Karen S Collister

Profession: Biomedical scientist

Registration Number: BS52833

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 12/08/2015 End: 12:00 12/08/2015

Location: Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

(As amended)

During the course of your practise as a Biomedical Scientist with the Countess of Chester Hospital NHS Foundation Trust, you:

1. Repeatedly failed bench competency tests, including:

a) a blood culture bench test over the period 4-13 January 2011, in which you made major errors in 18.8 per cent of total specimens and minor errors in 25 per cent, including:

i) you wrongly recorded Gram films;

ii) you failed to preserve isolates with regard to sample number 150163A;

iii) you left slopes at the back of the bench and/or you failed to label them properly;

iv) on 5 January 2011 and/or 6 January 2011 you did not report amoxicillin sensitivity results for sample numbers 150052A, 150052N, 156130A, 150076A and 150076N;

v) you reported CNSI from anaerobic bottle and CNS2 with the same sensitivity pattern from the aerobic bottle, in reference to sample number 156091N;

vi) you incorrectly read the sensitivity plates for the aerobic bottle numbered 150183J;

vii) you did not repeat the Oxacillin test for sample number 150008A.

b) a respiratory bench test over the period 4-13 January 2011, in which you demonstrated poor understanding of respiratory bacteriology, including:

i) In respect of number of sample number 170079P, you reported a Moraxella catarrhalis (MCAT) as sensitive to AMO because zone size was 31mm and larger than the zone on the template although the Beta lactamose (BLAC) was positive;

ii) In respect of sample number 170079P, you reported counts from the selective plates rather than the non-selective plates.

c) a blood culture bench test over the period 21 February - 4 March 2011, in which you made major errors in 17.8 per cent of total specimens and minor errors in 16 percent, including:

i) occasions where organisms were recorded as saved on beads but were not, for example, Samples 150863XB and 15075XN;

ii) you did not use the sensitivity templates in respect of sample 150894XN.

d)  a respiratory bench test over the period 21 February - 4 March 2011, in which you demonstrated that your knowledge and/or understanding were insufficient to avoid interpretive errors, in particular:

i) In respect of sample 17001, you carried out sensitivity testing on MCAT bacterium although it was not actually MCAT bacterium;

ii) In respect of sample numbers 171095 and 121203, you failed to realize that you had mixed up the BLAC results despite the sensitivity profiles indicating otherwise;

iii) In respect of sample number 171100, you failed to record the results at 48 hours;

iv) In respect of sample number 170981, you incorrectly reported the sample as Trimethoprim when it was Trimethoprim resistant.

2.In March 2011 you plagiarised a colleague's work in written evidence you submitted for your specialist portfolio.

3.The matters set out in paragraph 1 amount to lack of competence.

4.The matters set out in paragraph 2 amounts to misconduct.

5.By reason of your lack of competence and/or misconduct your fitness to practise is impaired.

Finding

Background:


1. Mrs Collister was a Band 5 Trainee Biomedical Scientist (TBMS) employed by the Countess of Chester Hospital NHS Foundation Trust (the Trust), now known as the Wirral University Teaching Hospital NHS Foundation Trust.  As a TBMS, Mrs Collister had already completed her HCPC registration by 2006 and would have then been expected to commence her specialist portfolio in order to progress to a Band 6 Biomedical Scientist.  She did not in fact start her specialist portfolio until 2008. 


2. By 2009, PH, Band 7 Biomedical Scientist and Mrs Collister’s mentor had concerns that Mrs Collister had still not completed her specialist portfolio within the allocated timeframe.  In discussion with the Laboratory Manager, Mrs Collister was given a one-year extension of time within which to complete it.  However, despite additional assistance and mentoring from PH and from SB, Chief Biomedical Scientist, Mrs Collister had still not completed her specialist portfolio by December of 2010.


