Dr Olga V Taylor

Profession: Biomedical scientist

Registration Number: BS48788

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 03/12/2018 End: 17:00 10/12/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

(As amended)

While registered with the Health and Care Professionals Council as a Biomedical Scientist, you:
1. On or around 24 November 2015, conducted a High Performance Liquid Chromatograph test of a sample provided by Patient X and you provided inaccurate and/or misleading information to him in that you reported that;
a) the high excretion of Homocysteine found in the sample was indicative of 'a significantly disrupted brain metabolism';

b) you had found some ketones and glucose and interpreted this as malfunctioning of sugar utilisation and liver problems;

c) the results indicated "decreased glycogen deposition both in the liver and the brain", which is inaccurate as a biopsy would be needed to confirm this;

d) the patient's "ketonuria clearly indicates that there is a serious problem with any normal cell respiration and general metabolism", which is inaccurate as such a statement should not be made on the basis of urine tests without further clinical enquiries and/ or investigations.

e) that the results confirmed that the patient had "a lack of glucose, oxygen, vitamins A and E and possibly magnesium in some brain areas", which is inaccurate as it not possible to assert these findings from the results of the urine test;

f) distinguished between the peripheral (body) homocysteine and central (brain) homocysteine, which is inaccurate as it is not possible to differentiate between 'brain' and 'peripheral' homocysteine in urine.

2. Acted outside of the scope of your practice in providing advice to Patient X in that you:

a) stated that "buproprion and amantadine will not resolve the metabolic problem but will mask them";

b) made recommendations about homeopathic remedies.

c) advised Patient X to change his diet and/or to take different supplements;
d) provided Patient X with a clinical interpretation of the results of tests you conducted.

3. The matters set out in paragraphs 1 - 2 constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matter

Application to amend the Allegation

1. Mr Chalmers applied to amend some of the particulars of the Allegation in this case. Notice had been given of the vast majority of them in a letter from the HCPC to the Registrant dated 18 January 2018. No objection from the Registrant had been lodged to this course. Additionally, Mr Chalmers contended that it was appropriate to correct a typographical error (“of” instead of “if” in the stem to particular 1) and to move the wording of the stem of particular 1 to a more logical position. Again, the Registrant did not oppose this aspect of the application – which Mr Chalmers stated was designed to clarify matters and to align the particulars to correspond with the expected evidence to be called by the HCPC. The Panel considered that it was in the interests of justice to grant this application.


Background

2. After graduating from a Russian university in 1972, the Registrant worked as an Analytical Biochemist at the Institute of Biologically Active Substances in Novosibirsk. Her research there involved the use of neuro-pharmacological drugs, methods of molecular biology and High Performance Liquid Chromatography (HPLC). She was awarded a PhD in 1995, which was the same year that she came to the UK. In 1997, the Registrant and her husband opened a private laboratory now called Galkina in Bournemouth. This business was established for the Registrant to use her acquired knowledge of neuroscience and she chose urine as the medium to evaluate the activity of the nervous system.

3. The first contact from Patient X came in 2014, although he never met the Registrant in person. According to the Registrant, he was suffering from a number of complex health problems, including anxiety, depression and insomnia.

4. The Registrant conducted a HPLC test on a urine sample provided to her by Patient X. This was followed by a urine analysis report dated 24 November 2015, which was sent to the Patient, who subsequently approached his General Practitioner. On the basis of the content of the Registrant’s report, Patient X was referred to EM, Consultant in Inherited Metabolic Diseases at the University College London NHS Foundation Trust. As a result, EM assessed Patient X and conducted further tests on him, including a plasma test. EM was concerned about the Registrant’s actions in respect of her assessment of Patient X and consequently informed the Chair of Federation of Clinical Scientists, who subsequently reported the concerns to the HCPC. 

5. The allegation in this case, broadly, revolves around what is said to be inaccurate and/or misleading information conveyed to Patient X by the Registrant as a result of the urine test provided by him in November 2015, as referred to above.

