Dr Tina Bartley

Profession: Practitioner psychologist

Registration Number: PYL26672

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 30/07/2018 End: 12:00 30/07/2018

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

The following allegation was considered by a Panel of the Conduct and Competence Committee at the substantive hearing on 1-5 August 2016:

During the course of your practice as a Practitioner Psychologist by the Fire Fighters Charity, you:

1. Failed to maintain appropriate boundaries with Patient A, who had accessed the charity’s rehabilitation services, in that you:

a) Between 6 October 2014 and 21 November 2014:

i. gave your personal telephone number to Patient A;

ii. Not Proved

iii. met with Patient A on at least one occasion;

iv. shared personal information with Patient A.

b) After Patient A’s discharge in November 2014 went for a drink and/or socialised with Patient A;

c) Following Patient A’s discharge in October and November 2014, communicated with Patient A by social media, telephone, email and/or text message;

d) In November 2014, visited Brighton with Patient A and whilst there engaged in physical contact with Patient A.

e) In January 2015, attended Patient A’s place of work when you were not invited to do so.

2. Your actions described in paragraph 1 (a) – (e) were:

a) Inappropriate; and/or

b) Sexually motivated

3. Your actions described in paragraphs 1-2 constitute misconduct.

4. By reason of your misconduct, your fitness to practise is impaired.

The Panel at the substantive hearing found particulars 1a(i), 1a(iii), 1(a)(iv), 1(b), 1(c), 1(d), 1(e), 2(a), and 2(b) proved, that these particulars amounted to misconduct, and that the Registrant’s fitness to practise was currently impaired.

Finding

Preliminary Matters

1. The Registrant indicated outside of the hearing that she thought she recognised the Registrant Panel Member. The Legal Assessor made enquiries with the Registrant Panel Member, who confirmed that, as far as she was aware, she had not met the Registrant in either a personal or professional setting. The Registrant Panel Member confirmed on the public record that she was satisfied that she was able to continue to hear the case and the Registrant confirmed that she had no objection to the case continuing on that basis.

Background

2. The Registrant is a Psychologist who was previously employed by the Fire Fighters Charity (“FFC”), based at Marine Court, from April 2013 to April 2015. The Registrant provided psychological rehabilitation therapy to patients as part of a multidisciplinary team. The Registrant provided one-to-one therapy sessions and group workshops. The majority of patients were resident at the centre during the rehabilitation therapy for a period of up to ten days.

3. Patient A, an employee of London Fire Brigade, was resident at Marine Court for a primary psychological programme from 5 October 2014 to 17 October 2014. During this time, the Registrant recorded six therapy sessions with Patient A.

4. Following Patient A’s discharge on 17 October 2014, the Registrant re- referred Patient A for further therapy and wrote to the London Fire Brigade requesting leave for Patient A in order that she could return to Marine Court. Leave was granted and Patient A returned to Marine Court on 17 November 2014. The Registrant recorded three therapy sessions with Patient A during her stay before Patient A left on 21 November 2014.

5. Concerns arose in respect of the Registrant’s conduct towards Patient A. An allegation was brought against the Registrant by the HCPC, as above.

6. At the substantive hearing which took place on 1-5 August 2016, a panel of the Conduct and Competence Committee found all the particulars proved, except for Particular 1a(ii). The panel found that the facts found proved constituted misconduct and that the Registrant’s fitness to practise was impaired as a consequence.

7. At the first review hearing which took place on 2 August 2017, the review panel acknowledged that the Registrant had engaged well with the regulatory process and had taken steps towards remediation. However, the first review panel concluded that the Registrant’s fitness to practise remained impaired and took the view that:

“…having been the subject of a Suspension Order, the Registrant has not had the opportunity to put her learning and reflections into actual practice in a clinical environment with real patients and under the pressures of a working environment. It is for this reason that the Panel is of the view that, while the future risk to patients has been diminished since the last hearing, it remains a real risk because her theoretical understanding, remediation and insight have not yet been put to the test in practice.”

8. The first review panel determined that the appropriate sanction was a 12-month Conditions of Practice Order which was imposed for the following reasons:

“It would allow the Registrant to re-enter her profession safely and in a supported manner, and allow her to demonstrate in a practical way her new levels of insight and remediation, while being subject to some monitoring which would safeguard the public.”

HCPC Submissions

9. Mr Mason, on behalf of the HCPC, outlined the history of this case. He referred the Panel to the progress the Registrant has made to date, which included her reflections, her records of Continuing Professional Development (CPD) training and her voluntary employment with a women’s aid charity. He submitted that the Registrant’s volunteer contract was terminated on the basis that she had not disclosed that she was subject to a Conditions of Practice Order and he drew to the Panel’s attention the reference to conditions that were included in the Registrant’s application form. He further submitted that the Registrant had fully engaged with the regulatory process.

