Mr Gordon Jarvie

Profession: Chiropodist / podiatrist

Registration Number: CH14060

Interim Order: Imposed on 07 Aug 2014

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 14/05/2018 End: 16:00 30/05/2018

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

During the course of your practice as an independent Chiropodist/Podiatrist at London

Bridge Hospital, you:

1. On 6 June 2011 in respect of Patient A, prescribed Pregbalin; a medication which you do not have authority to prescribe.

2. Between 20 April 2011 and 10 August 2011 you increased the fees charged to Patient A without warning and/or sufficient explanation

3. Charged Patient A:

a. for treatment, out of hours services, other procedures and/or your professional time on the following occasions, which you did not record

and /or perform:

i. 29 April 2011;

ii. 2 May 2011;

iii. 6 May 2011;

iv. 28 June 2011;

v. 1 July 2011;

vi. 5 July 2011;

vii. 6 July 2011;

viii. 10 August 2011.

b. for services which were not within your scope of practice, namely:

i. Pathology investigations on:

1. 29 April 2011

2. 02 May 2011

3. 4 May 2011

4. 6 May 2011

5. 9 May 2011

6. 11 May 2011

7. 13 May 2011

8. 16 May 2011

9. 18 May 2011

10. 23 May 2011

11. 25 May 2011

12. 27 May 2011

13. 30 May 2011

14. 1 June 2011

15. 3 June 2011

16. 6 June 2011

17. 10 June 2011

18. 13 June 2011

19. 15 June 2011

20. 17 June 2011

21. 20 June 2011

22. 22 June 2011

23. 24 June 2011

24. 27 June 2011

25. 28 June 2011

26. 29 June 2011

27. 1 July 2011

28. 4 July 2011

29. 6 July 2011

30. 8 July 2011

31. 10 July 2011

32. 15 July 2011

33. 20 July 2011

34. 22 July 2011

35. 27 July 2011

36. 3 August 2011 and/or

37. 10 August 2011

ii. Counselling for patient and carers on

1. 1 April 2011

2. 4 April 2011

3. 6 April 2011

4. 8 April 2011

5. 11 April 2011

6. 13 April 2011

7. 15 April 2011

8. 20 April 2011

9. 22 April 2011

10. 25 April 2011

11. 27 April 2011

12. 29 April 2011

13. 2 May 2011

14. 4 May 2011

15. 6 May 2011

16. 9 May 2011

17. 11 May 2011

18. 13 May 2011

19. 16 May 2011

20. 18 May 2011

21. 23 May 2011

22. 25 May 2011

23. 27 May 2011

24. 30 May 2011

25. 1 June 2011

26. 3 June 2011

27. 6 June 2011

28. 8 June 2011

29. 10 June 2011

30. 13 June 2011

31. 15 June 2011

32. 17 June 2011

33. 20 June 2011

34. 22 June 2011

35. 24 June 2011

36. 27 June 2011

37. 28 June 2011

38. 29 June 2011

39. 1 July 2011

40. 4 July 2011

41. 6 July 2011

42. 8 July 2011

43. 10 July 2011

44. 15 July 2011

45. 20 July 2011

46. 22 July 2011

47. 27 July 2011

48. 3 August 2011 and/or

49. 10 August 2011

iii. Microbiology liaison on:

1. 1 July 2011

2. 4 July 2011

3. 6 July 2011

4. 8 July 2011

5. 10 July 2011

6. 15 July 2011

7. 20 July 2011

8. 22 July 2011

9. 27 July 2011

10. 3 August 2011 and/or

11. 10 August 2011

iv. Pain management on:

1. 3 August 2011 and/or

2. 10 August 2011

v. “MRI” on:

1. 1 July 2011

2. 4 July 2011 and/or

3. 8 July 2011

vi. Liaison with out of hours pharmacy and supplies and duty staff on:

1. 22 April 2011

2. 25 April 2011

3. 29 April 2011 and/or

4. 2 May 2011

4. Sent threatening and/or unprofessional emails to Patient A's daughter

seeking payment of invoices in respect of Patient A on:

i. 16 August 2011

ii. 23 August 2011

iii. 24 August 2011; and

iv. 25 August 2011

5. On 12 October 2011 you used threatening and abusive language towards

Colleague A.

6. Your actions described in paragraphs 2 and 3 were dishonest.

7. The matters described in paragraphs 1-6 constitute misconduct.

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

Finding

Preliminary matters

1. The case for the Health and Care Professions Council (HCPC) was presented by Mr Matthew Kewley, instructed by Kingsley Napley, Solicitors. The Registrant was not present in person but Mr Richard Williams of Thompsons Solicitors was present and instructed by the Registrant to make an application to adjourn the hearing today.  Mr Williams advised that he was not instructed to remain in the hearing in the event of the application being refused.

2. The Panel agreed to hear the application to adjourn in private in terms of Rule 10(1)(a) of the Conduct and Competence Procedure Rules 2003, given that the application was being made on the basis of the Registrant’s health. The Panel accepted the advice of the Legal Assessor and considered the Practice Note on Conducting Hearings in Private. The Panel concluded that the right of the Registrant to protection of his private life and confidentiality of his health issues outweighed the general presumption of hearings being conducted in public. The application was therefore heard in private.

6. Taking all of these matters into account, the Panel is agreed that the application should be refused and that the hearing should proceed in the absence of the Registrant.

7. The Panel agreed to grant Mr Kewley’s application to hear the evidence of AM by video link, having been advised that for personal reasons, it would be difficult for her to attend the hearing in person, and having accepted the advice of the Legal Assessor. In reaching this decision, the Panel was aware that the Registrant had previously agreed to the evidence of another witness (CT) being given by video link and was of the view that there would be no prejudice caused to the Registrant as the Panel would have the opportunity to observe the manner in which the witness provided her evidence and to ask any questions of the witness.

Background

8. The Registrant was working as an independent, self-employed practitioner with practising privileges at London Bridge Hospital (”the Hospital”), between October 2010 and 24 January 2012. Between October 2010 and August 2011, the Registrant provided podiatry treatment to Patient A1, who was insured by Vanbreda International. Patient A1 passed away on 2 October 2011. On 23 September 2011 HW (Patient A1’s daughter) received an email from Vanbreda International explaining that they were concerned about the invoices the Registrant had been issuing in relation to Patient A1’s treatment.

9. HW then shared this email with the Hospital, and on 12 October 2011, a further concern was raised in respect of the Registrant’s behaviour towards KA (Colleague A).  In November 2011 JR, the Chief Executive Officer of London Bridge Hospital, appointed DK to undertake an investigation into the actions of the Registrant. The allegations were referred to the HCPC on 3 April 2012.

