Rebecca J D Overton-Applebee
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At the Final Hearing on 24-25 June 2013 the following allegations were found proved.
During the course of your employment as an Operating Department Practitioner from January to March 2012 with Gloucestershire Hospital NHS Foundation Trust, you:
1. On 7 March 2012, you received a caution for theft by employee of 4 x 30mg
Codeine phosphate from Gloucestershire Constabulary.
2. On 7 March 2012 you:
a. self-administered 4 x 30mg of Codeine phosphate stolen from the controlled drug cupboard whilst on duty.
b. falsified records in the controlled drugs book to show that patients A and B had received Codeine phosphate when they had not.
3. You falsified records in the controlled drugs book to show that patients had received Codeine phosphate when they had not:
a. on at least seven occasions and in particular on:
i. 3 February 2012 - 60mg, Patient C;
ii. 24 February 2012 - 60mg, Patient D;
iii. 27 February 2012 - 60mg, Patient E;
iv. 5 March 2012 - 60mg, Patient F;
v. 21 February 2012 - 60mg, Patient G;
vi. 24 February 2012 - 60mg, Patient H;
vii. 2 March 2012 - 60mg, Patient I.
b. and in so doing, you:
i. stole the Codeine phosphate.
ii. self-administered the Codeine phosphate.
5. Your actions in 2 to 3 were dishonest.
6. Your fitness to practise is impaired by reason of your Caution as set out in paragraph 1.
7. The matters set out in paragraphs 2, 3 and 5 constitute misconduct.
8. By reason of your misconduct, your fitness to practise is impaired.
1. Effective service of the notice of the hearing was not in dispute as the Registrant’s representative attended on her behalf. She was content for the matter to proceed in her absence.
Application to proceed in Private
2. Mr Oestreicher applied for the entire hearing to be heard in private on the basis that the matters are inextricably linked to the Registrant’s health and the health of her family. The HCPC did not oppose that application and having taken legal advice from the Legal Assessor and being reminded of the terms of HCPC practice note ‘Proceeding in Absence’ the Panel acceded to that request and the hearing was conducted in private.
3. The Registrant was employed by the Gloucestershire Hospital NHS Foundation Trust (the Trust) from 22 July 2002, initially as a Nursing Auxiliary, subsequently as an Operating Department Practitioner (ODP) in or about November 2006 after she had qualified as an ODP. She worked in the private sector between December
2006 and August 2008, after which she re- joined the Trust as a Band 5
Orthopaedic Scrub Practitioner. She moved into the Recovery Unit due to her recurrent back problems.
4. On the dates identified in the allegations, whilst on duty, the Registrant took codeine phosphate from Trust supplies and falsified the controlled drugs record book to make it appear that patients had been given the codeine phosphate. In relation to allegation 2, the Registrant was arrested and given a Police Caution.
5. The panel at the final hearing in June 2013 heard that codeine phosphate is a mild pain killer that should not be used over long periods as it has an addictive property. It is a prescription drug that cannot be bought over the counter. That panel took account of the number of occasions when the Registrant had falsely signed the drug out of the controlled medications store in the names of patients when she had in fact self-administered the drugs. The facts were admitted and found proved in relation to heads of allegation 1, 2, and 3. The Registrant admitted dishonesty, impairment and misconduct as alleged.
6. The Registrant acknowledged at the final hearing in June 2013 that the allegations constituted serious matters. That panel noted that self-administering medication whilst on duty was a matter of serious concern. Although there was no evidence of actual patient harm, the Registrant’s actions had exposed patients to a risk of harm in that, having been falsely recorded as receiving pain control, they may have been denied pain management when it was genuinely required.
7. It recommended that the Registrant provide to any reviewing panel evidence of remedial steps to preclude repetition as well as evidence of maintenance of professional skills and knowledge.
8. A review took place on 12 June 2014 but the panel at that hearing concluded that the Registrant had not provided any medical evidence which could have helped in determining whether there was any current risk of codeine misuse and had taken few steps towards maintaining her Continuing Professional Development. She had not used any resources other than reading magazine articles and remained of the opinion that she had only taken codeine phosphate and that was “not a major drug”. She expressed little insight into the effect of her actions on service users. That panel ordered a suspension for a further one year.
9. At a further review on 24 June 2015 the panel noted that since the last hearing the Registrant had had a new baby and as a result of her personal circumstances she had been unable rather than unwilling to remedy the failings in her practice or to address the recommendations made by the previous panel. That panel noted that, in a letter dated 18 June 2015, the Registrant indicated the difficulties that she had had had to deal with and it took account of her commitment to remaining on the Register as an Operating Department Practitioner. She expressed in that letter her remorse for what she had done in the past and expressed a wish to eventually return to her profession. That panel went on to state at paragraphs 13-14 the following:
“13. This Panel noted that a Striking Off order was an available option to it today but it concluded that such an order would be disproportionate at this stage. It is of course an available option for sanction at any future review of this order."
14. In conclusion the Panel concluded that a Suspension Order for 12 months was an appropriate and proportionate order. This Suspension Order will be reviewed before it expires. A reviewing Panel would be assisted by: independent medical evidence to show that the Registrant has been free from the use of Codeine phosphate for a substantial period; evidence of achievement of insight into dishonesty; and evidence that the Registrant has taken actual steps taken to maintain continuing professional development. The Registrant remains able to provide further evidence of remediation and to seek an earlier review if circumstances change”.
10. The Panel heard from both Mr Claughton for the HCPC and Mr Oestreicher for the Registrant. It received shortly in advance of the hearing a letter from the Registrant date 6 June 2016 and a letter from her GP dated 3 June 2016. Her letter does evidence some insight into the misconduct found proved at the final hearing. She states in that letter that she now realises that her dishonesty could have put patients that she was responsible for into a lot of danger as well as bringing disgrace to the Trust. She is a full time carer for her daughter as a result of which she has been unable to engage with the various remedial steps recommended by the previous panels. The GP letter also indicated that the Registrant was being investigated for her own health.