10. Mr Mason submitted that the HCPC was neutral as to whether the Registrant’s fitness to practise is currently impaired.

Registrant’s Evidence

11. The Registrant chose to give evidence. The Registrant explained that she had found it difficult to secure employment in a clinical setting because of the Conditions of Practice Order and her health. She stated that she had made 111 employment applications and had been invited to attend an interview on only nine occasions, one of which was the volunteer role at the women’s aid charity, which was terminated after only four weeks of actual practice. She explained that she had put the conditions of practice on her application form and assumed that the charity would undertake their own checks with the HCPC as part of the recruitment process. She stated that there was a six-month gap between submitting her application and being appointed, during which she thought that background checks were being conducted. The Registrant also stated that, after she had been appointed, she brought up the requirement for her supervisor to provide a report and was advised to remind her supervisor nearer to the deadline. The Registrant suggested that this demonstrated that she genuinely believed that her supervisor was aware of the conditions. However, in response to questions from the Panel, the Registrant accepted that the conditions listed on her application form were not the full list as set out in the Conditions of Practice Order and she accepted that it was not clear from the entry that these conditions were imposed as a sanction and were not applicable to all HCPC registrants.

12. The Registrant informed the Panel that she believed that she was ready to resume unrestricted practice and referred the Panel to her reflections, the report from her mentor, her CPD training, her job searches and the update with regard to her health. She stated that the incident with Patient A occurred four years ago and there have been no reports of any problems since. She expressed remorse and “shame” and informed the Panel that her previous conduct was completely out of character. In response to questions from the Panel the Registrant stated that she is now more “mindful” and “self-aware” and that as a consequence she has a heightened sensitivity to boundary issues and transference in a therapeutic setting.

13. The Registrant stated that she remains committed to her profession and hopes to be able to secure employment in trauma work or teaching psychology. She stated that she has no intention of working as a self-employed practitioner as she would prefer to be part of a team.

Panel’s Approach

14. In undertaking this review, the Panel took into account the hearing bundle, including the Registrant’s reflective piece and her portfolios. The Panel also took into account the Registrant’s oral evidence and the submissions made by Mr Mason on behalf of the HCPC. The Panel noted that the Registrant had done training and had applied for 111 jobs.

15. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt, in particular that:

• The purpose of the review is to consider the issue of impairment based on the previous panel’s findings of fact, the extent to which the Registrant has engaged with the regulatory process, the scope and level of her insight, whether her previous misconduct has been sufficiently and appropriately remedied, and the risk of repetition.

• In terms of remediation, relevant factors include whether the Registrant:

   • fully appreciates the gravity of the previous panel’s finding of impairment;

   • has maintained her skills and knowledge;

   • is likely to place patients at risk if she were to return to unrestricted practise.

• The Panel should have regard to the HCPC Practice Note “Finding that Fitness to Practise is ‘Impaired’” and must take account of a range of issues which, in essence, comprise two components:

   • the ‘personal’ component: the current competence, behaviour etc of the individual registrant; and

   • the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

• It is only if the Panel determine that the Registrant’s fitness to practise remains impaired that the Panel should go on to consider sanction, by applying the guidance as set out in the HCPC “Indicative Sanctions Policy” and the principles of proportionality, which require the Registrant’s interests to be balanced against the interests of the public.

Decision

16. The Panel acknowledged that the Registrant had engaged with the regulatory process and had taken appropriate steps towards remediation. However, the Panel was not satisfied that the progress the Registrant had made was sufficient to demonstrate that her fitness to practice is no longer impaired and that, as a consequence, she would be fit to return to the Register unrestricted.

17. The Panel was particularly concerned that the Registrant’s reflections lacked depth and the quality of analysis expected of a Practitioner Psychologist. The Panel took the view that, given the Registrant’s professional background, she ought to have been able to provide more meaningful reflections on her previous conduct and behaviour, articulate why it had occurred, and explain the link with her behaviour and her actions. The Panel noted that the Registrant’s oral evidence was more developed than her written evidence, but the Panel was concerned that she had to be prompted to provide a more detailed analysis of her own behaviour. The Panel also noted that at no time during her oral evidence did the Registrant make specific reference to the actions that led to the findings that were made against her. The Panel made appropriate allowances for the inherent stress involved in giving evidence and noted the Registrant’s feelings of “shame”. However, the Panel concluded that although the Registrant appreciated the impact her actions have had on her from a personal perspective, in the absence of meaningful insight, the Panel could not be satisfied that the Registrant fully appreciated the gravity of her previous conduct on her credibility as a Practitioner Psychologist.

18. The Panel was also concerned that the Registrant had not fully disclosed her Conditions of Practice Order to the women’s aid charity in advance of her employment. The Panel took the view that, by leaving room for ambiguity, the Registrant demonstrated that she had not fully appreciated the need for her prospective employer to conduct its own risk assessment based on an open and transparent disclosure. The Panel noted that the Registrant considers herself to be ready to resume unrestricted practice but the Panel took the view that a period of supervision in a clinical setting would provide the best evidence that she has learnt from her mistakes and has the resilience to maintain professional boundaries at all times.