10. The Registrant was subsequently employed as an Advanced Podiatrist within the Podiatry and Orthotic Services Department at Aneurin Bevan University Health Board (“ABUHB”). He commenced this role on 24 May 2013 and left the ABUHB on 13 January 2015.  Following various incidents, HB and LR (Colleague D) met with the Registrant on a regular basis to discuss the concerns. In January 2014, LR was informed by a consultant vascular surgeon that the Registrant had struck through a prescription of his. As a result JK was instructed to investigate a number of allegations relating to the Registrant’s actions. The allegations were referred to the HCPC on 18 February 2014.

Decision on Facts

11. The Panel heard oral evidence from 12 witnesses on behalf of the HCPC: LR (Colleague D), Clinical Director of Therapy at Aneurin Bevan University Health Board and the Registrant’s Senior Line Manager; JK, Head of Occupational Therapy Services at Aneurin Bevan University Health Board who was appointed as Investigating Officer in respect of allegation B; AM, Podiatry Clinical Assistant at Aneurin Bevan University Health Board (by video link); JW, Tissue Viability Nurse at Nevill Hall Hospital; CT, Consultant Vascular Surgeon at the Royal Gwent Hospital (by video link); JC, retired Deputy Head of Podiatry and Orthotics Service at Aneurin Bevan University Health Board; DK, Medical Director at London Bridge Hospital; JR, Chief Executive Officer at London Bridge Hospital; PC, General Manager at Meadbank Nursing Centre; HV, Fraud Investigator at Vanbreda International; KA (Colleague A), Senior Staff Nurse at London Bridge Hospital and HW (Patient A1’s daughter). The Panel also considered the written statement of PR, HCPC Registrations Department.

Credibility of the Witnesses and Assessment of the Evidence

12. The Panel made an assessment of the credibility of all the witnesses who appeared before it as follows:

Witness LR

13. The Panel found LR to be a credible witness who provided detailed evidence of matters within his knowledge. The Panel found that he did not seek to embellish any matters or comment on issues which were beyond his personal knowledge.

Witness JK

14. The Panel heard evidence from JK in relation to her investigation at the Aneurin Bevan University Health Board which included evidence of interviews conducted with the Registrant. Although she did not provide direct evidence, she assisted the Panel with evidence of her investigation and the records of interviews conducted with the Registrant. The Panel was of the view that she did not seek to avoid any questions and found her to be a credible witness.

Witness JW

15. The Panel found JW to be a credible and concise witness whose oral evidence was consistent with her statement. She assisted the Panel with evidence of the working environment and how the team worked together.

Witness CT

16. The Panel found CT to be a credible and reliable witness who was very clear in his evidence and provided very considered answers.

Witness JC

17. The Panel found JC to be a clear and concise witness whose oral evidence was consistent with her written statement.  She assisted the Panel with a very clear explanation of the process for ordering products within ABUHB and the Panel found her to be a credible witness.

Witness AM

18. The Panel found AM to be an extremely credible and reliable witness who admitted when she did not remember and did not in any way embellish her evidence. It is clear from her evidence that she is an experienced podiatry assistant and that she had a good view of Patient A in the small treatment room and was able to give a very clear description of what she witnessed.

Witness JR

19. The Panel found JR to be a concise, clear and credible witness who gave detailed evidence and did not go beyond his own knowledge and deferred to medical colleagues for matters outwith his own experience.

Witness DK

20. The Panel found DK to be a very clear, competent and credible witness who was able to assist the Panel with his detailed knowledge of processes within London Bridge Hospital and who had conducted a thorough review of both electronic and paper records within the Hospital later in respect of the treatment of Patient A1.

Witness KA

21. The Panel found KA to be a credible and reliable witness. Although she stated that due to the passage of time she was unable to recall the specific details of the incident, she was able to confirm that events were fresh in her mind when she wrote the contemporaneous account in the email she sent to the Chief Executive Officer on 12 October 2011.

Witness HV

22. The Panel found HV’s evidence to be very clear and concise. He provided detailed evidence on the invoicing process and of the investigations he carried out in respect of the invoices submitted by the Registrant to Vanbreda International in respect of Patient A. The Panel found him to be a credible and reliable witness. 

Witness PC

23. The Panel found PC had conducted a thorough investigation of the records held at the Meadbank Nursing Home and found his evidence in respect of that investigation to be credible and reliable. It is also clear to the Panel that he had no prior knowledge of the Registrant.

Witness HW (Patient A1’s Daughter)

24. The Panel found HW to be a very clear and credible witness who provided detailed evidence about her father’s health. The Panel heard that she visited her father at least three times every week either at the hospital or the Nursing Home and she therefore had a very good perspective of his care and treatment. 

Witness PR

25. The Panel also considered the written statement of PR who provided evidence from the HCPC Register as to the status of the Registrant in relation to prescription medicines. He also provided evidence as to the terms listed in Schedule 17 of the Human Medicines Regulations 2012 (a copy of which was produced with his statement).

26. The Panel carefully considered all of the evidence both oral and documentary. It noted the submissions of Mr Kewley on behalf of the HCPC and accepted the advice of the Legal Assessor. The Panel also considered the records of interviews with the Registrant which were conducted in the course of the internal investigation at ABUHB in which the Registrant sets out his position in respect of a number of the particulars in Allegation B. The Panel did not draw any adverse inference from the Registrant’s absence and ensured that his position as set out in his interviews, was put to the relevant witnesses.

Particular A1

27. The Panel heard evidenced from JR, Chief Executive Officer of London Bridge Hospital that on 6 June 2011, the Registrant wrote a prescription for Pregabalin. The Panel has also had sight of the prescription from which it can be seen that the Registrant has written his surname next to the box requiring the prescribing consultant’s name and has inserted an entry in the box requiring “GMC No.”. JR’s evidence is that although the prescription was written on London Bridge Stationery, it was not dispensed within the London Bridge Hospital Pharmacy. While it is unclear if the prescription was in fact ever dispensed, the evidence of DK who conducted the investigation at the London Bridge Hospital, was that the original prescription was completed with a carbon copy and the carbon copy was found in the patient’s notes.  In addition, the Panel has considered the statement of PR of the HCPC in which he confirms that the Registrant is not an independent or supplementary prescriber. PR also confirms that Pregabalin is a prescription only medicine and that it is not on the list of medicines that chiropodists or podiatrists with “prescription only medicines” or “local anaesthetics” annotations are able to sell, supply or administer without a prescription in terms of Schedule 17 of the Human Medicines Regulations 2012. The Panel has also had sight of the relevant sections of Schedule 17 within the evidence. The Panel is satisfied from the evidence of JR, DK and PR together with the documentary evidence that the facts of this particular are proved on the balance of probabilities.