3. Performance management procedures were initiated on 13 December 2010 and further assistance was provided to her to complete her specialist portfolio.  The Trust was concerned that, without completing the portfolio and associated competencies, Mrs Collister was unable to undertake the full range of duties required of her by her employers.


4. Mrs Collister failed blood culture and respiratory bench tests between 4 and 13 January 2011 and between 21 February and 4 March 2011.  In May 2011, Mrs Collister initiated a grievance procedure against SB, which was subsequently deemed to be unfounded.  However, it became apparent to the Trust that Mrs Collister had been plagiarising another colleague’s work.


5. On 22 March 2012, following the Stage 3 Performance Management meeting, by which time Mrs Collister’s portfolio had still not been completed, the decision was taken by the Trust to terminate her employment.


6. A referral was then made to the HCPC on 11 November 2011 about Mrs Collister’s lack of competence.


7. At the final hearing in 2013, Mrs Collister admitted the act of plagiarism, although she invited the Panel to accept that she had good reason for so doing.  She did not admit that this amounted to misconduct.  She denied the other particulars of the allegation. 

8. The Panel in 2013 found all but one of the particulars – particular 1aiii – proved against Mrs Collister and that these findings amounted to the statutory ground of lack of competence.  That Panel also determined that the admitted plagiarism was serious enough to constitute misconduct.


9. On the question of current impairment by reason of lack of competence, the 2013 Panel expressed its concerns about Mrs Collister’s lack of insight into her failings and the potential for harm, had she not been closely supervised.  There was an absence of obvious remediation through undertaking relevant training courses or otherwise.  In the circumstances, the Panel expressed itself as unable to discount the possibility of repetition of Mrs Collister’s deficiencies.  Impairment of her fitness to practise was, therefore, found on the ground of lack of competence.


10. As to impairment by reason of misconduct, the Panel did not accept that there was a justifiable reason for Mrs Collister’s misconduct, nor that she had expressed any particular remorse about her actions.  On the basis of the wider public interest and in order to maintain public confidence in the Biomedical Science profession, the Panel determined that Mrs Collister’s fitness to practise, as at the hearing in 2013, was impaired as a result of her misconduct.


11. In reaching its conclusions on the appropriate and proportionate sanction to impose, the 2013 Panel took account of the fact that Mrs Collister’s failings were capable of being remedied and that she had expressed a willingness to do this in pursuit of her career.  The Panel also adjudged that sufficient evidence had been presented at the hearing to suggest that Mrs Collister would be able, with appropriate training and support, to reach the professional standards required.  Conditions of practice were capable of being formulated that would ensure the proper level of public protection.  The Panel further determined that a period of two years would allow sufficient time for Mrs Collister to complete her portfolio and demonstrate her competence. 


12. At the hearing today, Ms Owusu-Akyem set out the background to the proceedings and drew on the decision from the substantive hearing.  She indicated that the HCPC had not received any documentation for this hearing from Mrs Collister, relating to CPD training or other professional development.  Neither had the HCPC received any evidence about work done by Mrs Collister as a BMS since the Conditions of Practice Order was imposed.  Ms Owusu-Akyem submitted on behalf of the HCPC that Mrs Collister had not demonstrated her remediation of the failings identified at the 2013 hearing and reminded the Panel of the need to take into account the Council’s Indicative Sanctions Policy (ISP).


13. Mrs Collister gave evidence to the Panel about her efforts to secure work, both within and outside the BMS field over the last two years.  She explained that BMS posts within commuting distance were limited and she had applied for anything suitable.  She had been interviewed for one post in April this year, but had not been offered employment.  She suggested that the requirement for supervision from a Training Officer, as she understood it to be, in the current conditions made it very difficult for her to obtain employment, especially locum work through an agency.  She is currently employed in a role unrelated to her profession and is grateful to have a job, but she would dearly like to return to BMS.