11. Mr Claughton for the HCPC proposed a further extension for a period of 12 months.
This was because the HCPC recognised that although the Registrant had not engaged with the various recommendations made by Panels for evidence of remediation, this was not due to a lack of desire by the Registrant but rather due to her full time caring responsibilities. Mr Oestreicher agreed with the HCPC’s submission. The Registrant would like to have an opportunity in the future to remediate her misconduct and her union would help her to do so.
12. This Panel has taken into account all the documentation placed before it. It has heard the parties’ submissions; taken and accepted the advice of the Legal Assessor; and it has reminded itself of the terms of the Council’s Practice Note-
‘Article 30 (2) Reviews’ which, while addressing a slightly different provision, contains useful guidance for the current application. In summary the legal principles in respect of an Article 30 (1) review are as follows:
a. The Primary objective of the Panel is to secure public protection in the most appropriate and proportionate way;
b. The Panel cannot go behind the original decision. Its task is to consider whether the order under review remains an appropriate and proportionate means of securing public protection;
c. The correct approach is to determine whether the Registrant’s impairment identified at the final hearing is still continuing and if so what level of restriction is appropriate;
d. The Panel can allow the current suspension order to lapse, extend or further extend it by a period up to one year or replace it with any sanction that could have been made at the time of the substantive hearing. That includes, in this case, removal from the register.
13. The Panel first considered the question of current impairment. The Panel were firmly of the view that the Registrant’s fitness to practise is currently impaired. This was not disputed by the Registrant. The very serious matters that led to the suspension order have not been fully addressed or remediated. There may be compelling reasons for this, the fact is the impairment identified by the Panel at the final hearing is still very much current and on-going.
14. As indicated above the Registrant’s letter sent in advance of the hearing does evidence some insight into the misconduct found proved at the final hearing in that she states she now realises that her dishonesty could have put patients that she was responsible for into a lot of danger as well as bringing disgrace to the Trust. In the following paragraph however the letter then states that she “should have been more vigilant with paperwork”. In the Panel’s view this is demonstrative of the limited insight the Registrant has at present towards her misconduct, how it came about and its impact on others. The issue was one fundamentally of dishonesty, not poor record keeping.
15. The Panel went on to consider which level of restriction was appropriate and proportionate to continue to provide Service User protection. In so doing it had to balance the Registrant’s interests in being able to return to safe unrestricted practice at an appropriate time with the protection of the public. Allowing the current Suspension order to lapse or the imposition of a Caution Order would, in the Panel’s view, provide wholly inadequate Service User protection.
16. A Conditions of Practice Order was not proportionate or appropriate in light of the very serious matters giving rise to the suspension which have not been fully addressed and the fact that the Registrant is not working in any capacity and has no plans to work in any capacity at the moment. Accordingly the Panel is not in a position to formulate any realistic and workable conditions even if such a sanction would have been proportionate. For the avoidance of doubt the Panel is not, on the evidence it has before it, of the view that such a sanction would in any event be a proportionate means of securing adequate public protection.
17. The Panel then went on to consider suspension from practice. The Panel was of the view that this order was appropriate and proportionate, and it decided to make such an order for 12 months. The Registrant does want to return to practice but has been precluded from doing so for personal reasons. She has the support of her Trade Union who are willing and able to provide assistance to her. A suspension order would provide sufficient public protection while leaving the possibility open of remediation taking place and allowing a return to practice in the foreseeable future. A striking off order would preclude a return to practice for a minimum of 5 years, and so was considered disproportionate at this stage.
18. The Panel has finally considered the issue of guidance for the Registrant in advance of a future review. The Panel is mindful that recommendations for evidence of remediation have been made in this case previously. Those recommendations have not been adhered to due primarily to the Registrant’s difficult domestic circumstances. It may be that in the light of those circumstances the previous recommendations may have been somewhat optimistic. The Panel therefore makes the following recommendations to the Registrant that may assist a future reviewing panel. The Panel believes these recommendations are practical even in the light of the Registrant’s caring responsibilities.
(i) The Registrant should attend the next review hearing preferably in person or in the alternative by phone/video link and be prepared to give evidence of remedial steps taken and evidence of continuing development of insight into her dishonest behavior.
(iii) The Registrant should provide documentary evidence of any CPD undertaken and of either actual steps taken to return to work or a structured plan for a future return to work.
Order: The Registrar is directed to suspend the registration of Miss Rebecca J D Overton-Applebee for a further period of 12 months on the expiry of the existing order.
The order imposed today will apply from 23 July 2016. This order will be reviewed again before its expiry.
Right of Appeal
You may appeal to the appropriate court against the decision of the Panel and the order it has made against you. In this case the appropriate court is the High Court in England and Wales.
Under Articles 30(10) and 38 of the Health and Social Work Professions Order 2001, an appeal must be made to the court not more than 28 days after the date when this notice is served on you.
History of Hearings for Rebecca J D Overton-Applebee
|Date||Panel||Hearing type||Outcomes / Status|
|21/04/2020||Conduct and Competence Committee||Review Hearing||Voluntary Removal agreed|
|16/10/2019||Conduct and Competence Committee||Review Hearing||Suspended|
|26/10/2018||Conduct and Competence Committee||Review Hearing||Suspended|
|12/03/2018||Conduct and Competence Committee||Review Hearing||Suspended|
|27/06/2017||Conduct and Competence Committee||Review Hearing||Suspended|
|17/06/2016||Conduct and Competence Committee||Review Hearing||Suspended|