Particular A2

28. The Panel has heard evidence from DK that the Registrant’s invoices in respect of his treatment of Patient A1 increased dramatically from £250 to £900 within a very short period of time. The Panel has also had sight of the invoices for the period 30/3/2011 to 10/08/2011 from which it can be seen that the prices of Patient A1’s treatment increased significantly. DK’s evidence was that as the Registrant was granted practising privileges at the hospital, he would never have been told what to charge his patients as this was entirely a matter for the practitioner. There was no hospital guidance detailing what independent practitioners are expected to charge for private work but that it should be reasonable. He also advised that practitioners must advise their clients of the charges before commencing any treatment. The Panel also heard evidence from HW, whose evidence was that she did not have any Power of Attorney over her father’s finances and had no control or influence over his money.

29. While the Panel has heard evidence from both DK and JR that the level of fees charged appeared to be excessive, the wording of this particular is that the fees were increased without warning and/or sufficient explanation. The Panel did not have any statement or evidence from Patient A1, the person to whom any warning or explanation would be given, and who died in 2011. In addition, the Panel heard oral evidence from HW that she was not privy to conversations between her father and the Registrant. In these circumstances, the Panel is not satisfied that the HCPC has discharged its burden of proof in respect of this factual particular and finds this is not proved on the balance of probabilities. 

Particular A3a(i) – (viii)

30. The Panel heard evidence from HW, JR, DK and PC in support of these particulars. The Panel has also had sight of the invoices for the dates listed in particulars 3a(i) to 3a(viii) and Patient A1’s medical records. The Panel heard evidence from JR that the Registrant was required to maintain a complete set of medical records including progress notes, within London Bridge Hospital for each of his in-patients in terms of his letter of offer from London Bridge Hospital (a copy of which has been produced within the bundle). The evidence of JR was that     there was no record within Patient A1’s notes of any appointments with the Registrant on 29 April 2011, 2 May 2011, 6 May 2011, 28 June 2011, 1 July 2011, 5 July 2011, 6 July 2011 or 10 August 2011 and therefore no evidence to suggest that these appointments with Patient A1 had taken place at London Bridge Hospital as an in-patient. DK confirmed that a search was undertaken of both paper and electronic records held within London Bridge Hospital. DK also confirmed that a check of patients who had registered at the hospital for outpatient treatment on each of these dates was conducted and again there was no record of the Registrant having treated Patient A1 on any of these dates.

31. In addition the Panel has heard evidence from PC, who provided evidence from the records at the Meadbank Nursing Centre where Patient A1 resided between 21 October 2010 and 18 September 2011.  He advised the Panel that he could find no evidence to show that the Registrant visited Patient A1 at the home on 29 April 2011, 2 May 2011, 6 May 2011, 28 June 2011, 1 July 2011, 5 July 2011, 6 July 2011 or 10 August 2011.  PC provided evidence of the detailed investigation which he conducted which included a search of the archives, checking diaries, looking at daily records and the signing in registers at both receptions in the home for the relevant dates and spoke to receptionists.  PC also stated that it would be unlikely that a professional would not sign in. In the course of his evidence, it was put to PC if it was possible that the Registrant visited the home without any record having been made of a visit. His response was that it would be a very, very rare occurrence as the Registrant would have to go through quite a few people before he could see a patient and would have to produce evidence of identity and gain consent from the patient and family.  The Panel also heard from HW that the Registrant was supposed to visit her father at the Nursing Home and did not do so, resulting in the nursing staff having to change her father’s dressings. She explained to the Panel that this was not part of her father’s care package at the Nursing Home and that the nurses should not have had to do that.

32. In respect of the invoice of 5 July 2011 relating to a payment of £1250 for “lumbar sympathectomy, patient prep, positioning, clerking, liaison with staff, carers and anaesthetist”, the Panel also heard evidence from DK that the lumbar sympathectomy documented on that invoice was in fact carried out by Dr Serge Nikolic and that such a procedure would have been outside the Registrant’s scope of practice. DK also stated that the Registrant would not have been expected to be present or to assist in theatre during the procedure. The Panel has also had sight of a letter from Dr Nikolic confirming that he carried out the procedure.

33. The Panel has also noted from Patient A1’s clinical record of 1 July 2011 it is recorded that “Gordon (Podiatrist) did not arrive today to dress patient’s foot as he was caught in a meeting in London”.

34. The Panel heard evidence from JR in relation to the invoice of 10 August 2011 for £900 for an out of hours intervention that lasted four hours and included Tissue Viability/wound care; Wound bed preparation; Sharp debridement; Routine foot hygiene and skin care; Pathology investigations; Counselling of patient and carers; Microbiology liaison; post bone debridement pain management and out of hours service. JR gave evidence that the dressing was in fact carried out prior to the patient receiving dialysis which took place during working hours. DK also confirmed that it would not be appropriate to carry out sharp debridement on the same day as a patient received dialysis. DK confirmed in his evidence that if the Registrant were to carry out pathology investigations or microbiology liaison, there would be a record of those and that he found no such records. Further, DK stated that the Registrant had charged for two MRI scans within three days and that this frequency of MRI scans “almost never happened in medicine”. The Panel also had regard to Patient A1’s clinical note for 10 August 2011 which records that the wound dressing was carried out by a nurse.

35. The Panel is therefore satisfied from the evidence of HW, JR, DK and PC and the  supporting documentary evidence that the Registrant charged Patient A1 for treatments which he did not perform on 29 April 2011, 2 May 2011, 6 May 2011, 28 June 2011, 1 July 2011, 5 July, 6 July 2011 and 10 August 2011 and therefore finds that facts of particulars 3a(i),(ii), (iii), (iv), (v), (vi), (vii) and (viii) proved on the balance of probabilities.

Particulars A3b(i) – (vi)

36. The Panel heard evidence from JR in support of this particular and has had sight of the Registrant’s scope of practice document listing the areas in which he has been deemed competent and granted practising privileges at the London Bridge Hospital. In his written evidence JR has stated that pathology investigations, counselling of patients and carers, microbiology liaison, pain management, MRI and liaison with out of hours pharmacy supplies and duty staff were all outwith the Registrant’s scope of practice. However in his oral evidence he has clarified that the issue was not whether the Registrant was competent in these areas, it was a question of whether or not these treatments were clinically appropriate for Patient A1. JR made it clear to the Panel that he was not saying that these matters were outside of the competence of the Registrant. Indeed the Panel has noted that a number of these services are referred to in the Registrant’s scope of practice document.  In the absence of any evidence to indicate that pathology investigations, counselling of patients and carers, microbiology liaison, pain management, MRI and liaison with out of hours pharmacy and supplies and duty staff are outwith the Registrant’s scope of practice, the Panel finds that particulars 3b(i), (ii), (iii), (iv), (v) and (vi) are not proved to the requisite standard.

