Posted inInvestigations

EXCLUSIVE: Oxford colleges violate doctor-patient confidentiality in forced suspension cases

This investigation was conducted and written by Anvee Bhutani, Carlotta Hartmann, Laura McBride and Shannon Yang. Infographics by Shannon Yang and Daria Maria Koukoleva.

When Emma* visited the hospital for a serious medical concern, little did she know that it would result in her being told she would have to suspend her studies for a year. Emma, a second-year undergraduate at the University of Oxford, had consulted the college GP for the same issue prior to her hospitalisation. She had also been seeing members of the welfare team—referred to as junior deans, assistant deans or sub-deans at different Oxford colleges—regularly.

However, the day she went to the hospital in Hilary Term this year, her issue was serious, and she reached out to the junior deans. “They took me to the hospital and then they shared all of the information from what happened at the hospital with the College Doctor, the senior tutor, and some of the other welfare team members,” Emma told The Oxford Blue. “That was without my consent.”

The day after she was discharged, Emma got a phone call from the college GP, who had, despite the fact that Emma was not a minor, told her parents what had happened without telling her or asking her first. The GP also got in touch with the Senior Tutor that day, without Emma’s consent, alleging that Emma was unfit to study.

“So then the process kind of happened very, very quickly from that point,” Emma said. A couple of days later, another senior member of college notified her via email that college would be invoking a “special procedure” which could lead to her suspension. Under this procedure, a student must prove his or her fitness to study; otherwise, a year’s suspension may be imposed by the college.

The information shared by the college GP was ultimately used against her in the Cases Committee meeting, the next step of the “special procedure”: after a student is deemed unfit to study by the GP, the Senior Tutor recommends their suspension to the Cases Committee. In the absence of the student, the committee makes a decision on whether or not their studies should be suspended. Emma had not seen the doctor after her hospitalisation, so the GP’s certificate deeming her unfit to study did not come out of an actual checkup. “This was based only on information provided by the college, and I guess kind of the information based on the consultations that I had already had with her,” Emma told The Blue. “But at that point I would have been considered well enough to stay anyway.”

Emma voiced these concerns to college officials in emails seen by The Blue, but her college continued ahead with the special procedure. Though the hospital had issued a discharge summary claiming that she was well enough to continue her studies, Emma’s college decided to suspend her. In accordance with her college’s regulations, Emma was then officially deemed unfit to study, and was informed by  a senior member of college that she would be suspended from the college.

In an email exchange with the Senior Tutor, seen by The Blue, Emma expressed her indignation towards the suspension process as she was not allowed to attend the Cases Committee meeting in which the college decided that she would be suspended for one year, without an ability to appeal this decision. Emma’s frustration led to a 20-minute meeting with the deans, the only meeting she was able to attend regarding her suspension. Emma is now at home, undergoing her year-long suspension. She told The Blue

“It was decided pretty quickly that I’d have to take exactly a year out, and I wasn’t allowed to appeal on the basis that I didn’t think it would be helpful to take a year out, so I involved my tutors, and they weren’t given a say, and neither were my parents, even though they contacted the college. It was based solely on the opinion of the college doctor. And I think the thing that I found most unfair was that the opinion of the college doctor wasn’t based on speaking to me directly, it was based on the information provided by the college, which was without my consent. That was the main thing.”

Emma’s incident is not an isolated one. A similar case also took place last year where Mary*, an Oxford undergraduate at a different college, was encouraged to suspend on the grounds that she had a former PTSD diagnosis. This diagnosis was shared between the College Doctor and the college without Mary’s consent. Her experience of sexual assault that she spoke to welfare staff about in confidence was also told to college officials. Aside from these two issues, Mary asserts that she was having no other problems within the college to warrant removal. 

Nonetheless, she was unexpectedly called into a meeting where she was informed that she would have to suspend because she was unwell. Mary recounts the Welfare Dean describing PTSD like “having a drug addiction [and saying] something like ‘because sometimes you can’t decide what’s best for you, other people need to step in’”. All the while, Mary told The Blue, she did not show any signs of her well-being or studies being impacted and there was no communication from academic tutors suggesting cause for concern, so the news came as a surprise.