19. For these reasons, the Panel determined that the Registrant’s fitness to practice remains impaired.

20. Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what sanction, if any, to impose.

21. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s misconduct, which remains un-remediated, to take no action on her registration would be inappropriate. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

22. The Panel went on to consider a Caution Order. As the Registrant has demonstrated insufficient insight into her misconduct, the Panel concluded that a Caution Order would be inappropriate and insufficient to protect the public and meet the wider public interest.

23. In considering whether to maintain the current Conditions of Practice Order, with or without amendment, the Panel noted paragraph 33 of the Indicative Sanctions Policy, which states:
“Conditions will rarely be effective unless the registrant is genuinely committed to resolving the issues they seek to address and can be trusted to make a determined effort to do so.”

24. The Panel was satisfied that the Registrant has demonstrated a genuine commitment to returning to practice as a Practitioner Psychologist. The Panel took the view that the Registrant’s current inability to demonstrate that she is fit to practise unrestricted is due, at least in part, to a difficulty in securing employment in a clinical setting. The Panel noted that this difficulty cannot be separated from the legitimate concern that any prospective employer would have in employing a practitioner who had failed to maintain professional boundaries with a patient which included sexually motivated behaviour, given that maintenance of such boundaries is fundamental to the role of a Practitioner Psychologist. Although finding suitable employment would be challenging, the Panel took the view that the Registrant should be given a further opportunity to persuade an employer to offer her either paid or unpaid work in a clinical setting. The Panel was satisfied that the current Conditions of Practice Order adequately protects the public whilst providing the Registrant with the opportunity to demonstrate that she is able to work safely and effectively as a Practitioner Psychologist. Therefore, the Panel concluded that the current Conditions of Practice Order should be extended for a further 12 months. In determining the period the Panel took into account the length of time that may be required for the Registrant to secure suitable employment and the length of time she will need to put into practice her reflections on strategies for maintaining boundaries and her appreciation of the therapeutic relationship between Practitioner Psychologist and service user.

25. Accordingly, the Panel determined that the Conditions of Practice Order should be extended for 12 months. The Panel recognised that the Registrant may have difficulties in gaining employment and/or demonstrating her ability to maintain professional boundaries, but it considered that there is no other means of satisfying a future panel that the risks have been managed appropriately.

26. In addition to compliance with the Conditions of Practice Order, a reviewing panel would also be assisted by:

• a more reflective piece from the Registrant;

• references from paid or unpaid employment; and

• (as the Panel recognised that employment in the Registrant’s field may be difficult to obtain) any references from such paid or unpaid employment which include working with members of the public and could, in some way, demonstrate how the boundary concerns identified have been remediated. These references should be from employers/managers who are fully informed of the Conditions of Practice.

Order

The Registrar is directed to extend the Conditions of Practice Order against the registration of Dr Tina Bartley for a further period of 12 months upon the expiry of the existing Order.

1. On commencing practice as a psychologist, you must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 7 days of the your date of employment. You must attend upon that supervisor at least once a month.

2. A report from your workplace supervisor dealing with your progress in returning to clinical practice is to be made available to the HCPC prior to the next review hearing.

3. On commencing practice as a psychologist, you must place yourself and remain under the guidance of a mentor registered by the HCPC or other appropriate statutory regulator and supply details of your mentor to the HCPC within 7 days of the your date of employment . This mentor must be outside your workplace and be at the same level as, or above, your professional standing. You must communicate with that mentor at least once a month to discuss:

    i. how you are putting into practice your reflections on, and strategies for, maintaining professional boundaries;

    ii. how you are putting into practice your understanding of the therapeutic relationship between a psychologist and patient.

4. A report from your mentor dealing with your progress in areas i and ii. is to be made available to the HCPC prior to the next review hearing.

5. You must maintain a reflective practice profile detailing your progress in areas i. and ii. above, and must provide a copy of that profile to the HCPC on a quarterly basis, the first profile to be provided within 3 months of the Operative Date.

6. You must promptly inform the HCPC if you take up any employment as a registered practitioner psychologist.

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

8. 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;

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

    C. any prospective professional employer (at the time of your application).

Notes

The order imposed today will apply from 2 September 2018.

This order will be reviewed again before its expiry on 2 September 2019.

Hearing History

History of Hearings for Dr Tina Bartley

Date Panel Hearing type Outcomes / Status
30/07/2018 Conduct and Competence Committee Review Hearing Conditions of Practice
02/08/2017 Conduct and Competence Committee Review Hearing Conditions of Practice
01/08/2016 Conduct and Competence Committee Final Hearing Suspended