14. As far as maintaining her knowledge of current practice and professional development generally is concerned, Mrs Collister said that she has kept in touch with former colleagues about developments in analysis techniques and around the question of antibiotic resistance and hospital infections, in which she has a particular interest.  She does read the microbiology sections of the IBMS Gazette, but she had not attended any specific CPD courses, mainly out of concern for the cost, given her limited means at present.  She was unaware of the CPD section of the Gazette.  She did attempt to offer her services in a volunteering role in a laboratory, but was told that this was not possible.


15. The legal assessor advised the Panel about the need to be satisfied first about continuing impairment and only then considering which, if any, of its powers under Article 30(1) to exercise in respect of sanction, bearing fully in mind the provisions of the ISP.


Decision: 


16. The Panel accepted the advice of the legal assessor in respect of the approach to be taken when considering this review.  The Panel has applied its independent judgment to the question, first, of whether there is continuing impairment – taking proper account of the factors set out in the relevant Practice Note. 


17. The Panel took account of the observations of the 2013 panel that the competence issues identified in respect of Mrs Collister were capable of remediation.  This is still the case, although the Panel observed that a further two years have passed since Mrs Collister last worked as a BMS and this will have had an impact on her maintenance of relevant skills.  The 2013 panel considered that Mrs Collister’s impairment of fitness to practise arose both in terms of risk of harm to the public as well as the wider public interest (that is, public confidence in the BMS profession and the declaring and upholding of standards within that profession). 


18. The Panel was not presented with any evidence by Mrs Collister that demonstrated her remediation of the failings identified.  She has not worked within a BMS or related environment and her skills have not been observed or tested.  The Panel was also concerned that Mrs Collister’s evidence demonstrated a continued lack of insight into the failings identified in her practice.

19. In the circumstances, the Panel was not persuaded that the position was materially different from that which was presented to the 2013 panel.  The Panel, therefore, determined that Mrs Collister’s fitness to practise remains impaired. 


20. The Panel then considered which of its powers under Article 30(1) it should exercise to address this continuing impairment.  The Panel took account of the Indicative Sanctions Policy and, in particular, of the need to ensure that any sanction imposed is reasonable and proportionate to the issues giving rise to the finding of impairment.  The Panel was also mindful that the purpose of sanction is not to be punitive, but to ensure adequate protection of the public and of the public interest, which is the maintenance of public confidence in the profession, as well as the declaring and upholding of proper standards of conduct and behaviour within the profession.


21. The Panel noted that Mrs Collister had made some efforts to obtain work within the terms of the conditions of practice.  However, this was limited and the Panel noted the evidence that, of the two BMS related applications, Mrs Collister had been interviewed for one of them, despite the disclosure of conditions of practice.

 
22. In view of the absence of evidence of remediation, the Panel was satisfied that some form of restriction on Mrs Collister’s practice remains necessary.  It took the view that no action or a Caution Order would be wholly inadequate to protect the public and to maintain public confidence in the BMS profession, given the nature of the deficiencies in Mrs Collister’s clinical competence that remain unaddressed.


23. The Panel next considered whether an extension of the existing conditions of practice order would be a suitable and proportionate disposal.  It noted that, although Mrs Collister in currently working outside the BMS field, she has expressed a desire to return to practice if possible.  In her evidence to the Panel, she had specifically identified conditions 1c and 1d, specifically the reference to a “nominated Training Officer”, as being the conditions that were most likely to be restricting her access to work, although she could not be certain.  Her evidence on this point and more generally gave the Panel grounds for considering that Mrs Collister could still, possibly, comply with a Conditions of Practice Order and achieve remediation of the identified deficiencies in her clinical skills.  The Panel also took account of Mrs Collister’s engagement in this review process and her expressed wish to return to practice. 