Particular A4(i) - (iv)

37. The Panel heard evidence from HW and DK in support of this particular. The Panel has also had sight of the emails dated 16, 23, 24 and 25 August 2011 from the Registrant to HW. The Panel heard evidence from HW that she had no power of attorney, control or influence over Patient A1’s money.

38. The Panel’s attention was drawn to the following summary of extracts from Mr Jarvie’s email correspondence to HW:

• Email of 16 August 2011:
“I am unsure why you may sign cheques but not conduct bank      transfers on behalf of your father. I will be looking for cleared funds today. How that is arranged is a matter for your own judgment.”
• Email of 23 August 2011, headed “Urgent pre legal proceedings”
“It is no doubt unsurprising to you that the cheque which you wrote and applied a postage stamp to so loosely that it is only providence that it arrived in the first place. Given the issues had in obtaining this payment I am more than a little aggrieved.”
“I have not at this stage informed London Bridge of this situation...however I must now insist that payment is made….I recall you saying you cannot do this previously but I must insist that you do this.”
“I am sorry but if the full sum is not made...by 10am late payment penalty of 10 percent will be levied immediately and charged every 7 days in addition to the matter being escalated tomorrow morning to a registered debt collections agency.”
“The cheque you wrote has been returned unpaid, a fact I suspect you knew.”
“I would suggest you speak with your father’s bank tonight to receive guidance as I am sure you don’t pay the nursing home etc in the same drawn out manner.”
• Email of 24 August 2011:
“The issuing of a cheque which was dishonoured by the bank is not       only inconvenient, it contrary to the bills of exchange act.”
• Email of 25 August 2011:
“As a chartered accountant you must know that by your previous communications in which you acknowledged the debt owed and arranged for a cheque which was returned unpaid is illegal under the bill of exchange act … and you have personally acknowledged the debt.”
“I find it strange that if you felt that the invoice was [not] properly constituted why did you post a cheque in the first place or give a disingenuous commitment to have your fathers banker make payment on Wednesday.”
“Remittance advices are posted to the address which your father registered with Vanbreda. It is not my responsibility to find this information out and it is concerning that you do not know this basic information.”

39. The Panel is satisfied that the Registrant sent each of these emails and that the email of 23 August headed “Urgent pre legal proceedings” and stating that the matter would be escalated to a registered debt collection agency. In her oral evidence, HW said that she felt bullied and threatened by the Registrant. The Panel is of the view that the tone of this email was threatening.

40. The Panel also finds that the emails of 16, 24 and 25 August were unprofessional. It was clear from the emails from HW to the Registrant that she did not have control of her father’s finances. However, in the emails sent by the Registrant to HW, he seemed to be ignoring this fact and seemed to be putting pressure on her to pay his invoices. In addition, the Panel found the tone of the emails sent by the Registrant to be unprofessional and heard evidence from HW that she felt bullied by these. The Panel therefore finds the facts of particulars 4(i), (ii), (iii) and (iv) are proved on the balance of probabilities.

Particular A5

41. The Panel heard evidence from KA, at that time a junior sister at London Bridge Hospital, whose evidence was supported by a contemporaneous account which she sent in an email dated 12 October 2011 to the Chief Executive Officer and other staff within the hospital. KA describes the Registrant’s behaviour towards her on the ward as becoming increasingly aggressive and swearing. The Panel also heard evidence from DK that the Registrant was invited to attend a meeting about KA’s complaint on 11 November 2011 and that the Registrant attended the meeting and apologised for his behaviour towards KA and accepted that his conduct had been unacceptable. The Panel accepts the evidence of KA and that of DK and finds that the Registrant used threatening and abusive language towards KA and finds the facts of this particular proved on the balance of probabilities.

Particular A6

42. The Panel next considered whether the Registrant’s actions in particulars A3a(i) to (viii) were dishonest.  In considering this issue, the Panel accepted the advice of the Legal Assessor and applied the test set out in the case of Ivey v Gentings Casinos (UK) Ltd (2017) UKSC 67. The Panel first considered the Registrant’s state of knowledge or belief as to the facts. It then considered in the light of his state of mind, whether his conduct was dishonest applying the objective standards of ordinary reasonable people.

43. In each of particulars A3a(i) to (viii),  the Panel has found that the Registrant has charged Patient A1 for treatments or services which he did not perform.  The Panel is of the view that at the time the Registrant issued the invoices, he would have been aware that he had not in fact carried out the treatments. The repetition of his actions on eight separate occasions in this regard was seen by the Panel as ruling out any likelihood of mistake on the Registrant’s behalf. The Panel has concluded that he did so for financial gain and that reasonable and honest people would consider his behaviour to be dishonest. The Panel is therefore satisfied that his actions in each of particulars 3a(i) to (viii) amount to dishonesty.  

Particular B1

44. The Panel heard evidence from AM and LR in support of this particular. The Panel also had sight of the Formal Investigation Report from Aneurin Bevan University Health Board; letter of complaint from Patient A; a note of the meeting on 24 February 2014 between LR and Patient A, a note of the meeting on 24 February 2014 between LR and Patient A’s husband and a note of the meeting on 26 February 2014 between LR and AM; Patient A’s clinical record from 29 August 2013 and LR’s review of the record. The Panel also considered the transcript of the interview with the Registrant on 15 August 2014 in which he denied that he performed debridement without clinical justification, denied that the patient did not consent, denied that the patient asked him to stop and denied that the patient records were inadequate.

45. The Panel has heard evidence from LR that debridement is the physical removal of devitalised tissue around a wound. He also confirms that Patient A’s notes from 29 August 2013 do not refer to debridement having taken place. The Registrant has recorded in the patient notes on 29 August 2013 “wound open and granulating”. LR also interviewed Patient A who maintained that there was no open wound on her foot when she attended with the Registrant on 29 August 2013. The Panel has also heard evidence from AM that the Registrant carried out a quite aggressive debridement on Patient A’s foot, more so than any other podiatrist she had observed, and that while there was a small circular red area on Patient A’s foot, there was no open wound, no crack or break in the skin when the patient attended for the appointment.

 

46. The Registrant has recorded in the patient notes “foreign body removed, on examination stone in shoe”. AM, in interview with ABUHB, stated that nothing was sent off for examination, which she would have expected if a foreign body had been found.

