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1. Between 18 and 21 February 2017 in relation to Case A, you attempted to conceal your incorrect identification of the screening test results as negative, in that you:
a) Amended your recording on the Apex LIM system from negative to
b) Amended your reviewer colleague’s recording on the Apex LIM system from high-grade to negative;
c) Removed your reviewer colleague’s blue dots on the slide which
identified the presence of abnormal cells and replaced them with black dots;
d) Concealed the original request form which recorded a negative result;
e) Created a second request form which recorded a high-grade result by photocopying and amending the original request form;
2. Your actions described at particular 1 were dishonest;
3. Your actions described at particulars 1 and 2 constitute misconduct;
4. By reason of your misconduct your fitness to practise is impaired.
1. A written notice of hearing dated 7 November 2017 was sent on that date by first class post to the Registrant at his registered address, giving notice of the date, time and location of the hearing. In those circumstances, the Panel was satisfied that good service of the Notice of Hearing had been established for the purposes of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 as amended (‘the Rules’).
Proceeding in absence
2. Ms Rangamuwa applied to proceed in the absence of the Registrant. The Legal Assessor gave legal advice, which the Panel has accepted. The relevant principles of law referred to him and by Ms Rangamuwa included r. 11 of the Rules, the principles identified in the decision of the Court of Appeal in GMC v Adeogba  EWCA Civ. 162, the contents of the HCPTS’ Practice Note, Proceeding in Absence and Davies v HCPC  EWHC 1593 (Admin) at , so far as relevant to this case.
3. As there had been proper service of the Notice of Hearing, the Panel proceeded to decide whether or not it would be appropriate to proceed in the absence of the Registrant. The Panel took into account a ‘Response Proforma’ completed by the Registrant dated 7 August 2017 and a Response Pro-forma’ also completed by him, dated 18 October 2017. Which made clear that the Registrant did not propose to attend the hearing or to be represented at it. In the light of those documents, the Panel concluded that Registrant’s absence is the result of a voluntary decision on his part not to attend. He has also chosen not to be represented and it is unlikely that he would attend or wish to be represented if the case were adjourned. There is a public interest in the expeditious disposal of these proceedings and it is in the interests of justice that the case proceeds today. In those circumstances, the Panel has decided that it would be appropriate to proceed in the absence of the Registrant.
4. It became apparent during the closing submissions made by Ms Rangamuwa that particular 1 e) of the Allegation was likely to fail in the light of the evidence, because the ‘high-grade result’ that did appear on the photocopied document to which that part of the Allegation relates was only recorded after the document had been created, and not by the Registrant but by another person. Ms Rangamuwa decided not to make an application to amend the Allegation but did refer to the Panel’s power of amendment to avoid under-charging: PSA & HCPC v Doree  EWCA Civ. 319 at .
5. The Legal Assessor advised that the Panel’s power to amend arose in the context of its investigatory function, that in the circumstances of this case it would be appropriate for the Panel to exercise its power to amend this sub-particular by deleting the words ‘which recorded a high-grade result’ from the sub-particular so that it would read, ‘Created a second request form which recorded a high-grade result by photocopying and amending the original request form.’ The Panel decided to amend the Allegation in that form, having decided this amendment reflected the evidence and that any unfairness to the Registrant was minimal and was outweighed by the importance of ensuring that the circumstances of the case are fully addressed by the Panel. Therefore, the Panel directed that the Allegation be amended in the form set out above.
Decision on Facts
6. The Panel heard oral evidence on behalf of the HCPC from the following witnesses, -
KAR – Biomedical Scientist, St George’s Hospital.
RA – Biomedical Scientist and Technical Lead of Cellular Pathology Department, St Georges’ Hospital.
RA was an impressive witness. He was knowledgeable and his evidence was consistent, measured and he sought to assist the Panel. KAR’s evidence was also consistent and credible. The Panel accepted their evidence.
7. Although the Registrant did not give oral evidence, he did make various statements during the investigation conducted by RA on behalf of the Trust. The Panel has taken these into account and given them such weight as appears later in this.