After enduring much hardship due to this threat by the college, Mary was finally able to have a psychiatrist at the University Counselling Service write a letter to her college indicating that she was fit to study. Though this ordeal proved to be a very difficult experience, she was able to continue her studies.

Though in the end she was not forced to suspend, the breach of confidentiality made Mary feel violated and unsafe in welfare and medical settings. “It was really traumatic in itself, and has meant I’ve not been able to go back to the college welfare team or doctors for help ever since, because I’m worried that it will be used against me again,” Mary said.

College policies on forced suspension vary greatly

Policies regarding suspension on medical grounds vary greatly across Oxford colleges, an investigation by The Oxford Blue shows. Several students report breaches of doctor-patient confidentiality by college doctors. Some colleges, like Emma’s, heavily involve college doctors in the process of forced suspension. Others make no mention of college doctors at all. According to the NHS website, students “need to register with a GP near [their] university”, meaning students should be registered with a doctor in Oxford. Some Oxford colleges explicitly require students to be registered with the college GP.

Regardless of requirements and regulations for doctors’ certificates or doctor-patient confidentiality, our investigation reveals that, at most colleges, procedures like the special procedure that Emma went through are inscribed into the fine print of college suspension policies. Colleges have the authority to suspend students without their consent by invoking such a procedure.

The Blue has examined undergraduate student handbooks and college regulations and policies on suspension, for the 33 undergraduate colleges. 
For 22 of these, The Blue was able to identify procedures which allow the college to suspend a student on medical grounds. Concerns about students’ health and welfare are primarily dealt with within college, alongside attempts by colleges to suspend students on medical grounds. However, “where all other normal procedures (whether at college or University level) have been exhausted or are inappropriate”, cases will be referred to the university’s Fitness to Study Panel. Here, ‘fitness to study’ means “a students fitness to commence (…) or continue with [their] current course of academic study; or to return to [their] current or another course of academic study”, as well as “[their] ability to meet: the reasonable academic requirements (…) and the reasonable social and behavioural requirements (…) without [their] physical, mental and emotional or psychological health or state having an unacceptably deleterious impact” upon their own or other students/staff health, safety or welfare.

Five colleges, Exeter, Magdalen, Queen’s, Trinity and University College, when considering to impose an intermission, may require a medical certificate to be issued by the College Doctor, explicitly. At these colleges, should the college doctor deem students unfit to study, they may be suspended. Exeter’s guidelines state that, “If the student is certified unfit to study by the College Doctors a suspension of status may be imposed upon the student (…) with or without the student’s consent”. Furthermore, all five of these colleges detail that a student’s failure to attend such a medical assessment is treated as a case where the student has been deemed unfit to study by the College Doctors.

Four other colleges, Harris Manchester, Merton, New and St John’s College, outline that college will seek medical advice, often from the College Doctor, encouraging students to consent to an assessment. In cases where the student refuses to do so, the college will continue the procedure based on information in its possession.

Jesus College places less weight on the college doctor’s judgement: the college “may require the junior member to be seen by a College Doctor for an assessment”. Should the college believe that a second assessment would be helpful, students may be required to “attend for an independent medical examination”. Refusal to do so can lead to the student’s suspension, until they cooperate.

Other colleges either do not mention College Doctors, specifically, in their policies, or allow students to provide evidence of their fitness to study by other medical professionals, subject to assessment by the college and College Doctors.

Colleges require students to waive doctor-patient confidentiality

Much like procedures for suspension, policies on doctor-patient confidentiality vary greatly across Oxford colleges. Some colleges require students to waive confidentiality in the process, facilitating their own suspension. The Blue has analysed these policies to understand how student information is treated.

At Exeter, Magdalen, Queen’s and University college, students will, when College Doctors are asked to contribute either an opinion or a certificate, be required to grant a limited waiver of doctor-patient confidentiality. Magdalen College states that “a limited waiver of doctor-patient confidentiality [is required] for that sole purpose”, and that “failure to grant a waiver of confidentiality to the College Doctors are the same as the consequences, under this Procedure, of failure to consult the College Doctors when so required.” For all four colleges, a student’s failure to waive confidentiality may lead to their suspension.

At Harris Manchester, Merton, New and St John’s College, students can, when College Doctors are asked to contribute either an opinion or a certificate, be required to grant a limited waiver of doctor-patient confidentiality. Should a student fail to grant full disclosure of the results of a medical examination in the suspension process, the college may continue the procedure based on information in its possession.

