Miss Rebecca J D Overton-Applebee
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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.
4. Your actions in 2 to 3 were dishonest.
5. 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 4 constitute misconduct.
8. By reason of your misconduct, your fitness to practise is impaired.
Proof of Service
1. On 12 February 2018, the HCPC sent the notice of this hearing by first class post to the Registrant’s registered address. A copy of the notice was also sent to the Registrant by email. The notice contained the required particulars.
2. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied on the documentary evidence provided, that the Registrant, had been served notice of this hearing in accordance with the Rules.
Proceeding in the absence of the Registrant
3. Mr Mason, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor, who advised that the discretion to proceed in a Registrant's absence should only be exercised with the utmost care and caution.
4. The Panel considered that the Registrant had been engaging with the HCPC throughout the course of these proceedings. She had attended and been represented at the substantive hearing and had participated in the previous reviews of the Order either by being present herself, or through her representative in her absence, or providing medical evidence to explain her non-attendance.
5. On 6 March 2018, the Registrant telephoned the HCPC to advise that she was not able to attend today’s (12 March 2018) review hearing. She was offered the option of participation by telephone and invited to send in written submissions if she wished to do so. On 9 March 2018, the Registrant wrote to the HCPC to confirm that she would be unable to attend today’s (12 March 2018) review hearing, nor would she be in a position to participate by telephone, given her daughter’s health. She provided written representations for the Panel’s consideration. For the purposes of today’s hearing, the Registrant’s representative had also sent an email, dated 8 March 2018 to the HCPC on the Registrant’s behalf, to explain that the Registrant would not be attending the hearing because she was caring full time for her daughter.
6. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve the notice on the Registrant in accordance with the Rules.
7. In light of the correspondence between the Registrant and the HCPC, the Panel was satisfied that the Registrant was aware of the hearing today. The Panel was mindful of the personal circumstances and difficulties which affected the Registrant’s ability to participate in the hearing either in person or by telephone, and gave careful consideration as to whether it should proceed in the Registrant’s absence. However, it noted the Registrant’s own comments in the telephone conversation with the case officer on 6 March 2018, to the effect that she would not be able to attend any adjourned hearing as she did not have any support with childcare, and her daughter’s childcare needs were extensive, requiring much medical support. No adjournment had been sought by her representative on her behalf, and the position was that the Registrant would be unable to attend an adjourned hearing before the expiry of the current Order. The Panel considered that it was in the public interest for the hearing to take place, as this was a statutory review of a substantive order due to expire on 23 April 2018.
8. 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 rejoined the Trust as a Band 5 Orthopaedic Scrub Practitioner and subsequently moved into the Recovery Unit.
9. On the dates identified in the Allegation, between February 2012 and March 2012, 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 Particular 2, the Registrant was arrested and given a police caution on 7 March 2012.
10. 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 Particulars 1, 2, and 3. The Registrant admitted dishonesty, impairment and misconduct as alleged.
11. The Registrant acknowledged at the substantive hearing in June 2013, that the allegations constituted serious matters. That substantive 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 analgesia, they may have been denied pain management when it was genuinely required. 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.
12. The first review took place on 12 June 2014. 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 phosphate misuse and had taken few steps towards maintaining her Continuing Professional Development (CPD). 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.
13. At the second review on 24 June 2015 the panel noted that since the previous hearing the Registrant had given birth 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. The second reviewing panel noted that, in a letter dated 18 June 2015, the Registrant indicated the personal difficulties that she had to deal with and it took account of her commitment to remaining on the Register as an ODP. 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.
14. That second reviewing panel concluded that a Suspension Order for a further 12 months was the appropriate and proportionate order. It indicated that a future reviewing panel would be assisted by: independent medical evidence to show that the Registrant had been free from the use of Codeine phosphate for a substantial period; evidence of achievement of insight into dishonesty; and evidence that the Registrant had taken steps to maintain her CPD.
15. The third review hearing took place on 17 June 2016. That third reviewing panel concluded that although the Registrant had not provided information suggested by the previous 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. That panel noted that the Registrant had written a letter detailing her reflections for the Panel, as well as providing a letter from her GP, dated 3 June 2016, which indicated that the Registrant’s own health was being investigated and treated. The third reviewing Panel extended the Suspension Order for a further 12 months and gave similar guidance which the previous panels had given, of the areas of information which may assist a future reviewing panel.