8. In making its decision, the Panel has taken into account all the evidence, both oral and documentary, as well as the submissions made by Ms Rangamuwa for the HCPC. The Registrant admitted the HCPC’s factual case in the Response Proforma and provided no written representations to the Panel. The Panel has also received legal advice from the Legal Assessor, which it has accepted, the more important parts of which are summarised below.
9. The HCPC bears the burden of proving its factual case to the standard of the balance of probabilities and in deciding the issues of fact before it; the Panel has applied that burden and standard of proof.
10. The proper approach to the meaning of dishonesty was recently authoritatively stated by the Supreme Court in Ivey v Genting  UKSC 67, where Lord Hughes giving the judgment of the court stated, at  -
‘…. When dishonesty is in question the fact-finding tribunal must first ascertain (subjectively) the actual state of the individual’s knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the (objective) standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.’
11. An allegation of dishonesty is serious, requiring cogent evidence and a very careful consideration of all relevant factors is necessary before such a finding is made: In re H (Minors) (Sexual Abuse: Standard of Proof)  AC 563 at 586D-H and In re B  UKHL 35 at , Quereshi v GMC  EWHC 3729 (Admin) at .
12. At the time to which the Allegation relates, the Registrant was a registered Biomedical Scientist employed by St. Georges Healthcare Trust (‘the Trust’) as an Advanced Biomedical Scientist (Band 7) in the Cytology Section of the Cellular Pathology Department at St George’s Hospital. He had been employed in this role since 28 February 2014.
13. On the morning of 18 February 2017, KAR, a Band 6 Biomedical Scientist and colleague of the Registrant, was double-checking (rapid – reviewing) cervical smear samples which the Registrant had screened. KAR noted some abnormal (known as ‘high-grade’) cells, which she considered the Registrant had missed in his screening that morning and marked her review appropriately. On 21 February 2017, KAR noticed that the electronic record she had made of her review for that sample had been altered. She escalated her concerns to RA, who conducted a formal investigation and completed a report dated 10 April 2017, having interviewed the Registrant, KAR and GH, another Biomedical Scientist.
‘Whilst registered as a Biomedical Scientist and employed by St George’s Healthcare NHS Trust:
14. Insofar as the Panel has found particulars 1 and 2 of the Allegation to have been proved (see below), the acts found proved each took place while the Registrant was registered as a Biomedical Scientist and employed by the Trust.
1. Between 18 and 21 February 2017 in relation to Case A, you attempted to conceal your incorrect identification of the screening test results as negative, in that you:
(a) Amended your recording on the Apex LIM system from negative to high-grade;’
15. Despite the admission made by the Registrant, there was no oral or documentary evidence to support this sub-particular, which has been found not proved.
‘b) Amended your reviewer colleague’s recording on the Apex LIM system from high-grade to negative.’
16. The Cytology Section receives cervical specimens for screening under procedures and produces diagnostic reports. The screening is requested by General Practitioners and by other members of the medical profession. Each specimen is screened by a Biomedical Scientist as the ‘primary screener’ and the result of that screening is then rapid – reviewed by another Biomedical Scientist, each recording their results. If high grade disease is noted, the case is reviewed by a senior checker and sent to a consultant. The results observed by these screeners are written up by each of them on a written ‘request form’ and entered by each of them into the electronic system of the Trust, known as ‘Apex LIM’ or ‘LIM’.
17. On the morning of Saturday 18 February 2017, the Registrant and KAR were working on overtime. They were screening samples of cervical specimens. Once KAR had finished her primary screens, she rapid-reviewed a number of samples that had been screened by the Registrant, which included a sample relating to Case A. She entered a finding of abnormal high-grade (represented as a number ‘7’) for Case A on LIM.
18. RA exhibited to his witness statement copies of screen-shots of LIM that he made during the course of his investigation. A copy screen-shot of the entry made by KAR was in the documents before the Panel and it showed that KAR made that entry on 18 February 2017 at 09.11hrs. The screen shot also showed that the primary screening had been carried out by the Registrant, who had scored the screen result with a number ‘2’, indicative of a negative or normal result. A copy screen-shot of the entry made by the Registrant for Case A was also before the Panel and it showed that the Registrant had made that entry at 08.48 hrs on 18 February 2017.