6. By way of example, the Registrant told Patient X, in a post-test email, that his “high central homocysteine level is associated with a significantly disrupted brain metabolism”. However, Patient X later provided a blood sample, a better indicator it is claimed, to EM, which was returned as completely normal. Her (EM’s) view was that, taking into account this result coupled with her clinical examination of him, Patient X had none of the symptoms of homocystinuria.

7. The Registrant’s position is that she continues to believe that the results of her tests were accurate and that the use of the HPLC test represents the gold standard.

8. It is further contended that Patient X was misinformed when told by the Registrant that the discovery of ketones and glucose were indicators of malfunctioning of sugar utilisation and possibly liver problems. The case for the HCPC is that other explanations should have been offered and that an unrepresentative picture of his state of health was painted to Patient X.

9. Similarly, other information, as drafted within particulars 1(c), (d), (e), and (f) was conveyed by the Registrant to Patient X that led, allegedly, to scientifically unjustified comments.
 
10. The HCPC alleged that some of the Registrant’s recommendations made to improve Patient X’s health were premature because further confirmatory tests should have been performed.

11. Some statements made to Patient X by the Registrant (e.g. in relation to ketonuria) should not have been made in the absence of further clinical enquires and/or investigations.

12. It is claimed that chemicals identified within the urine analysis are not specific to the brain. Therefore, it is impossible to conclude that some areas of Patient X’s brain lacked glucose, oxygen, vitamins A and E and magnesium, as the Registrant did.

13. Other areas where Patient X was allegedly misled include the information he was provided about his high level of homocysteine which the Registrant wrote was “associated with a significantly disrupted brain metabolism”. This is a central claim, denied by the Registrant.

14. Another general area of alleged misconduct and/or lack of competence is the fact that the Registrant, who is not a medical doctor, acted outside the scope of her permitted practice as a Biomedical Scientist by providing advice to Patient X that she had no authority to do. These allegations are detailed in particular 2(a) – (d). In particular, it is alleged that the Registrant had no right to give Patient X a clinical interpretation of the urine test result.

15. In response, the Registrant has always been adamant that it was appropriate for her to conduct the HPLC test and that she was entitled to provide interpretations of the results, which were accurate. Her position was, and continues to be, that both EM and Dr Webster, a biochemist expert called by the HCPC, are quite wrong when they contradict what she says. Everything she did was to the benefit of the Patient, who was grateful for the help provided by the Galkina Laboratory. The Registrant added that she felt she was entitled to give her opinions to Patient X on what remedies he should adopt to improve his state of health.


Decision on Facts

16. The Panel has considered all of the oral and documentary evidence placed before it from both sides, in the knowledge that the burden of proof rests throughout upon the HCPC and the requisite standard is on the balance of probabilities. The Panel accepted the advice of the Legal Assessor.

17. The HCPC called two witnesses to give live evidence:

• EM, Consultant as described in paragraph 4 above. She told the Panel of the visit paid to her by Patient X on 10 May 2016, prompted by the Registrant’s reported findings that the urine sample taken from him showed a high excretion of homocysteine, a method of diagnosis, she said, that is not medically recommended. EM conducted a blood test on Patient X which was returned as completely normal.
The Panel found her to be a credible witness who was prepared to accept that some of the matters she was asked about were outside her area of experience. On matters within her experience, she gave cogent and consistent evidence. 
• Dr Rachel Webster, an expert in the field of biochemistry who had spent 8 years as a specialist in metabolic biochemistry in a children’s hospital and was currently the head of the largest biochemistry department in a Birmingham hospital. Her evidence was critical of the Registrant’s actions as catalogued in the Allegation.
The Panel found her to be an impressive and informed witness. She gave her evidence in a restrained manner and was the first to acknowledge that some questions she was asked she was not qualified to answer. Those opinions she did give were within her area of expertise and were accepted by the Panel.

18. Additionally, Mr Chalmers introduced a number of documentary exhibits and the written representations of the Registrant, which were accompanied by certificates of attendance at conferences and lectures from 2004 – 2016.

