Miss Sarah Jane Perrin
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By reason of your physical and/or mental health, your fitness to practise as a Dietician is impaired
Sitting in Private
1.Ms Shameli applied for the hearing to be conducted in private. The ground on which she relied is that this is a Health Allegation and the Registrant’s health is central to this hearing. Ms Brown supported this application. The Panel took into account the Health and Care Professions Tribunal Service (HCPTS) Practice Note: “Conducting Hearings in Private”. In general, HCPTS cases should be heard in public, but the Procedure Rules permit hearings to be conducted in private where it is necessary to protect the private life of a Registrant. The Panel heard and accepted the advice of the Legal Assessor. The Panel accepted the submissions of Ms Shameli and Ms Brown. It determined that it is not practicable to try to separate the hearing into private and public portions. The Panel decided the proper course was to hold the whole hearing in private.
2.Two versions of this Decision have been prepared. One is a “Private” version and the other is a “Public” version.
3.At the commencement of the hearing Ms Brown on behalf of the Registrant admitted the Allegation in its entirety, including the allegation of impairment. The Panel is aware that these admissions though relevant, are not binding on the Panel.
4.The Panel decided to consider the facts and impairment as a single stage and then, if appropriate, to consider sanction separately.
5.The Registrant qualified as a Dietitian in 2004. She commenced work as a Band 5 Dietitian at Hastings and Rother Primary Care trust in March 2005. She commenced work with Kent and Canterbury NHS Trust in January 2006. She worked with the Medway Community Health Care (MCHC) from 25 January 2008 until she resigned from her post in February 2015.
6.Capability proceedings were issued in the summer of 2014 and included an assessment. MCHC was awaiting the results of the assessment before reviewing the capability process with the Registrant.
7.The Investigating Committee (IC) considered this case on 20 January 2016 and determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise.
8.At the hearing before the Conduct and Competence from 2 to 6 October 2017 the Registrant’s Representative submitted that the allegation should be referred to the Health Committee because the fitness to practise concerns related directly to the Registrant’s health. The Panel directed that the matter should be referred to the Health Committee.
9.Kingsley Napley were therefore further instructed to carry out an investigation into an allegation of impairment by reason of health condition and instructed Dr Sajid Suleman to prepare a report on behalf of the HCPC.
10.The Registrant is presently working as a Support Coordinator with Dover Young Persons Service and is not currently working as a Dietitian.
A summary of the evidence and other material before the Panel
11.The Registrant gave oral evidence and responded to questions. In summary the evidence that she gave both in her written statement and in her oral evidence was as follows:
•She accepted that she suffered from a health condition. She described its impact on her, both historic and present. She said that she was now managing much better than she had previously as she had not been diagnosed since 2015.
•She described the medical support and treatment that she was presently receiving. She also described the medical support that she had arranged to receive from The Medical Practice this would include review of her medication as well as health indicators.
•She described her plans for the future. In this context she said that she wanted to return to the profession of Dietitian. She wanted to work in the community rather than in an acute setting and hoped to be able to find employment which enabled her to work part time.
•She described the steps that she had taken to obtain a return to practise placement with Newham University Hospital and how she had sought to maintain her professional skills and knowledge. She accepted that as she had not worked as a Dietitian since 2015 she would have to be assiduous in rebuilding her professional skills and needs to comply with return to practice requirements.
Submissions made as to facts and impairment.
12.The Panel considered the submissions as to facts and impairment made by Ms Shameli on behalf of the HCPC. In summary she said as follows;
•As to the factual aspects of the Allegation: She submitted that all the factual allegations set out in Schedule A to the Allegation were established by the oral and written evidence of Dr Suleman. She further relied on the formal admission made by Ms Brown at the commencement of these proceedings and on the oral and written admissions made by the Registrant in her written statement and in the oral evidence that she gave to the Panel.
•As to impairment; she submitted that the evidence of Dr Suleman and the oral and written evidence of the Registrant established that the Registrant’s fitness to practise was impaired. She submitted that by reason of the Registrant’s health she poses the risk of causing unwarranted harm to service users and that the public’s confidence in the profession of Dietitian and in the HCPC as its regulator would be undermined if no finding of current impairment was made.
13.The Panel considered the submissions as to facts and impairment made by Ms Brown on behalf of the Registrant. In summary she said as follows;
•As to the factual aspects of the Allegation: She accepted that the Registrant suffered from the conditions which are set out in Schedule A to the Allegation.
14.The Panel heard and accepted the advice of the Legal Assessor as to facts, and impairment.
15.The Panel was aware that on matters of fact the burden of proof rests on the HCPC and that the standard of proof is the civil one namely on the balance of probabilities.
Decision on facts.
16.The Panel considered all the evidence that it has heard or has read, together with all the submissions that have been made. The Panel has relied primarily on the oral and written evidence of Dr Suleman.
17.The Panel found the evidence of Dr Suleman to be both professional and credible. Dr Suleman had carried out a full assessment of the Registrant in November 2017 and that assessment and all his findings were fully set out in his report of 04 January 2018, which also contained a very useful summary of the Registrant’s medical history as reflected in historic medical notes.
18.The Panel was also greatly assisted by the written report and the oral evidence that it had received from Dr Suleman following the supplementary assessment that Dr Suleman made of the Registrant on 23 July 2018 at the commencement of these proceedings.
Decision on Impairment
19.The Panel next considered whether by reason of the Registrant’s health as set out in Schedule A to the Allegation her fitness to practise is impaired.
20.The Panel considered the submissions that have been made. It considered the oral and written evidence of Dr Suleman and that of the Registrant and all the material that has been submitted to the Panel.
21.The Panel heard and accepted the advice of the Legal Assessor.
22.The Panel was aware that any finding as to impairment was for the independent judgement of the Panel.