19. KAR had not made a note of the identification number of the sample, which she usually did to prompt her to compare her opinion of abnormal specimens with those of the other screeners and consultants. It was when she returned to work on 20 February 2017 that she checked to see if the slide was still in the tray, but it was not. On 21 February 2017 KAR checked the records and noticed that her opinion on the LIM system for Case A had been changed from a ‘7’ to a ‘2’. The Panel has seen a copy screen-shot of that electronic record for Case A, showing an update made at 09.26 on that date. The change was shown on the screen-shot as having been made by the Registrant. The screen-shot for Case A had been updated to record a ‘2’ in the place of the ‘7’ for the rapid-review conducted by KAR. When RA interviewed the Registrant on 16 March 2017 as part of his investigation, the Registrant admitted that he had made this alteration to the electronic record.
20. In the circumstances, the Panel has found particular 1 b) of the Allegation (by reference to the stem of particular 1) to have been proved.
‘c) Removed your reviewer colleague’s blue dots on the slide which identified the presence of abnormal cells and replaced them with black dots;’
21. At the time when KAR carried out the primary screening for Case A on 18 February 2017, she took the slide, which had no dots on it and after examining the sample she placed several blue dots on the slide. She placed the slide, with a request form on which she had recorded her rapid-review of the sample, in the tray for checking by a Senior Biomedical Scientist. She did so at approximately 09.15 hrs.
22. RA examined the slide as part of his investigation. The slide was marked with black dots to indicate the presence of abnormal cells. KAR told him that she had used a blue marker pen to record on the slide the presence of abnormal cells when she had rapid-reviewed the case. RA’s evidence was that Biomedical Scientists tend to use a particular colour to mark slides when reviewing specimens. RA was aware that the Registrant used a black marker pen to record abnormal cells.
23. In a statement dated 4 March 2017 made by the Registrant as part of RA’s investigation, the Registrant admitted that he had ‘rubbed off the reviewer’s dots from the slide and I marked the slide ..’ In his interview on 16 March 2017, he admitted that it was on 21 February 2018 that he had removed the dots that KAR had placed on the slide and that he had replaced them with his own dots, using a black marker pen.
24. In those circumstances, the Panel has found particular 1 c) of the Allegation (by reference to the stem of particular 1) to have been proved.
‘d) Concealed the original request form which recorded a negative result;
e) Created a second request form which recorded a high-grade result by photocopying and amending the original request form.’
25. It is convenient to set out the Panel’s findings on these two parts of the Allegation together, even though in making its findings the Panel considered each of them separately.
26. RA began to investigate the concerns raised by KAR on the same day that she raised them with him, namely 21 February 2017. He spoke to the Registrant in his office that day and asked him to explain the change to KAR’s rapid-review for Case A. He asked the Registrant to explain the whereabouts of the original request form, which should have been left in the tray in the laboratory on 18 February 2017. After what RA described as ‘some prodding’, the Registrant showed RA the original form in his office, which he took from beneath a magazine on his desk.
27. The following further details arose from the Registrant’s statement of 4 March 2017 and from statements he made in the interview he gave to RA on 16 March 2018. He had put ‘a sticky note’ on the original request form and then photocopied it on 18 February 2018, having removed the slide number, or ‘accession number.’ (This consisted of a rectangular sticky label bearing a unique number and a barcode.) On the same day he placed that photocopy with the original form that he had put (with the slide) under a magazine on the table in his office by the microscope that he used.
28. The original form was produced in evidence by RA. The ‘sticky note’ referred to by the Registrant consisted of a white label placed in a rectangular space on the front (bottom right) of the form. That space was headed ‘CYTOLOGY REPORT’. It showed the figure ‘2’ beneath a sticky white label, together with the signature [‘OS’]. The figure ‘2’ and the signature ‘OS’ did not appear on the copies of the photocopy produced in evidence, though there were two faint marks that did show through on the photocopy.