47. The Panel accepts the evidence of AM, a very experienced podiatry assistant who was present throughout the treatment. Her evidence was carefully examined in the light of the Registrant’s position as stated in the internal investigation report. Her evidence was consistent with her statement given to LR on 26 February 2014 and was also supported by the written statement of Patient A. The Panel prefers the evidence of AM to the position of the Registrant, as set out in the internal investigation. The Panel therefore accepts that there was no wound on Patient A’s foot and therefore no clinical justification for performing debridement and finds the facts of this particular proved on the balance of probabilities.

Particular B1(b)

48. The Panel has heard evidence from AM that the Registrant did not ask Patient A for her consent before he started performing debridement. In her initial interview with LR on 26 February 2014 she states: “Gordon just picked up the scalpel and dug! He just dug and dug and dug”. In the course of her evidence to the Panel, AM was clear that the Registrant did not ask for the patient’s consent. The Panel is aware from the notes that there is no reference to consent in the entry for 29 August 2013.  The Panel has also considered the statement provided by Patient A to LR confirming that the Registrant “took my good foot, stuck it with a knife and made it bleed”. The Panel has also considered the written statement provided by Patient A’s husband who was also present during the appointment on 29 August 2013 in which he states “….she didn’t want him to touch it. He just grabbed her foot and stuck the knife in and there was blood all over the couch and the floor”. The Panel does not accept the Registrant’s version of events, as set out in his interview in the internal investigation. The Panel is satisfied from the evidence of AM which is supported by the interview with the patient, her husband and the patient notes that the Registrant did not obtain informed consent from Patient A in relation to the debridement and finds the facts of this particular proved on the balance of probabilities.

Particular B1(c)

49. The Panel has heard evidence from AM in support of this particular. She is clear that Patient A asked the Registrant to stop on numerous occasions and he did not do so. In her interview with LR on 26 February 2014, AM stated that “she asked him to stop lots of times because it was hurting her”. In her evidence to the Panel she has been clear that the patient asked the Registrant to stop and he carried on with the treatment. The Panel has also had regard to the record of the interview with Patient A in which she stated that she told the Registrant not to touch her foot and told him to leave it. The Panel rejects the Registrant’s assertion in the interview during the internal investigation that at no time did the patient ask him to stop. The Panel accepts the evidence of AM which is supported by the statement of Patient A. AM further explained that Patient A was known to be anxious and historically would ask podiatrists to stop their treatment. She explained that podiatrists would stop and reassure Patient A seeking her agreement to continue with the treatment. She said that the Registrant took none of these steps. In her oral evidence, AM stated “I can’t recall specifically what she said but I know she did ask him to stop”. The Panel finds the facts of this particular proved on the balance of probabilities.

Particular B1(d)(i) to (iii)

50. The Panel has heard evidence from LR’s review of the clinical entry for Patient A of 29 August 2013 in which he observed that the entry did not mention extensive debridement, excessive bleeding or post clinical advice to the patient. The Panel has also had sight of that clinical entry which supports the evidence of LR. The Panel heard evidence from AM that the bleeding was so extensive that there was blood on the patient’s leg and on the couch and floor.  She gave evidence to the Panel that she had not witnessed this level of bleeding before or since this incident and that in 12 years she had worked with forty to fifty different podiatrists. She also gave evidence that she had to use a full box of Kaltostat wound dressings to stem the bleeding. The Panel accepts the evidence of LR and AM which is supported by the patient notes and finds the facts of this particular proved on the balance of probabilities.

Particular B1(e)

51. The Panel has heard evidence from AM that when the Registrant had finished performing debridement, he did not provide Patient A with any advice about wound management. She also gave evidence that she would have expected the Registrant to advise Patient A to attend A & E if the bleeding continued and to ensure that the practice nurse was monitoring the wound for signs of infection. The Panel has also had sight of Patient A’s clinical notes in which there is no reference to advice given in relation to wound management. The Panel accepts the evidence of AM which is supported by the clinical notes and finds the facts of this particular proved on the balance of probabilities.

Particular B2(a) – (c)

52. The Panel heard evidence from LR in support of these particulars which relate to an appointment which the Registrant had with Patient B on 7 January 2014. The Panel also had sight of the letter of complaint (and photographs) from Patient B dated 16 January 2014, the note of the meeting between Patient B and LR of 5th February 2014, Patient B’s clinical record and LR’s review of that record. The evidence of LR is entirely hearsay evidence and there is no direct evidence to support this particular. It is entirely a matter for the Panel to determine what weight should be given to hearsay evidence when it has not had an opportunity to question or assess the credibility of the person who is the source of that evidence and where that evidence has not been tested. In the circumstances where the only evidence to support particulars B2a) to c) is hearsay evidence, the Panel is not satisfied that the facts of these particulars have been proved on the balance of probabilities.

Particular B3

53. The Panel heard evidence from LR that having reviewed Patient C’s clinical records, there was an entry for 4 December 2013 indicating that the Registrant undertook an examination of a female patient and produced a treatment plan relating to a wound to the perineum area which is the area between the anus and vulva. The Panel had sight of Patient C’s clinical record from which it can be seen that the Registrant undertook the examination on 4 December 2013 and produced a treatment plan. The Panel also had sight of LR’s review of that record.

54. In the course of his interview for the internal investigation, the Registrant states that he did a joint examination with Dr Santosh, that he (the Registrant) recommended a dressing with adequate drainage and that this was only temporary until a Tissue Viability Nurse (TVN) could see the patient. He did not accept that it was outside his scope of his knowledge and skills stating that wound care was the same for any wound and that podiatrists could treat wounds above the knee. He also stated that the patient needed to be seen by a TVN and that the TVN was not available. He did accept that it was not ideal but stated there were extenuating circumstances.

55. The evidence of LR is that performing treatment and/or examining a patient’s perineum is outside of the Registrant’s scope of practice which was strictly limited to the lower limb and foot regions. He also gave evidence that in order to treat a wound in a particular part of the body would require knowledge of the structure of the area surrounding the wound.

56. The Panel accepts the evidence of LR and accepts that the Registrant’s examination of Patient C’s wound in the perineum area was clearly outside the Registrant’s scope of practice as a podiatrist which was limited to the lower limb and foot areas. The Panel therefore finds the facts of this particular proved on the balance of probabilities. 

Particular B4(a)

57. The Panel heard evidence from JC and LR that the ABUHB operated a Wound Care Formulary which set out the guidelines in terms of wound care products that were available to staff. Both witnesses confirmed that Hyiodine was not included in the Wound Care Formulary and was not therefore authorised for use at ABUHB. The Panel has also had sight of the Wound Care Formulary which sets out the products classification and categories to reflect the level of authorisation needed prior to using a product.

