual speech patterns, requests to undress, controlling/sexualised elements) insufficient to overcome serious doubts about reliability.

For Patient A, inconsistencies across her police interview, witness statement, and 2023 evidence, combined with polypharmacy (pregabalin, diazepam, duloxetine) known to cause memory fragmentation and perceptual changes, rendered her account unreliable overall. The tribunal placed little weight on her evidence as a credible witness.

For Patient B, the tribunal highlighted evolution in her complaint: initial texts and PALS email focused on coffee requests and relationship comments; fuller undressing allegations emerged later. Contemporaneous GP records noted vivid dreams, sleepwalking, variable sleep, and one possible auditory hallucination around the relevant period. Expert evidence supported sertraline side-effects (potentially worsened by recent vaccination) as plausible causes of distorted or false recollections. The panel found it entirely plausible that Patient B fell asleep during or after the consultation and incorporated elements of a dream or hallucination into her memory of events.

6.3 Treatment of hearsay evidence

The tribunal expressly weighed the 2023 transcripts and statements of both patients as hearsay. It noted the earlier case-management ruling admitting them, the understandable reasons for non-attendance (distress and prior full participation), and the absence of any material change justifying re-opening.

While acknowledging that direct questioning by the new panel might have clarified certain details, the tribunal did not discount the evidence solely for its hearsay character. Instead, it scrutinised reliability against contemporaneous documents, internal inconsistencies, and expert pharmacology. Ultimately, the hearsay nature reinforced caution where accounts already appeared fragile.

6.4 Dr Garrard’s evidence and good character

Dr Garrard gave live evidence for a second time. The tribunal found his account consistent across police interview, first tribunal, and remitted hearing. He offered clinical rationales for aspects of the consultations (e.g., asking Patient B to remove a hoodie for blood pressure; exploring psychosocial factors in anxiety). His good character—no prior fitness-to-practise history or convictions—was treated as relevant to credibility and as reducing the likelihood of the alleged propensity. The panel gave positive weight to his willingness to give evidence again and to the coherence of his denials when tested against the records.

6.5 Final findings: coincidence not excluded

After holistic assessment, the tribunal concluded that the GMC had not discharged the burden of proof. Similarities existed on the surface, but were not sufficiently cogent to exclude coincidence once medication effects and perceptual vulnerabilities were properly factored in. Both patients could plausibly have formed false or distorted memories of their last significant interaction before sleep.

No particular was found proved on the balance of probabilities. The allegations of sexual motivation, lack of consent, and inappropriate conduct therefore fell away. Fitness to practise was not considered; any interim order was revoked with immediate effect, and the case concluded.

7. Key Themes and Implications

7.1 Vulnerability, psychotropic medication, and memory reliability

Both patients presented in acute distress with pre-existing mental-health or neurological conditions treated by psychoactive drugs. Patient A’s regimen included pregabalin and diazepam—agents known to impair memory consolidation and induce perceptual distortions. Patient B’s sertraline, possibly potentiated by recent vaccination, was linked in expert evidence to vivid dreams, sleepwalking, and isolated auditory hallucinations.

The tribunals repeatedly accepted that such pharmacology could plausibly generate false or confabulated recollections, especially when the last significant interaction before sleep involved a softly spoken clinician. This factor proved decisive: even after cross-admissibility was properly applied, the possibility of medication-induced distortion remained a credible alternative explanation that the GMC could not exclude on the balance of probabilities.

7.2 The high bar for proving sexual motivation in regulatory proceedings

Sexual motivation requires the tribunal to be satisfied that a reasonable person would view the conduct as sexual and that, in all the circumstances, it was in fact sexually motivated—typically pursuit of gratification or a future sexual relationship.

In closed consultation rooms, absent CCTV, contemporaneous witnesses, or forensic evidence, proof hinges heavily on the complainant’s account and any documentary trail. Where that account faces material reliability challenges (inconsistencies, delayed elaboration, pharmacological alternatives), the inference of sexual intent becomes difficult to draw to the required standard. The repeated failure to find facts proved illustrates how exacting this threshold can be in A&E settings involving vulnerable patients and powerful medication.

7.3 Limits and proper use of cross-admissibility in MPT cases

Cross-admissibility on the coincidence basis is a powerful tool: independent similar complaints from unrelated sources can powerfully reduce the likelihood of fabrication or innocent explanation. Yet the High Court made clear that it is not a shortcut past core credibility issues.

The evidence must first show sufficient factual connection and similarity; even then, if individual accounts are already undermined by independent factors (here, medication effects), cross-admissibility cannot salvage them. The 2026 tribunal’s holistic assessment—acknowledging surface similarities but finding coincidence plausible—demonstrates that the doctrine operates as a supporting mechanism, not a substitute for direct proof.

7.4 Procedural safeguards versus delay and re-traumatisation

The case exemplifies the tension inherent in professional regulation. The High Court’s intervention ensured legal accuracy; the remittal preserved fairness through a fresh panel and corrected directions. The November 2025 ruling to rely on 2023 transcripts protected complainants from further oral evidence while allowing Dr Garrard to give live evidence.

Yet the overall journey—five years, two tribunals, one appeal—imposed significant burdens: prolonged uncertainty for the doctor, repeated public exposure of sensitive allegations, and emotional cost to complainants even without live re-examination. It raises the question whether streamlined pathways (e.g. more flexible use of preserved evidence from the outset) could better reconcile rigour with proportionality.

8. Closing Reflections

8.1 What the repeated outcome suggests

Two tribunals, separated by a High Court correction on a point of law, reached the same conclusion: no facts proved on the balance of probabilities. This consistency, despite the remittal forcing a fresh look under stricter cross-admissibility principles, carries weight.

It suggests that the evidential core—the reliability of the complainants’ accounts in the face of plausible alternative explanations rooted in medication and mental-state vulnerability—proved insurmountable for the GMC. The surface similarities that might otherwise have rebutted coincidence were not robust enough to outweigh independent doubts about memory and perception. The outcome does not declare the allegations false; it declares them unprovable to the required civil standard in the circumstances presented.

8.2 Open questions for the regulatory system

Several broader issues linger.

First, how should tribunals calibrate the threshold for sexual motivation when consultations occur in private, without independent corroboration, and when complainants present with conditions and treatments that reliably impair accurate recall? The case shows that even strong surface patterns can dissolve under scrutiny of pharmacology and chronology.

Second, is the current balance between procedural rigour and efficiency sustainable? Five years elapsed between the first complaint and final closure. While the appeal and remittal upheld fairness, the cumulative toll—on doctor, complainants, and public resources—prompts reflection on whether earlier case-management tools (for example, more proactive use of preserved evidence or focused expert joint statements) could shorten such cycles without compromising justice.

Third, the reliance on hearsay in the remitted hearing, though carefully justified, highlights a tension: protecting vulnerable witnesses from repeated evidence versus affording the panel direct observation of demeanour and responsiveness. The tribunal itself noted it would have welcomed clarifying questions it could not ask.

Finally, the repeated findings invite consideration of whether A&E settings, with their high-pressure, low-witness environment and frequent prescribing of psychoactive drugs, present a particular challenge for proving or disproving allegations of this nature. If so, are there practical steps—enhanced contemporaneous documentation, routine chaperone policies in sensitive examinations, or targeted training on side-effect recognition—that might reduce future ambiguity without presuming guilt or innocence?

The case closes with no sanction and a doctor free to practise. The questions it raises remain live for regulators, tribunals, and the profession.