29. The ‘original’ photocopy was also produced by RA. It showed the original accession number placed on the top right-hand corner of the document.
30. In the light of these findings, the Panel drew the following conclusions in relation to the original request form. The original request form did record a negative result, represented by a ‘2’ and the Registrant concealed it by placing it under a magazine in his office, having removed it from the tray in the laboratory where it should have been. In so concluding, the Panel has also taken into account the admissions made in the Response Proformas.
31. The Panel drew the following conclusions in relation to the photocopy. That document was a second request form which was created by the Registrant by amending the original request form in two respects, namely by (1) removing the accession number and putting it onto the photocopy, and (2) placing a white sticky label over the space bearing the Registrant’s original findings that he had recorded on the document on 18 February 2017, namely the negative test result shown by a ‘2’ and his signature.
32. Therefore, the Panel has found particulars 1 d) and 1 e) (in relation to the stem of particular 1) of the Allegation to have been proved.
‘Your actions at particular 1 were dishonest.’
33. The facts proved under sub-particulars 1 b), 1 c) 1 d) and 1 e of the Allegation consisted of a set of elaborate steps, that were deliberately designed by the Registrant to create a false record of the screening tests carried out by him and by KAR on 18 February 2017. These were intended to show that he had discovered the abnormality in the specimen for Case A, when he knew that he had failed to detect the abnormality when he carried out his primary review of the sample.
34. That this was the Registrant’s motivation was apparent from the statements made by the Registrant in interview and on 4 March 2017, which the Panel has concluded did constitute his motivation in the light of all the relevant evidence.
35. By making the alteration to LIM, he falsely represented that KAR’s review of the sample had been a negative (normal) result whereas he knew that she had found an abnormal result.
36. The creation of the photocopy of the original request form amounted to a false representation that he had not recorded a negative (normal) result on the request form, whereas he knew that he had done so. The subsequent of the original form also facilitated the creation of the photocopied form.
37. By making the alterations to the slide, he removed KAR’s assessment of the abnormality and created a false representation that he had discovered the abnormality, when he knew that she, and not he, had done so.
38. This conduct, whether taken as a whole or by reference to its component parts, was dishonest by the standards of ordinary decent people.
39. Therefore, the Panel has found Particular 2 proved by reference to sub-particulars 1 b), 1 c) 1 d) and 1 e.
40. The Panel received and accepted further legal advice from the Legal Assessor on the issue of statutory ground. The facts proved will amount to the statutory ground of misconduct if they fell short of what would have been proper in the circumstances and if, in context, they were sufficiently serious bearing in mind any relevant mitigating factors: Roylance v GMC  1 AC 311, PC at pp. 330 to 331 and R (Campbell) v GMC  1 WLR 3488, CA at  - .
41. In view of the findings of fact made by the Panel, it has concluded that the Registrant failed to comply with the following parts of the HCPC’s Standards of conduct, performance and ethics, January 2016 (‘the Standards of Conduct’) and of the Standards of Proficiency for Biomedical Scientists 1 December 2014 (‘the Standards of Proficiency’): -
The Standards of Conduct
Standard 2.5 – ‘You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users . ….’
Standard 6.2 - ‘You must not do anything, …., which could put the health or safety of a service user … at unacceptable risk.’
Standard 8.1 - ‘You must be open and honest when something has gone wrong with the care, treatment or other services you provide by:
taking action to put matters right
Standard 9.1 - ‘You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.’
Standard 10.1 - ‘You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.’
The Standards of Proficiency
Standard 2.8 - ‘be able to exercise a professional duty of care’;
Standard 3.1 - ‘understand the need to maintain high standards of personal and professional conduct’;
Standard 10.1 - ‘be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines.’
Standard 10.3 - ‘be able to recognise, communicate and understand the risks and possible serious consequences or errors and omissions in both requests for, and results of, laboratory investigations’.
42. The Registrant’s failure to comply with these professional standards included an elaborate and dishonest scheme on his part designed to create a false record of an abnormal cervical screening test by altering the electronic record maintained by the Trust so as to show a normal result.