58. The Panel also heard from LR that the ABUHB operated a policy relating to the use of free sample medication (The Supply of Free Samples of Prescription Items Policy), a copy of which has been produced in evidence.  LR gave evidence that in terms of the policy, staff are not free to use sample prescriptions or to supply free samples to patients.

59. The Panel heard evidence from JC that she recalled the Registrant bringing a box of Hyiodine samples to her office and that she agreed to keep the box under her desk. She advised the Panel that the Registrant said he was going to be conducting a study. JC gave evidence that in order for Hyiodine to be used, it would have to be submitted to and approved by the Wound Formulary Group and also be considered by the Medical Ethics Committee.

60. The Panel is therefore satisfied from the evidence of JC and LR which is supported by copies of the relevant policies, that Hyiodine is not authorised for use in ABUHB.

61. In the course of the Internal Investigation, the Registrant stated that LR was fully aware that he had used Hyiodine on some patients and that it was JC who supplied him with Hyiodine. LR was very clear in his evidence that he was not aware that the Registrant was using Hyiodine. LR did recall a discussion regarding the use of Hyiodine following nail surgery and that of a poster presentation at Harrogate but gave evidence that he would not have supported its use in a clinical trial as there would have been no benefit to the hospital. In addition JC gave evidence that she did not supply Hyiodine to the Registrant and explained that it would not have been possible for her to order Hyiodine as it was not approved by the Wound Formulary Group. This was consistent with the evidence given by LR. The Panel accepts the evidence of LR who was clear that he was not aware of the Registrant’s use of Hyiodine and that of JC that she did not supply and could not order Hyiodine.

62. The Panel heard evidence from LR that the Registrant had used Hyiodine with Patient D on 25 July 2013. The Panel has also had sight of the patient record for that day from which it can be seen that Hyiodine was used on the Patient and the record has been signed by the Registrant. The Panel is therefore satisfied that the facts of this particular have been proved on the balance of probabilities.

Particular B4(b)

63. The Panel has also had sight of the records for Patient E from 4 June 2013 and 3 July 2013 from which it can be seen that Hyiodone was used. However in each of these entries, the signatures have been redacted and the Panel cannot therefore be satisfied that these treatments were carried out by the Registrant. The Panel has also had sight of Patient E’s records from 17 July 2013, 24 July 2013 and 31 July 2013 from which it can be seen that Hyiodone was used. However the Registrant was not the treating podiatrist on each of these occasions. The Panel has had sight of Patient E’s record for 29 May 2013 from which it can be seen that Hyiodone was used and that the Registrant was the treating podiatrist. The Panel therefore finds that the facts of particular 4b(iii) have been proved on the balance of probabilities and finds the remaining particulars -  4b (i), (ii), (iv), (v) and (vi) not proved .

Particular B4(c) (i) to (iv)

64. The Panel has also had sight of the records for Patient F from 21 June 2013, 29 August 2013, 13 September 2013 and 11 October 2013 from which it can be seen that Hyiodone was used. However in each of these entries, the signatures have been redacted and the Panel cannot therefore be satisfied that these treatments were carried out by the Registrant. The Panel is therefore not satisfied that the facts of these particulars have been proved on the balance of probabilities.

Particular B4(d) (i) to (iii)

65. The Panel has had sight of the records for Patient G from 21 November 2013, 28 November 2013 and 5 December 2013 from which it can be seen that Hyiodone was used and that the Registrant was the treating podiatrist. The Panel has also had sight of an email dated 15 November 2013 from the Registrant to another podiatrist in ABUHB in which he confirms that he will initiate Patient G onto Hyiodone. The Panel is therefore satisfied that the facts of particular 4d)i), ii) and iii) are proved on the balance of probabilities.

Particular B5

66. The Panel heard evidence from LR and JW in support of this particular. The Panel heard evidence from LR and JW that larvae therapy can only be authorised by tissue viability nurses. The Panel also had sight of the ABUHB Wound Healing Products Formulary and Guidelines in which larvae therapy is classified for use under Clinical Nurse Specialist Tissue Viability Authorisation only. JW stated in evidence that she gave the Registrant a copy of the Wound Formulary Guidelines during his induction. LR also confirmed that the Registrant was aware that he could not authorise this treatment. He gave evidence that the Registrant had complained to him on several occasions that the levels of authorisation within the Formulary were too restrictive.

Particular B5(a)

67. The Panel heard evidence from LR that he was notified on 5 June 2013 by JW, a Tissue Viability Nurse, that the Registrant had ordered larvae therapy without the authorisation of a tissue viability nurse.  The Panel also heard from JW that on that date, the Registrant informed a colleague who worked in the pharmacy, KV, that JW was not in the hospital so was unable to provide authorisation for him to order larvae therapy. JW’s evidence is that she was in work on that day and that the Registrant did not contact her to request any authorisation. Ms Warren also states that the Registrant told KV that he was authorised to order larvae therapy. In the absence of evidence from KV, the pharmacist, the HCPC case is based solely on hearsay evidence and the Panel has not therefore had any opportunity to test that evidence. It’s also alleged that the Registrant’s actions in particular 5 were dishonest. This is a serious allegation requiring cogent evidence. In the absence of any direct evidence, the Panel does not find the facts of this particular to the requisite standard.

Particular B5(b)

68. The Panel heard evidence from LR that on 28 October 2013, a pharmacist, TB, emailed the Registrant about an order for larvae therapy. In an email exchange, TB indicated that when she went to order larvae therapy, she established that the Registrant was not authorised to request larvae therapy. The HCPC case is based solely on hearsay evidence from LR. It’s also alleged that the Registrant’s actions in particular 5 were dishonest. This is a serious allegation requiring cogent evidence. In the absence of any direct evidence from the pharmacist that the order for larvae therapy was placed by the Registrant, the Panel does not find the facts of this particular to the requisite standard.

Particular B5(c)

69. As the Panel has found particular 5a) not proved, it follows that this particular is not proved.

Particular B5(d)

70. As the Panel has found particular 5a) not proved, it follows that this particular is not proved

Particulars B6(a) and (b)

71. The Panel heard evidence from CT in support of these particulars. In the course of his interview in the internal investigation, the Registrant accepted that he cancelled the prescription stating that it was the wrong product on the prescription and that he could not get hold of the Consultant, CT.