19. The Registrant herself gave evidence on her oath, via a video link. What she said was consistent with the denials contained within her previously submitted written representations.

20. She seemed to the Panel to be a dedicated scientist who, nonetheless, would not count herself within the mainstream of her profession. She was not, in the view of the Panel, seeking to depart from what she perceived to be the truth in providing her answers.

21. She appeared to the Panel not to understand the full ramifications of how she conducted her laboratory tests, nor to appreciate the limits to be attached to the scope of practice of a Biomedical Scientist.

22. Some of her answers were not entirely logical and the Panel considered that she did not possess a full understanding of what her job should have entailed. She displayed a lack of clarity about what was expected of a registered Biomedical Scientist in her position.

23. The Registrant provided a letter of support from Margaret Lofthouse, a work colleague of some 14 years standing and a testimonial from Martyn Hudson, a friend, patient and lawyer to the Registrant for the best part of 30 years.

24. With regard to the particulars of the Allegation, the Panel made the following findings:

Particular 1(a)
25.  The Panel accepted the evidence of EM who said that by using the expression “a significantly disrupted brain metabolism”, the Registrant was indicating that she felt that the levels of homocysteine were sufficiently high to be causing cerebral dysfunction. When EM physically examined Patient X, she noticed none of the classic symptoms of homocystinuria and stated that the results of the blood test performed on him were returned as completely normal. The Panel accepted this evidence from EM and found this particular proved, insofar as it amounted to the provision of misleading information.

Particular 1(b)
26. Reading the stem of particular 1 and sub-particular 1(b) together, the Panel’s view is that the ketones and glucose results were not determined by HPLC methodology, but, rather, by an automatic, basic urine analysis. Therefore, the Panel has determined that this particular is not proved.

Particular 1(c)
27. The email communication from the Registrant to Patient X in the above terms, according to the evidence of Dr Webster, is misleading because the Registrant would not be able properly to comment upon the deposition of glycogen in the liver or the brain without the results of a biopsy or other confirmatory tests. Dr Webster added that such conclusions drawn by the Registrant should not have been based upon the results of a single urine sample, which is neither sensitive nor specific. In accepting this evidence from the biochemist expert, the Panel found this particular proved, insofar as it amounted to providing misleading information.

Particular 1(d)
28. Dr Webster’s opinion was that the Registrant was incorrect to draw the conclusions as particularised because automatic basic urine analysis is neither sensitive nor specific for the claims the Registrant made. These conclusions and interpretations, based as they were upon the results of urine tests alone, were unfounded. Further testing should have been done. Despite the contentions of the Registrant to the contrary, the Panel accepted the expert’s view and found this particular proved, in that the stated claims made were misleading, because other explanations (for example diabetes) were more common and therefore more likely and were not referenced in the report to Patient X.

Particular 1(e)
29. The chemicals identified within the urine analysis, in the opinion of Dr Webster, are not specific to the brain. The Registrant had not directly measured the concentrations of oxygen, vitamins A and E or magnesium. For these reasons, Dr Webster said that it was impossible to make the claim that is drafted in this particular. The Panel consequently has found that this particular is proved because the claim was misleading as there was no acknowledgment in the report supplied to Patient X of the significant limitations which needed to be placed upon the conclusions drawn.

Particular 1(f)
30. The understanding of Dr Webster, as provided in her evidence, is that it is impossible to distinguish between peripheral and central homocysteine merely with the use of a urine sample. Her understanding is that there are not different types of homocysteine released from different parts of the body. If there were, she continued, the technology which the Registrant used in this case was not sufficiently specific to be able to differentiate them from each other. The Panel, in accepting this evidence, found this particular proved because the assertion in the email supplied to Patient X, that different types of homocysteine was present, was misleading.

Particular 2(a)
31. The words drafted in this particular were contained within an email from the Registrant to Patient X. Dr Webster told the Panel that, in making this statement, the Registrant was acting outside the scope of her practice. She should not have been providing advice about medication. The Panel, in accepting this evidence, found this particular proved because the Registrant is not clinically qualified in this area of expertise, a fact admitted by the Registrant.