43. As a result of his conduct, the Registrant has brought the profession into disrepute. Therefore, in all the circumstances, the facts proved did cross the threshold of seriousness and amounted to the statutory ground of misconduct.
Decision on Impairment
44. The Panel directed itself in accordance with the advice given by the Legal Assessor, who referred to the relevant case law, including CHRE v NMC & Grant  EWHC 927 (Admin) at  – , to the guidance given in the HCPTS’ Practice Note, ‘Finding that Fitness to Practise is Impaired’ and to the Overarching Objective contained in Art. 3(4) and 3(4A) and paragraph 18(10A) of Schedule 1, Health and Social Work Professions Order 2001, as amended. The Panel is tasked to decide whether the Registrant’s fitness to practise is currently impaired.
45. The Panel considered the guidance given by Silber J. in R (on the Application of Cohen) v GMC  EWHC 581 Admin at , referred to in the above passage from CHRE & NMC v Grant. The Registrant’s conduct was in principle remediable. However, he has not remedied his misconduct for the following reasons.
46. It is clear from the statements he made as part of RA’s investigation that he had no insight into the potential consequences of his conduct for the patient relevant to Case A. He stated the following in the interview, -
‘RA - If your actions had not been detected, what would the repercussions have been for the patient?
OS - Nothing would happen to the patient as I was going to change the result to abnormal.
RA - What if something had happened to you, and you were unable to change the result?
OS - The results in the computer were abnormal. I left the result as abnormal until I came back on Tuesday 21st February.’
These responses ignored the possibility of something happening to the Registrant after he had changed the result, the danger to the patient and the potential damage to the Trust. The potential consequences for the patient were described by RA in his evidence as ‘catastrophic’. This was a routine screen and the patient would not have been offered routine screening for another three years, at least. In the meantime, she could have developed cancer. RA also stated that the potential consequences for the Trust were ‘catastrophic’, because it would have missed the abnormality. The truth behind the Registrant’s deceptions was only discovered by chance due to the diligence of KAR, because she wanted to reflect on her own work.
47. Further, the Registrant had no insight into the potential consequences of his actions for KAR. By altering the electronic record of her rapid-review, he exposed her to the possibility of adverse consequences arising from her having failed to notice the abnormality of the sample.
48. The explanations given by the Registrant related to his own circumstances, wholly ignoring the potential impact on others. In the investigation, he referred only to his unspecified ‘stress’. When asked by RA whether he was aware of the HCPC’s Code of Conduct (i.e. the Standards of Conduct), he stated only, ‘Yes. It was because of my stress. I didn’t think about the HCPC as my priority.’ The Panel was not satisfied that the Registrant has displayed either insight or remorse about his actions.
49. There is no evidence that the Registrant has since reflected on, or sought to remediate his misconduct and his engagement with the HCPC fitness to practise proceedings has been limited.
50. Therefore, in all the circumstances, the Panel has concluded that there remains a risk that the Registrant would act again in a similar manner. Hence, there is a risk of repetition of the misconduct.
51. In paragraph 76 of her judgment in Grant, Cox J. stated, -
‘ I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph 25.67 she identified the following as an appropriate test for panels considering impairment of a doctor's fitness to practise, but in my view that test would be equally applicable to other practitioners governed by different regulatory schemes.
"Do our findings of fact in respect of the doctor's misconduct, deficient professional performance, adverse health, convictions, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:
a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk or harm; and/or
b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or
c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession: and/or
d. has in the past acted dishonestly and/or is liable to act dishonestly in the future."’
52. In view of the conclusions reached by the Panel, it was satisfied that all four factors were satisfied by reference both to the Registrant’s past actions and his likely future conduct.
53. In those circumstances, a finding of impaired fitness to practise is necessary in order to protect the health, safety and wellbeing of the public, to maintain public confidence in the profession and to maintain proper professional standards and conduct for members of the profession.
