WARNING: This article deals with sexual abuse and suicide and may be upsetting.
The shocking extent of sexual offending by an American psychiatrist who worked at Waikato Hospital has sparked fears for his New Zealand patients and renewed questions over a review into his treatment of them.
The sexual abuse by Dr Paul Fox of a patient in the United States immediately before he worked in Hamilton is outlined for the first time in a powerful victim impact statement by the young woman he assaulted.
But Waikato District Health Board has twice refused to release a review of Fox's treatment of patients at the Henry Rongomau Bennett Centre, saying the review did not identify any issues.
Fox hid his offending from health authorities when he applied to work in New Zealand in March 2012, just months before he gave up his American registration over misconduct charges relating to the "boundary violations".
Until now his abuse of the young American woman, known as Jane Doe, has not been detailed publicly.
The 29-year-old, who was a teenager when Fox began sexually abusing her during treatment for depression and an eating disorder, told a Connecticut court how gruelling it had been to recover from "more than two years of a sexually exploitative relationship".
In her victim impact statement, read at Fox's sentencing in July last year and obtained by the Herald, the woman said the psychiatrist systematically broke her down at a time when she was already broken.
Jane was first referred to Fox as an 18-year-old university student with post traumatic stress disorder for abuse she suffered at the hands of her father.
"You got people to respect you and listen to you," she told Fox at his sentencing. "You were a psychiatrist. But, behind your educated and professional front you're a sexual predator."
She detailed how Fox, almost 40 years her senior, touched her when he wasn't entitled to.
"You knew it was wrong because you did it behind closed doors."
Jane said Fox manipulated her so she would stay in his cycle of abuse and keep his secret.
She wanted to get away from the psychiatrist but had nowhere else to go.
"He created a trauma bond. A destructive paradox that the same person who was hurting me was the only person I could turn to.
"He ripped out my instinct by telling me what he was doing was to show me nurturing and love. He didn't love me. Abuse isn't love."
She said the more he told her how connected they were the more disconnected she became from reality.
"The more he made me believe that I was mental the more I'd take the drugs. He used his access to drugs to create another layer of dependency and keep me totally unbalanced."
She told Fox: "... even if my story makes it as far as a filing cabinet, it's still worth it to chisel away at the silence so that you and people like you won't be able to exploit the vulnerable and think no one's listening."
Soon after Jane overdosed on the drugs and told a doctor what was happening, Fox applied for registration to work in New Zealand and became a locum at Waikato Hospital in June 2012.
It was only when Fox's treatment of a teenaged Adam Lanza, who went on to commit mass murder, came to light that New York State Board charges against him for professional misconduct were discovered by media in early 2014.
Fox was stripped of his New Zealand registration and returned to the States.
The Medical Council of New Zealand said it no longer registers overseas doctors where there is an open investigation, as was the case with Fox.
"We would not register a doctor unless we had received full information about the matter under investigation and are satisfied that it raises no concerns about public health and safety or questions about the doctor's fitness to practice."
A supporter of Jane Doe's told the Herald the full extent of Fox's abuse should be revealed to make people aware of the reality of his behaviour and that abuse by mental health providers was happening, and needed to be addressed.
"The perpetrator gets out of jail soon, so this is why we feel so strongly about exposing the truth."
Jane sought a 60-year restraining order on Fox, now aged 67, who was sentenced to 18 months in prison. He is currently set to be released two months early for good behaviour, on November 12.
The supporter said knowing the details of Fox's offending against Jane Doe made them suspicious of the psychiatrist's work in New Zealand.
Jane Stevens, the mother of Nicky Stevens - who took his own life while under Waikato District Health Board care in March 2015 - said it was Fox who put her son on the drug regime he was taking when he died.
She said earlier reporting of Fox's offending was shameful in its diminishing of what happened.
"This was no consensual relationship and I can't believe he has got off so lightly. I'm feeling quite sick and scared for other possible victims of this man, including potentially my own son.
"This man was in such a powerful position over very vulnerable people who have very little power. I am sickened at the thought that he was allowed to practice in New Zealand, that he was my son's doctor."
She said Nicky initially liked Fox but later called him evil and became desperate to escape the Henry Rongomau Bennett Centre.
"But I will never know if anything happened to him while under Fox's 'care' as he is dead.
"What is important to me now is that this can never happen again. That men like Dr Fox can never get anywhere near our loved ones. That the systems and scrutiny of these overseas doctors coming into New Zealand is radically improved."
Most importantly Stevens wanted district health boards to take responsibility, be open, transparent and responsive to impacted patients and whānau in such situations.
"This didn't happen at Waikato DHB. This is a prime example of why we need an independent investigation of mental health services at Waikato DHB and an investigation by national health bodies into screening of doctors to ensure this never happens again."
Asked whether, in light of the details of Fox's offending in the victim impact statement, the DHB should re-examine his relationships with Waikato patients, it said some of the Herald's questions had already been answered previously and it would need to treat the rest as a request for official information, which allows 20 working days to respond.
Where to get help
• If it's an emergency and you feel that you or someone else is at risk, call 111.
• If you've ever experienced sexual assault or abuse and need to talk to someone call the confidential crisis helpline Safe to Talk on: 0800 044 334 or text 4334. (available 24/7)
• Mosaic - Tiaki Tangata: 0800 94 22 94 (available 11am-8pm)
• Alternatively contact your local police station
• If you have been abused, remember it's not your fault.
If you need to talk to someone, the following free helplines operate 24/7:
DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234
There are lots of places to get support. For others, click here.