Particular 2(b)
32. Again, Dr Webster told the Panel that the Registrant should not have been making recommendations about homeopathic remedies because she is not clinically trained in this area, a fact admitted by the Registrant. Although the Registrant claimed that there was no practical alternative to doing this, the Panel took the view that the Registrant should have explained to Patient X that to offer this type of advice was outside her scope of practice. The Panel therefore found this particular proved.

Particular 2(c)
33. The Urine Analysis Report completed by the Registrant contained recommendations of a change of diet and the taking of supplements by Patient X. The view of EM was that the test results revealed no clinical evidence to support the necessity for it nor was the Registrant qualified to suggest it. The Panel, in accepting this evidence, found this particular proved.

Particular 2(d)
34. The results of the tests conducted by the Registrant upon Patient X included a clinical interpretation of them. The view of Dr Webster was that the Registrant did not possess the necessary expertise to undertake this type of work and that, in doing so, she was acting outside the scope of her practice. The Registrant did not provide any evidence to the Panel that she had the requisite medical qualifications. The Panel therefore found this particular proved.


Decision on Grounds

35. The Panel accepted the advice of the Legal Assessor.

36. Throughout its deliberations on these subjects, the Panel reminded itself that lack of competence is regarded as less serious than misconduct and that the proved facts, in appropriate cases, can amount both to misconduct and lack of competence.

37. As far as misconduct is concerned, the Panel was aware that this could not be found unless it judged that the conduct concerned was serious and brought the profession into disrepute.

38. As far as lack of competence is concerned, the Panel recognised that this is conceptually separate from misconduct and connotes a standard of professional competence which is unacceptable, in relation to a fair sample of the Registrant’s work.

39. Mr Chalmers submitted that any facts found proved in this case should consistently be categorised either as misconduct or as lack of competence, but not a mixture of the two. In the context of the need for any lack of competence to amount to a fair sample of the Registrant’s work, Mr Chalmers drew the attention of the Panel to Vali v GOC [2011] EWHC 310, a case which stressed that a fair sample should amount to a “pattern of conduct underlying the allegation”. He reminded the Panel that the Registrant accepted that what she did in this case was typical of her work pattern.

40. The Registrant, for her part, invited the Panel to judge that any facts proved could not be said to amount either to lack of competence or misconduct on her part.

41. With these submissions in mind and with consideration of all of the evidence in the case, the Panel’s judgement is as follows:

• Although the Panel accepts that the Registrant is well-meaning and has the best interests of her patients at heart, the results and the report of the urine analysis together with her emails had the potential to confuse Patient X with its provision of a significant amount of misleading information. Indeed, it may well have led to causing him anxiety and psychological harm.
• When questioned, the Registrant’s evidence about her recent professional development was, at best, vague, and the Panel’s view is that the Registrant is not up to date with her Continuing Professional Development (CPD). In this context, the Panel also judged that the Registrant is not familiar with current biomedical science practice and methodology.
• In the view of the Panel, the Registrant’s evidence demonstrated that she was unclear and unconvincing about accreditation and quality assurance in respect of her laboratory.
• Doubtless, these factors were a contributory cause to the Registrant’s inability to understand the proper limits to her scope of practice.

42. The Panel found that the Registrant fell below the following “Standards of Conduct, Performance and Ethics”:

• 1 - You must act in the best interests of service users.

• 5 - You must keep your professional knowledge and skills up to  
     date.

• 6 - You must act within the limits of your knowledge, skills and
     experience and, if necessary, refer the matter to another
                     practitioner.

• 7 - You must communicate properly and effectively with service
     users and other practitioners.

43. The Panel found that the Registrant also fell below the following “Standards of Proficiency for Biomedical Scientists”:

• 1 – be able to practise safely and effectively within their scope of
      practice.