54. Therefore, the Panel has found that the Registrant’s fitness to practise is impaired.
Decision on Sanction:
55. Ms Rangamuwa drew the Panel’s attention to the purpose of sanctions and to the particular considerations of public protection and the wider public interest and referred to the HCPTS’ Indicative Sanctions Policy, 22 March 2017 (‘the ISP’). She identified what she submitted were aggravating factors in the case and referred to the particular sanctions available to the Panel. She also informed the Panel that an Interim Suspension Order was in place. That order was imposed on 8 June 2017. Ms Rangamuwa submitted that in its decision-making, the Panel should take the interim order into account.
56. The Panel also accepted the advice of the Legal Assessor, who also referred to the principles from the ISP, including that of proportionality and drew attention to the statutory overarching objective to which the Panel was required to have regard. In particular, the protection, promotion and maintenance of the health, safety and well‐being of the public; the promotion and maintenance of public confidence in the profession and proper professional standards and conduct for members of the profession: Article 3(4),(4A) and paragraph 18(10A) of Schedule 1 of, the 2001 Order. He advised that the interim order should be taken into account, though undue weight should not be placed on it.
57. The primary function of any sanction is to address public safety from the perspective of the risk which the registrant concerned may pose to those who use or need his or her services. However, in reaching its decision, the Panel must also give appropriate weight to the personal interests of the registrant and strike an appropriate balance with the public interest, which also includes the deterrent effect to other registrants, the reputation of the profession and public confidence in the regulatory process.
58. The Panel has taken into account the following aggravating factors, -
• the deception carried out by the Registrant was pre-meditated, elaborate and included the concealment, concoction and alteration of documentary records;
• it created a potentially catastrophic risk to the health of a patient;
• the Registrant’s dishonest actions potentially endangered the professional reputation of a junior colleague; and,
• created a potential risk of very serious damage to the reputation of the Trust;
• the Registrant has shown no insight into his misconduct or into these three potential consequences;
• the lack of remorse shown by the Registrant.
59. The mitigating factors included the admissions he made to the Trust, his co-operation with its investigation and the admissions he made to the HCPC in the Response Proformas.
60. The Panel considered the available options in ascending order of severity. This was plainly not a ‘no action’ case in view of the gravity and nature of the misconduct. Mediation is inappropriate in this context.
61. As a result of the risk of repetition found by the Panel, a Caution would provide insufficient protection to the public. In view of the seriousness of the dishonesty, a caution also would not meet the demands of the wider public interest, in particular the need to maintain public confidence in the profession and to uphold professional standards.
62. The Panel did consider the possibility of a Conditions of Practice Order. However, the nature of the misconduct, which included a substantial element of dishonesty, is not amenable to conditions.
63. Despite the mitigating factors present in the case and the fact that the Registrant has been subject to an interim order since 8 June 2017, the Panel concluded that a Suspension Order would not be appropriate in this case. The lack of evidence of insight, in particular, has led the Panel to conclude that there is no realistic prospect that the Registrant would not repeat his actions in the future. Further, the aggravating features of the case are so serious that an order of suspension would not be sufficient to mark the seriousness of the misconduct, nor have the necessary deterrent effect on other members of the profession, nor meet the demands of the overarching objective.
64. In this case, the Registrant Biomedical Scientist has engaged in a pre-meditated and elaborate dishonest scheme to alter test results, and as a result has potentially endangered the life of a patient. Furthermore, the Registrant’s actions had the potential to jeopardise the professional reputation of a colleague and the reputation of his employing Trust. The seriousness of what the Registrant did, coupled with the continuing risk that he would repeat that type of conduct, his lack of insight and lack of remorse have led the Panel to conclude that an order of suspension would not be a sufficient regulatory response in the circumstances.
65. In the circumstances, the Panel has concluded that the only appropriate order in this case is a Striking off Order, which is necessary to protect the public, to maintain public confidence in the profession and to maintain proper professional standards and conduct.
66. Therefore, the Panel has decided that a Striking off Order be made against the Registrant.
This Order will come into effect on 30 March 2018 if no appeal is made against the Panel's decision and order.
History of Hearings for Olivier Sivakumaran
|Date||Panel||Hearing type||Outcomes / Status|
|01/03/2018||Conduct and Competence Committee||Final Hearing||Struck off|