23.The Panel is aware that what is to be assessed is the Registrant’s current fitness to practise.
24.In considering this issue the Panel considered and applied the principles stated by Mrs Justice Cox in the case of the Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council ; Paula Grant  EWHC 927 [Admin]
25.The Panel has concluded that the Registrant’s fitness to practise is currently impaired by reason of health conditions. These conditions both have an impact on the Registrant’s concentration, record keeping, diary management and working memory. These issues clearly can have an impact on patients and colleagues. The Panel therefore concluded that the Registrant did pose a risk of causing unwarranted harm to service users.
26.Given that the Registrant currently poses a risk to service users, the Panel also found that public confidence in the profession, and the need to uphold public confidence in the profession and the HCPC as its regulator, would be undermined if a finding of present impairment was not made.
27.For all the reasons set out above the Panel concludes that a restriction should be imposed on the Registrant’s ability to practise.
28.Having concluded that the Registrant’s fitness to practise is impaired, the Panel proceeded to consider what Order is appropriate, and proportionate to protect the public and to safeguard the public interest.
29.The Panel has considered all the submissions and evidence that it has heard and read. It has accepted the advice of the Legal Assessor.
30.The Panel took into account the principles of proportionality balancing the interests of the Registrant with the public interest.
31.The Panel has had regard to the contents of the Indicative Sanctions Policy published by the HCPTS on 22 March 2017. The Panel is aware that sanctions should be considered in ascending order of severity. The Panel is aware that the purpose of sanctions is not punitive but to protect members of the public and to safeguard the public interest. The latter objective includes maintaining standards within the profession, together with public confidence in the profession and in its regulatory processes.
32.The Panel has concluded that to take no action would be wrong. Such an outcome would be inappropriate having regard to the facts of the case. It would not serve to maintain public confidence in the profession or in the HCPC as its regulator. The Panel further concluded that a Caution Order would be inappropriate in a health case of this kind.
33.The Panel concluded that a Conditions of Practice Order for a period of 2 years and in the terms set out below was the appropriate, workable, enforceable and proportionate order to make and would address the risks that it has identified. In coming to this conclusion the Panel took into account the following:
•The Registrant has developed good insight into how her diagnosis previously affected her practice and recognises the importance of rebuilding her professional skills and of the need to comply with the HCPC requirements for her return to practice.
•The Panel is satisfied that the Registrant would comply with the Conditions that are set out below.
•The Panel was further satisfied that the Registrant can manage her health conditions satisfactorily and with work place adjustments, it should be possible for the Registrant to practise as a Dietitian in a safe and effective manner.
34.The Panel did not consider that a Suspension Order was either necessary or proportionate.
35.This Order will be reviewed within 18 months of the Operative. A reviewing panel would be assisted by the presence of the Registrant.
Order: The Registrar is directed to annotate the HCPC Register to show that for a period of 24 months from the date that this Order takes effect (“the Operative Date”) you Sarah Jane Perrin must comply with the following Conditions of Practice:
1.Within 12 months of the Operative Date you must complete the Return to Practice requirements for Dietitians or as otherwise required by the HCPC.
2.You must formulate a Personal Development Plan designed to address the deficiencies in your practice arising from your medical conditions. You should use the Dietitian Standards of Proficiency as a framework to identify the key areas you need to address, in addition to updating your general practice as part of your return to practice programme.
3.Within 3 months of the Operative date you must forward a copy of your Personal Development Plan to the HCPC.
4.You must undertake a practice placement of at least 10 days as part of your return to practice program. You must provide a report from your supervisor at the end of that placement within a month of completion.
5.You must forward to the HCPC written evidence that you have successfully completed the Return to Practice requirements within one month of completion.
6.In line with the recommendations of Dr Suleman, once you are in work (as a Dietitian) you must place yourself and remain under the supervision of a workplace supervisor who is registered with the HCPC. You must supply details of your supervisor to the HCPC within 1 month of taking up paid employment. You must attend upon that Supervisor as required and follow his or her advice and recommendations. The Panel recognises that this requirement may make it difficult for you to work as a locum.
7.Once in work, you must seek a report as to your performance from your supervisor and supply a copy of that report to the HCPC not less than 21 days before the next review date.
8.You must provide the HCPC with a reflective piece that includes references to your Personal Development Plan. It should reflect on your own progress and development and how you are managing your professional work while also taking care of your health. You must supply a copy of this piece to the HCPC not less than 21 days before the next review date.
9.You must remain under the care of your General Practitioner and inform him or her that you are subject to these Conditions.
10.You must register with the Specialist GP (currently at the Medical Practice) within 14 days of the Operative Date and inform that Practice that you are subject to these Conditions.
11.At least 3 weeks ahead of the HCPC review date, you must provide a report from your Specialist GP (or family GP if unavailable) outlining your progress, your compliance with the medical regime, and your prognosis.
12.You must keep your professional commitments under review and limit your professional practice as a Dietitian in accordance with the advice that you receive from your GP or from the Specialist GP.
13.You must cease your practice as a Dietitian immediately if you are advised to do so either by your Specialist GP, or any other clinician.
14. You must promptly inform the HCPC if you take up employment as a Dietitian.
15.You must promptly inform the HCPC of any disciplinary or performance proceedings taken against you by your employer.
16.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 employer (at the time of your application).
17.Any condition requiring you to provide any information to the HCPC is to be met by you sending the information to the offices of the HCPC, marked for the attention of the Director of Fitness to Practice or Head of Case Management.
An Interim Conditions of Practice Order was imposed to cover the Appeal period.
History of Hearings for Miss Sarah Jane Perrin
|Date||Panel||Hearing type||Outcomes / Status|
|23/07/2018||Conduct and Competence Committee||Final Hearing||Conditions of Practice|