• 2 – be able to practise within the legal and ethical boundaries of
      their profession.

• 4 - be able to practise as an autonomous professional, exercising
     their own professional judgement.

• 8 - be able to communicate effectively.

• 12 – be able to assure the quality of their practice.

44. The Panel, throughout its deliberations, has been conscious that the Registrant has hitherto had a record without blemish. No other patients have ever complained about her competence. The Panel recognises the Registrant’s many years of experience in HPLC. The Panel is also aware that this case revolves around a single patient. Nevertheless, the Panel takes into account the Registrant’s concession that the way she treated Patient X was typical of the work she performs.

45. In relation to all the proved facts, both taken individually and collectively, the Panel’s judgement is that the allegation of misconduct is well founded.


Decision on Impairment 

46. Whether or not a Registrant’s fitness to practise is currently impaired is a question for the Panel alone.

47. The Panel paid due regard to the submissions on both sides and reminded itself of the content of the HCPTS’s Practice Note entitled “Finding that Fitness to Practise is Impaired”. It also accepted the advice of the Legal Assessor.

48. In reaching its determination, the Panel considered the personal component and, in so doing, concluded that the Registrant has consistently demonstrated an almost total lack of insight into her failings.

49. In the view of the Panel, her misconduct is remediable, although for it fully to be remedied, the Registrant has to demonstrate that she recognises the error of her ways. Unless she does so, in the judgement of the Panel, there is a high likelihood of repetition of this misconduct. She seems to the Panel, at the moment, incapable of appreciating what the true role of a registered Biomedical Scientist is. The facts found proved within particular 2 served to demonstrate this. Add to this, the fact that it seems that the Registrant is not up to date with her Continuing Professional Development obligations. The Panel has noted, incidentally, that the last conference she has evidence of attending was in 2016.

50. As far as the public component is concerned, the Panel has borne in mind the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession and the regulatory process. To fail to find that the misconduct of the Registrant amounts to current impairment, would, in the judgment of the Panel, undermine confidence in the profession and the regulatory process.

51. The Panel therefore concludes that, in relation both to the personal and public components, the Registrant’s fitness to practise is currently impaired.


Application to continue to proceed in the absence of the Registrant

52. Before the Panel was addressed on the topic of sanction, the Registrant, in an email received by the Hearings Officer at 09:35 on Thursday 6 December 2018, wrote as follows:
“I can no longer attend meetings through the video link, on the grounds of the health of my husband as his health has been so badly affected by this hearing. He requires my continuous attention.”

53. After the receipt of this email, the Registrant was contacted by telephone in order to establish whether this remained her position. She said that it did and that she no longer wished to participate in the hearing by video link.

54. As a result of this, Mr Chalmers made an application to the Panel that it would be appropriate to continue with this hearing in the absence of the Registrant.

55. The Panel recognised that it must exercise the utmost care and caution in reaching its decision. It was plain to the Panel that the Registrant had voluntarily decided no longer to join the hearing by video link, for the reasons stated in her email. The Panel noted that the Registrant had not requested an adjournment and took the view that nothing could be achieved by an adjournment. Within the same email referred to above, the Registrant included a number of observations that she wished the Panel to take into account on her behalf at this stage of the proceedings.

56. Bearing all these factors in mind, the Panel regarded it as being in the public interest to grant this application. Throughout its deliberations on this point, the Panel had in mind the concept of public protection. 


Decision on Sanction

57. In coming to its own independent decision on sanction, the Panel has paid careful regard to the submission of Mr Chalmers that it is open to the Panel to impose an appropriate sanction in this case. It has taken into account the contents of the HCPTS Indicative Sanctions Policy (ISP). It has also noted the advice of the Legal Assessor that it should apply the principle of proportionality in weighing the interests of the public against those of the Registrant. The public interest includes not only the protection of service users, but also the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.

58. The Registrant submitted her observations within the 6 December 2018 email. They consisted principally of criticisms of the evidence adduced in this case by the HCPC and complaints by her that her answers to the Allegation had been “completely ignored”.