16. The fourth review hearing took place on 27 June 2017. That fourth reviewing panel concluded that the matters which had led to the Suspension Order had not been fully addressed or remediated, although it acknowledged that there were understandable reasons for that. It determined to extend the Suspension Order for a further 9 months, and made further, similar recommendations of the information which may assist a future reviewing panel. This panel also made references to this being the Registrant’s ‘last chance to remediate her misconduct’.
17. Mr Mason, on behalf of the HCPC, submitted that the Registrant appeared to have addressed some of the issues of concern raised by the previous panels. He acknowledged that her email, dated 9 March 2018, addressed the significance of her actions, and demonstrated insight and an appreciation of how her actions would have affected the reputation of the profession. He submitted, however, that the Registrant had not been in practice for 5 years, and her personal circumstances were such that she would not be in a position to return to practice for some time. He submitted that her fitness to practise remained impaired and that a further period of suspension was appropriate.
18. The Panel heard and accepted the advice of the Legal Assessor. The Panel exercised its independent judgement in determining whether the Registrant’s fitness to practise remains impaired. It had regards to the HCPTS Practice Note on Impairment and the Indicative Sanctions Policy (the Policy).
19. The Panel had regard to the Registrant’s written reflective piece, dated 9 March 2018. It considered that her reflections were genuine and powerful. It was clear to the Panel that the Registrant had undergone very difficult personal circumstances throughout the HCPC proceedings. Her reflective piece demonstrated to the Panel that the Registrant had, through her own experiences, developed considerable insight and remorse into her actions and her dishonesty.
20. The residual concern of the Panel was the Registrant’s current state of health, and medication regime. It considered that information in respect of this would be of assistance to determine the level of risk of repetition if placed in a similar situation of access to prescription only medication. The Panel was concerned that it did not have before it up to date medical or other information regarding the Registrant’s state of health, what medication she was taking and any coping strategies she had in place, to satisfy it that there was no longer a risk of repetition.
21. Accordingly, the Panel finds that the Registrant’s fitness to practise remains impaired on the grounds of both public protection and the wider public interest in maintaining public confidence in the profession and declaring and upholding proper standards of conduct and behaviour.
22. In light of the Panel’s findings in respect of impairment, the Panel was of the view that the options of taking no further action and a Caution Order would not restrict the Registrant’s practice and so would also fall short of protecting both the public and the wider public interest. As such, the Panel finds that either allowing the Order to lapse on its expiry or replacing it with a Caution Order on expiry would be neither appropriate nor proportionate in the circumstances of this case.
23. The Panel next considered a Conditions of Practice Order. However, it did not consider it possible to formulate workable conditions of practice in the circumstances of this case, given that the findings were for dishonesty, and self-medication of prescription medication.
24. The Panel next considered a Suspension Order. It had regard to the real progress made by the Registrant since the last review, in particular, the Panel was now satisfied that she had developed sufficient insight and remorse. The Panel had regard to the Policy, and considered that this was a case where the Registrant may well be able to return to safe and effective practice in the future, albeit she was not realistically in a position to do so at this stage, given her personal circumstances. As such, a Striking-Off Order would be disproportionately punitive.
25. In all the circumstances, the Panel concluded that a Suspension Order for a further period of 7 months was the appropriate and proportionate response. In deciding upon this length, the Panel had regard to the representations of the Registrant’s representative that a further review date be scheduled for October 2018, at a date to be fixed after consultation with all parties. This date would be anticipated to give the Registrant the opportunity to participate in person or by telephone, and to provide up to date medical and other relevant information to confirm what medication she is taking and any coping strategies she has in place to satisfy that there is no longer a risk of repetition. In considering the principle of proportionality, the Panel had regard to the representative’s confirmation that in view of the Registrant’s current childcare commitments, this would not cause her undue hardship.
ORDER: The Registrar is directed to suspend the registration of Miss Rebecca J D Overton-Applebee for a further period of 7 months upon the expiry of the existing Order.
The Order imposed today will apply from 23 April 2018.
This Order will be reviewed again before its expiry on 23 November 2018.
History of Hearings for Miss 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|