72. CT gave evidence that he was the clinician responsible for Patient H and that he was in the hospital on 15 January 2014 and was contactable. He gave evidence that on 15 January 2014 a Registrar wrote a prescription for Patient H to receive Fusidic Acid. He advised the Panel that on 16 January 2014 he received an email from the Registrant indicating that he had amended the prescription written by the Registrar and that he had written a letter to Patient H’s GP asking for the prescription to be amended. The Panel has also had sight of the email exchange, the prescription and the letter written by the Registrant to Patient H’s GP asking him to reissue the prescription to include Flucloxacillin.

73. As an experienced Consultant, CT was able to assist the Panel with the proper process to be followed in the event that another health professional wished to raise concerns about a prescription. He explained to the Panel that it would be appropriate to discuss this with him as the clinician responsible for Patient H. He also provided evidence to the Panel that, he had not experienced a podiatrist altering one of his prescriptions, either prior to this incident or since the incident with the Registrant.

74. The Panel also heard evidence from LR that by striking through the prescription and asking the GP to issue a new prescription, the Registrant acted outside the scope of his practice as in terms of the Medicines Act 1983 only the prescriber is able to amend a prescription.

75. The Panel is satisfied from the evidence of CT and LR which is supported by the documentary evidence that the Registrant struck through the prescription and amended it and finds the facts of particulars 6(a) and (b) proved to the requisite standard.

Particular B7

76. The Panel heard evidence from LR that on 30 September 2013, he received an email from the Registrant as follows: “welcome back eh…I really wish I had not bothered…this place is staffed by bitchy, lazy, useless, incompetent people.” The Panel has also had sight of that email.  In the course of his interview in the internal investigation when asked about this email, the Registrant stated that “You need to consider the context of who this is about…..I can understand how it may be perceived but in the context of the whole email trail, I consider it appropriate”. LR understood Mr Jarvie to be referring to a consultant anaesthetist. The Panel is satisfied that the email sent by the Registrant to LR was inappropriate and amounted to a failure to maintain effective communication with LR as its content was unprofessional and disrespectful to colleagues. The Panel therefore finds the facts of particular proved on the balance of probabilities.
Particulars B8(a) and (b)

77. As the Panel did not find particulars 5c) and d) proved, these particulars are not proved.

Decision on Grounds

78. The Panel next considered whether the Registrant’s actions in particulars A1, A3a)i) to viii), A4) i) to iv), A5, A6, B1a) to e), B3, B4a)i), B4b)iii), B4d)i) to iii), B6a), B6b) and B7 amount to misconduct. The Panel is aware that this is a matter for its professional judgement. In reaching its decision, the Panel has considered the submissions of Mr Kewley on behalf of the HCPC and has had regard to the HCPTS Practice Note on Finding Fitness to Practice is Impaired. The Panel has also accepted the advice of the Legal Assessor. The Panel had regard to the records of interviews given by the Registrant in the course of the internal investigation at the ABUHB.

Particulars in respect of which misconduct is not found

Particular B1d) iii)

79. The Panel has found that as matter of fact the Registrant did not record post clinical advice to Patient A in the record of the appointment of 29 August 2013. The Panel has concluded that the Registrant did not provide post clinical advice to the patient and as a result of this finding, he would not be required to record this in the patient records. The Panel therefore does not find that his failure to record post clinical advice in the patient records in particular B1d)iii) amounts to misconduct.

Particular B7

80. The Panel has also found in particular B7 that the Registrant did not maintain effective communication with LR when he stated in an email “This place is staffed by bitchy, lazy, useless, incompetent people.”  While the Panel finds the content and tone of this email to be inappropriate in a professional setting, the Panel is of the view that, in itself, it is not sufficiently serious to amount to misconduct.

Particulars in respect of which misconduct is found

81. The Panel has found that the Registrant has prescribed medication which he was not authorised to prescribe. In prescribing medication which he was not authorised or qualified to prescribe, he posed a risk to the patient and also to the reputation of his employer and the profession.

82. The Panel has also found that on eight separate occasions the Registrant has dishonestly charged a patient for services which he has not performed. As a podiatrist, the Registrant must behave with integrity and honesty in order to maintain confidence in the profession and justify the trust of patients. In acting as he did, the Registrant has repeatedly breached that trust with Patient A1. In sending threatening or unprofessional emails to a patient’s daughter in respect of invoices for which she had no responsibility, the Registrant behaved inappropriately and caused upset to Patient A1’s daughter.

83. In using threatening and abusive language towards a colleague on a hospital ward when that colleague properly challenged his authority to request an x-ray, the Registrant’s conduct was wholly inappropriate, unprofessional and left that colleague feeling threatened.

84. The Registrant’s conduct in relation to Patient A in performing a treatment without clinical justification or consent, failing to stop when asked, failing to record in the patient records and failing to provide post clinical advice clearly caused distress and suffering to a vulnerable and anxious patient. His conduct also caused distress to his assistant who witnessed his actions.

85. In conducting an examination which was outwith his scope of practice and which involved an intimate examination of a female patient, the Registrant’s conduct fell well below the standards expected of a registered health professional. It is also of concern to the Panel that the Registrant continued to maintain that such an examination was within his scope of practice. 

86. The Panel has found that the Registrant used Hyiodine which was not authorised by the Hospital on five occasions with three different patients and that he was aware that this was not approved for use within ABUHB. The Panel heard evidence from LR that if there had been an unanticipated or negative outcome as a result of this use, patients could have been compromised and there could have been negative effects on ABUHB. 

87. In striking through and amending a prescription, the Registrant acted outwith his authority and did not have the necessary knowledge or experience to do so. In addition, his actions were contrary to the Medicines Act 1963 and undermined the patient’s care plan putting them at potential risk of harm.

88. In respect of the allegations amounting to misconduct, the Panel has found that on numerous occasions over an extended period of time, the Registrant has demonstrated serious errors of judgement and serious attitudinal issues. The Panel is of the view that the Registrant’s conduct found proved, fell far short of what would be proper in the circumstances. The Registrant’s conduct found proved, also breached the following standards of the HCPC’s Standards of Conduct, Performance and Ethics (2008 and 2012):

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

• Standard 3 - You must keep high standards of personal conduct.

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

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

• Standard 9 – You must get informed consent to provide care or services (so far as possible).

• Standard 10 – You must keep accurate records.

• Standard 13 – You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.

89. Taking all of these matters into account, the Panel is satisfied that the Registrant’s conduct in particulars A1, A3a)i) to viii), A4i) to iv), A5, A6, B1a) to c), B1d)i), B1d)ii), B1e) B3, B4a)i), B4b)iii), B4d)i) to iii), B6a) and B6b) is serious and amounts to misconduct.