59. The Panel took into account the following mitigating and aggravating factors:
• The mitigating factors include the previous unblemished record of the Registrant, amplified by the production by her of two testimonials. She has proved herself to be a dedicated scientist for many years. The Panel reasserts its view that the Registrant is a well-meaning professional and has the welfare of her patients at heart. She has engaged fully in the regulatory process, although, for the reasons provided above, she decided to absent herself from the last day of these proceedings.
• The aggravating factors include the potential for anxiety and psychological harm that her actions may have caused to a vulnerable service user. Coupled with this is her acceptance that what happened in this case is typical of the work that she continually undergoes. Above all, it seems to the Panel that the Registrant has limited concept of what the job of a Biomedical Scientist entails and how that role integrates with other healthcare professionals. She remains adamant that her way of doing things is the gold standard. Her emailed observations of today’s date only serve to reinforce the view of the Panel that she has little or no insight into her misconduct.

60. The Panel is satisfied that the Registrant’s actions would be regarded as sufficiently serious by fellow practitioners and the public at large as to merit the imposition of an appropriate and proportionate sanction. Given the nature of the Registrant’s misconduct and its potential to undermine the reputation of the profession, the Panel is of the view that it would not be sufficient to conclude this case by taking no action or by referring it for mediation. Neither course would serve to protect patients or maintain the standing of, and public confidence in, the profession.

61. The Panel then moved to consider whether to conclude this case by the imposition of a Caution Order. Again, given the nature and seriousness of the conduct and, in particular, the Registrant’s continuing refusal to accept the error of her ways, such a course would not be in the public interest in its widest sense. It would neither provide adequate public protection, nor lay down proper standards of conduct and behaviour for the profession at large.

62. The Panel then considered whether the case could be concluded with a Conditions of Practice Order. In so doing, it had regard to the advice of the Legal Assessor that conditions must be appropriate, measurable and workable. In this context, the Panel considered that the Registrant’s failings were remediable. However, the Panel concluded that any conditions that could be drafted would be problematic in the case of a practitioner who runs her own laboratory without supervision. The Panel also took into account the contents of the Indicative Sanctions Policy at paragraph 31 which stipulates that, before imposing such a sanction, a Panel should be satisfied that the Registrant can be expected to comply with conditions. The Registrant has shown no insight and has continued throughout to deny that her actions as a Biomedical Scientist were wrong. In the circumstances, the Panel was far from satisfied that the Registrant would comply with any conditions imposed and therefore it did not consider the imposition of a Condition of Practice Order to be appropriate.

63. The Panel then went on to consider the question of the imposition of a Suspension Order. Given the belief of the Panel that the Registrant, if so minded, could remedy her defects of practice, the Panel determined that the appropriate and proportionate sanction to impose in this case was one of an order of suspension. The Panel considered that this sanction gave due recognition to the issues of both public protection and the wider public interest. The appropriate period of suspension is one of 9 months. This period should give the Registrant sufficient time to gain insight into her shortcomings and do her utmost to remedy them.

64. This Panel recommends that any future reviewing panel may be assisted by:
• A reflective piece to address the identified failings - in particular, in relation to her scope of practice.
• Evidence of up to date CPD as a Biomedical Scientist which addresses failings identified by the Panel.
• Any up to date references and testimonials.
It is recommended the Registrant should also provide evidence that she has visited a diagnostic laboratory in order to acquaint herself with the standards therein adopted.

65. The imposition of a Striking-Off Order would, in all the circumstances, be disproportionate. Thus, the sanction imposed by the Panel is a Suspension Order for 9 months.

Order

The Registrar is directed to suspend the registration of Dr Olga V Taylor for a period of 9 months from the date this Order comes into effect.

Notes

This order will be reviewed again before its expiry on 3 October 2019.

Hearing History

History of Hearings for Dr Olga V Taylor

Date Panel Hearing type Outcomes / Status
03/12/2018 Conduct and Competence Committee Final Hearing Suspended