AOX v Secretary of State for Health and Social Care: High Court dismisses article 3 investigative duty claim over hospital sexual abuse

The High Court has dismissed a judicial review brought by a patient who was sexually assaulted by a locum doctor at the Royal Cornwall Hospital, ruling that neither the Secretary of State for Health and Social Care nor NHS England was in breach of any investigative duty arising under article 3 of the European Convention on Human Rights.

The judgement, handed down on 4 June 2026 by Mr Justice Eyre in the Administrative Court, concerns the conduct of Iuliu Stan, a locum senior house officer in the Trauma and Orthopaedics unit at the Royal Cornwall Hospital, Treliske. Stan administered medication per rectum to a significant number of male patients without following the hospital's chaperone policy and, the Medical Practitioners Tribunal found, in several cases for the purpose of his own sexual gratification. Stan was erased from the medical register in February 2024.

The claimant, referred to as AOX, attended the hospital in November 2019 aged 20, having injured his arm. Stan persuaded him to accept a suppository for pain relief, a procedure the claimant found deeply distressing and which he later learnt was both clinically unnecessary and sexually motivated. AOX sought a declaration that the defendants had failed to establish an article 3 compliant inquiry into the circumstances surrounding Stan's conduct.

On the article 3 threshold

The court first considered whether the treatment crossed the high threshold required to constitute inhuman or degrading treatment. Eyre J acknowledged the factors pointing against that conclusion: the claimant was not in custody, Stan was not a state agent, the intervention was brief and carried no adverse medical consequences, and the claimant had not learnt of Stan's motivation until more than four years after the event.

Against that, the judge identified a series of countervailing considerations. The claimant was vulnerable and in pain, his apparent consent was theoretical rather than real, and Stan persisted with an intimate physical intervention despite the claimant's visible distress, using him as an instrument of sexual gratification. Describing the point as finely balanced, Eyre J concluded that the treatment did arguably amount to degrading treatment within the meaning of article 3, sufficient to engage the investigative duty.

On the investigative duty

The more substantial part of the judgement concerns the nature and attribution of the procedural obligations that follow. Applying the framework set out by the Supreme Court in R(Maguire) v Blackpool & Fylde Senior Coroner [2023] and the Divisional Court's analysis in R(Morahan) v West London Assistant Coroner [2021], Eyre J held that article 3 duties must be assessed by reference to the particular defendant and that entity's specific role, powers and responsibilities. It is not sufficient, the judge emphasised, to identify an emanation of the state with a general responsibility in the relevant field.

The court found no arguable breach of either the systems duty or the operational duty on the part of either defendant. Any such breach lay at the level of the Trust and the Royal Cornwall Hospital itself. Crucially, the court rejected the argument that the Trust was incapable of conducting an adequately independent investigation. The Trust's refusal to date to commission an inquiry, its non-disclosure of internal reports, and its conduct in the civil litigation did not demonstrate an attitude incompatible with good faith compliance with a court order compelling one. An investigation commissioned by the Trust and conducted by appropriately independent external experts could, the court held, satisfy article 3.

Because the Trust retained the capacity to discharge the relevant obligation, neither the enhanced procedural obligation nor the redress procedural obligation fell upon either defendant. Ample alternative avenues for redress also remained open, including complaints to the Parliamentary and Health Service Ombudsman and the possibility of challenging the Trust's own refusal directly by way of judicial review.

Permission was granted to both defendants but the claims were dismissed. The judgement is a significant clarification of the principle that article 3 investigative duties attach to identifiable public bodies with specific relevant responsibilities, not to the state in the abstract.

AOX, R (on the application of) v Secretary of State for Health and Social Care & Anor [2026] EWHC 1217 (Admin)