24. In balancing appropriately the need for adequate public protection, as well as the need to address the wider public interest aspect of the case, with the facilitation of Mrs Collister’s safe return to practice as a BMS, the Panel concluded that the proportionate exercise of its powers under Article 30(1) would be to extend the Conditions of Practice Order for a further 12 months.  However, the Panel was persuaded that there should be a variation in conditions 1c, 1d and 1e, which ought to assist Mrs Collister in securing suitable employment.  The amendment removes the reference to a “Training Officer” and replaces it with a reference to “a nominated person of Band 6 (or equivalent) or above, who is registered with the HCPC as a Biomedical Scientist”.  This amendment widens the scope for the identification of this person and should reduce the impact of the condition on Mrs Collister’s obtaining employment as a BMS.  The amendment entails no appreciable decrease in the protection afforded to the public.


25. The Panel determined that 12 months would be a sufficient period of time within which to see whether Mrs Collister is motivated to achieve a return to practice.  A longer period was not indicated given the length of time that has already passed since she last practised as a BMS.  The Panel also viewed 12 months as adequate time for Mrs Collister to demonstrate remediation of the lack of competence identified by the previous panel. 


26. The Panel did go on to consider whether it was necessary to replace the current Order with a Suspension Order, given the lack of progress towards remediation over the last two years.  However, at this stage, the Panel concluded that a Suspension Order would be disproportionate when Mrs Collister’s lack of competence remains remediable, she continues to engage in the HCPC proceedings and she expressed a motivation and desire to return to practice.  However, the Panel would be concerned about the length of time that Mrs Collister would have been out of practice if she were not to secure suitable employment during the course of the next 12 months, or otherwise provide evidence of remediation of her proven failings. The extension of the Conditions of Practice Order should be seen by her as a final opportunity to remediate the concerns about her practice as a BMS.


27. For the avoidance of doubt, the Panel has reached its conclusions on impairment and sanction in relation to Mrs Collister’s lack of competence. The misconduct matter has, in this Panel’s view, been addressed by the order made in 2013 and there is no evidence of any recurrence.  In taking this view, the Panel was mindful of the views expressed by the 2013 panel that, but for the competence issues, the misconduct matter alone might properly have been addressed through a Caution Order. 


The order will be reviewed prior to the expiry of the extension, which comes into force immediately on the expiry of the current Conditions of Practice Order. 

Order

Order: That the Registrar is directed to annotate the register to show that for a period of 12 months from 13 September 2015, the registrant, Mrs Karen S Collister, must comply with the following conditions of practice:

1. If you take up any employment as a Biomedical Scientist, paid or unpaid:


a. You must inform the HCPC and advise it of the name and address of the employer within 14 days.


b. You must only undertake work up to an NHS Agenda for Change Band 5, or an equivalent scope and level of practice if working outside the NHS.


c. You must provide to the HCPC the name of a nominated person within the organisation within which you are working.  This nominated person must be of Band 6 (or equivalent in the private sector) or above and registered with the HCPC as a Biomedical Scientist.


d. You must send to the HCPC a report prepared by the nominated person, referred to in condition 1c, six months after the commencement of any employment and every six months thereafter, which outlines the standard of your work and the achievement of any competencies.


e. You must only authorise the release of test results when you have been found to be competent to do so by your nominated person, referred to in Condition 1c. The relevant competence requirements should be those of the particular discipline within the Microbiology Specialist Portfolio of the Institute of Biomedical Science.


2. You must inform the following parties that your registration is subject to these conditions:


a. any organisation or person employing or contracting with you to undertake professional work, paid or unpaid;


b. any agency you are registered with or apply to be registered with (at the time of application); and


c. any prospective employer (at the time of application).


3. You must promptly inform the HCPC of any disciplinary or competence proceedings taken against you by your employer.

Notes

The Order will be reviewed before it expires.

Hearing History

History of Hearings for Karen S Collister

Date Panel Hearing type Outcomes / Status
15/08/2017 Conduct and Competence Committee Review Hearing Voluntary Removal agreed
12/08/2016 Conduct and Competence Committee Review Hearing Suspended
12/08/2015 Conduct and Competence Committee Review Hearing Conditions of Practice