Decision on Impairment

90. The Panel next considered whether the Registrant’s current fitness to practise is impaired by that misconduct. In reaching its decision the Panel has considered both the personal component and the public component. In addition, the Panel has considered the submissions of Mr Kewley on behalf of the HCPTS and has also had regard to the HCPTS Practice Note on Finding Fitness to Practice is Impaired. The Panel also accepted the advice of the Legal Assessor. The Panel had regard to the records of interviews given by the Registrant in the course of the internal investigation at the ABUHB.

91. In terms of the personal component, the Panel’s finding in respect of the allegation found proved and amounting to misconduct indicated deep seated attitudinal concerns that potentially placed service users at serious risk of harm. Further, the Registrant showed a lack of respect for colleagues and for procedures in place to underpin the safe delivery of patient care.

92. In terms of insight, the Panel has heard evidence that the Registrant attended a meeting with JR on 11 November 2011 and apologised for his conduct towards KA as described in particular 5. The Panel has heard that while he acknowledged that his conduct was unacceptable, he did not apologise directly to KA. Other than this very limited insight in respect of that one particular, the Registrant has not demonstrated any insight, remorse or acceptance of responsibility for his actions.

93. The evidence before the Panel is that on a number of occasions when challenged the Registrant continued to maintain that his actions were appropriate and in respect of the issues with Patient A1, he failed to respond to a complaint made on behalf of Patient A1 when requested to do so by London Bridge Hospital. 

94. In addition, the Panel has seen no evidence of remediation or recognition by the Registrant of the impact his actions had on colleagues or patients.

95. The Panel is of the view that the Registrant has demonstrated wide-ranging, deep seated attitudinal failings including dishonesty, a lack of adherence to professional boundaries and failures to follow procedures and policies. In light of these attitudinal concerns, the absence of both remediation and insight, the Panel is of the view that there is a real risk of repetition.

96. The Panel has also considered the critically important public policy issues which include the collective need to maintain public confidence in the profession and in the regulatory process, the protection of service users and the declaring and upholding of proper standards of behaviour. The Panel is of the view that the Registrant’s conduct towards Patient A1 demonstrated a deep seated dishonesty which is profoundly at odds with the standards of propriety expected of a registered podiatrist, bringing the profession into disrepute. The Panel has also found wide ranging failures on the part of the Registrant in two different settings and sustained attitudinal issues.

97. The Panel has concluded that there is a serious risk of an adverse impact on public confidence in the profession of Podiatry and in the regulatory process, if a finding of impairment were not made in these circumstances.

98. The Panel therefore finds that the Registrant’s current fitness to practise is impaired by his misconduct in terms of both the personal component and the wider public component and the allegation is well founded.

Decision on Sanction

99. The Panel has heard submissions from Mr Kewley on behalf of the HCPC on the issue of sanction. The Panel has also considered the advice of the Legal Assessor and had regard to the HCPTS’s Indicative Sanctions Policy.

100. The Panel is aware that the function of fitness to practise panels is not to be punitive, and that the primary function of any sanction is to address public safety from the perspective of the risk the Registrant may pose to those using or needing his services in the future and determine what degree of public protection is required. The Panel must also give appropriate weight to the wider public interest which includes the deterrent effect on other Registrants, the reputation of the profession and public confidence in the regulatory process.

101. The Panel considered the following mitigating factors:- the Registrant has demonstrated limited insight into one of the particulars; the Registrant has had no previous findings made against him; he co-operated to some extent with the internal investigation at the ABUHB.   There has been some history of engagement between the Registrant and the HCPC in the lead up to this hearing. 

102. The Panel also had regard to the following aggravating factors:- the Registrant’s actions involved a range of misconduct including serious shortcomings in his general practice over an extended period in respect of decision making, recordkeeping, adherence to policies, acting outside his scope of practice and disregard for professional boundaries; his actions also involved eight instances of dishonesty for financial gain included considerable sums of money; his actions involved an abuse of trust with a patient, his colleagues in two separate hospitals; he demonstrated a disregard for the professional status of colleagues; his actions impacted on patients, colleagues, the reputation of the profession and on both hospitals; there is no evidence of remorse or remediation, there is an absence of meaningful insight, the Panel has identified a serious risk of repetition.

103. The Panel has considered the sanctions available to it in ascending order of severity. The Panel considered that to take no action or to impose a Caution Order would not be appropriate, given that the lapse was not isolated or minor in nature, the Panel has identified wide ranging serious misconduct and has found dishonesty and identified a serious risk of repetition of his past failings.  In addition the Panel is of the view that neither option would be sufficient to address the wider public interest considerations.

104. The Panel next considered a Conditions of Practice Order. The Panel is of the view that the matters found proved are such that nature and scope of the failings could not be addressed by the imposition of conditions. There are serious, persistent failures on the part of the Registrant, including dishonesty and serious attitudinal issues. The Panel therefore considers that a Conditions of Practice Order would not be an appropriate and proportionate sanction in this case as it would not address the public interest considerations nor would it protect the public.

105. The Panel next considered a Suspension Order.  In terms of the Indicative Sanctions Guidance, a Suspension Order may be appropriate where the allegation is of a serious nature but is unlikely to be repeated. The Panel is of the view that the Registrant’s failings are wide ranging, the dishonesty is serious and it has identified a serious risk of repetition across his range of his failings.  In these circumstances, the Panel is of the view that a Suspension Order would not be appropriate or proportionate.

106. The Panel next considered a Striking Off Order. In terms of the Indicative Sanctions Guidance, striking off is a sanction of last resort for serious, deliberate or reckless acts involving  abuse  of trust  such  as  sexual  abuse,  dishonesty  or persistent failure. The Panel has found that the Registrant’s failings were serious involving an abuse of trust, dishonesty and persistent failure. The Panel is of the view that the nature and scope of the Registrant’s failings and deep seated attitudinal concerns are such that they are incompatible with ongoing registration, in that members of the public would have serious concerns if a registered health professional who is in a position of trust were able to return to practise with repeated failings of this nature and repeated acts of dishonesty. The Panel has therefore concluded that given the nature and gravity of the Registrant’s conduct, a Striking Off Order is the only sanction which would adequately protect the public and address the wider public interest considerations in terms of maintaining public confidence in the profession and declaring and upholding proper standards of conduct.

Order

That the Registrar is directed to strike the name of Mr Gordon Jarvie from the Register on the date this order comes into effect.

Notes

 

Hearing History

History of Hearings for Mr Gordon Jarvie

Date Panel Hearing type Outcomes / Status
14/05/2018 Conduct and Competence Committee Final Hearing Struck off