Brasenose, Lincoln, Oriel, St Edmund Hall, St Hilda’s and Trinity College outline that students are encouraged to grant consent to discuss their case with relevant members of the college. Brasenose College, for example, will “seek the student’s consent to discuss (in a discreet manner and on a need-to-know basis) his or her circumstances with other relevant College or University officers.”

The other undergraduate colleges included in our analysis – Balliol, Corpus Christi, Jesus, Keble, Lady Margaret Hall, Mansfield, and St Anne’s College – include no mention of a requirement to waive confidentiality in their regulations.

Fitness to study is often a condition to return from suspension

“In order to come back I need to get the certificate of fitness to study from the college doctor,” Emma told The Blue. Coming back from suspension, she says, “in some ways has been harder than getting into Oxford in the first place.” Getting a letter from her college doctor is proving difficult because she is no longer registered there. However, her college will not accept a certificate of fitness to study from a different doctor.

Our investigation found that students’ return from suspension on medical grounds – forced or voluntary – is tied to a number of conditions, including a medical certificate. The Blue was able to identify conditions for return specified in 27 college’s handbooks.

The Blue contacted Magdalen College on August 20th, and Exeter College, Harris Manchester College, Merton College, New College, Queen’s College and St John’s College on August 21st for comment on their suspension policies. Trinity College and Jesus College were contacted on the 22nd and 23rd of August, respectively. At publication, only St John’s College had responded.

They commented: “The issues of doctor-patient confidentiality that you raise are something the College takes seriously. The College would not want to place itself in the way of the doctor-patient relationship. At the same time, the procedure you outline is closely modelled on that which applies in an employment context and it is usually possible to work with this framework in a constructive way that balances the needs of the individual and the college. Any disclosure of medical information to the college is always treated confidentially, whatever the context.”

Oxford colleges have faced criticism in regards to their suspension procedures

Out of the response to a Freedom of Information request, The Blue found that most suspensions occur on medical grounds, either imposed or voluntary. The data from the FOI also showed that suspension rates and numbers varied widely among Oxford colleges.

Emma and Mary’s accounts are not the first documented cases of forced suspension and the ambiguous procedures around medical certificates at the University of Oxford. In 2016, an investigation by student newspaper Cherwell revealed that policies and practices around student suspension varied dramatically across colleges and individual experiences, with some students being suspended against their will, and some having to take special or penal collections, often with a required pass mark higher than what is usually expected. In 2015, The Telegraph revealed that then-PPE student, Sophie Spector, who lived with disabilities including dyslexia, ADHD, and OCD, was forced to suspend by Balliol College. According to emails obtained by Spector through a subject access request, the dean of the college requested for her to be seen by a specific doctor who could be more “firm”. After her year out, according to The Telegraph, Spector dropped out of the university, citing a toxic culture.

Suspension policies have also worked in the opposite direction, barring access to a year out from students who request one for medical reasons, where colleges accept medical certificates from college doctors only. In an article written by Wadham alumna Nathalie Wright in The Guardian, she details how despite seeing multiple doctors in her home county of Yorkshire for ME, Wadham would not accept her doctor’s certificate. Ultimately, Wright was able to suspend to take time to recover, and graduated afterwards. However, according to her piece, she faced penal collections (having to attain at least a 2:1) despite the fact that her suspension was purely medical, rather than academic or disciplinary. Wright’s story sheds light on the often difficult procedures students face with regards to medical certificates and suspension.

The Blue’s investigation not only reveals that colleges violate doctor-patient confidentiality to suspend students on medical grounds, but also shows just how complicated the suspension process is. When interviewing Emma, she mentioned: “There’s a lot of people in Oxford who aren’t aware of the suspension process, especially forced suspension, which can be very, very difficult. It’s important to raise awareness for things like that.”
Emma added, “I wasn’t very happy with the process. I don’t know what it’s like at other colleges, but in my case certainly, the nature of the college regulations made it okay for the college to treat students in a really, really horrible way, I’d say.”

*The names of these students have been changed in order to maintain their privacy.

This article was edited at 8:35pm on August 27th to remove a graph which included misinterpreted data.