Mr Paul Perrett
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Additional Documentation provided at the hearing
1. At the start of the hearing, the Panel was provided with additional documents by the parties.
2. The HCPC provided the Panel with three documents which were available to the previous panel. Including;
I. A reflection piece, from the Registrant, dated 17 October 2018.
3. The Panel labelled these documents as bundle ‘B2’.
4. The Registrant also provided the Panel with a one-page document titled ‘For the HCPC’, which amounted to a further reflective piece from the Registrant. The Panel labelled this document as ‘R1’.
Application for hearing to be heard in Private
5. Miss Knight, on behalf of the HCPC, submitted that parts of the hearing should be conducted in private, under Rule 10(1)(a) of the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 submitting that evidence relating to the Registrant’s health and private life would be provided to the Panel and therefore those matters of the case should be considered in private.
6. The Registrant did not object.
7. The Panel accepted the Legal Assessor’s advice which had drawn their attention to the HCPTS Practice Note on ‘Conducting Hearings in Private’.
8. The Panel was satisfied that given the nature of the Registrant’s reflective piece and his earlier submissions to previous panels, regarding his private life and his own health, there was a need for requisite parts of the evidence, pertaining to the Registrant’s health and the Registrant’s private life, to be heard in private, pursuant to Rule 10(1)(a) of the 2003 Rules.
9. The Registrant was engaged by Sandwell Metropolitan Borough Council (‘the Council’) to work as a locum Occupational Therapist from 3 March 2015. Service User A contacted the Council for assistance and an appointment was made for her to be assessed by the Registrant on 6 July 2016. Between 6 July 2016 and 23 August 2016, the Registrant had contact with Service User A on a number of occasions.
10. CLC was an Interim Social Care Team Manager within the Therapy and Sensory Service of the Council at the relevant times and she had operational responsibility for the work of the Registrant. On 24 August 2016, Service User A telephoned the Council to make a complaint regarding the Registrant. In response, CLC visited Service User A on the same day in the company of another officer to make enquiries about the complaint.
11. The essence of the complaint was that the Registrant had overstepped professional boundaries between him and Service User A by attempting to instigate a personal friendship/relationship with Service User A. On 26 August 2016, the Registrant was interviewed by CLC about the complaint. The result was that the Council created a Register of Concern, a copy of which was provided to the agency that had supplied the Registrant, and to the HCPC. Further, the Council ended the Registrant’s engagement as a locum Occupational Therapist.
12. The substantive hearing of the HCPC Allegation took place between 29 and 31 January 2018. The Registrant did not attend the hearing. It was determined that the facts found proved amounted to misconduct, but that they were not sexually motivated, and the facts proved amounted to current impairment.
13. The substantive hearing panel imposed a 9-month suspension order.
14. At the review hearing on the 19 October 2018, the Registrant did not attend and was not represented. The review panel considered whether the Registrant’s fitness to practice remained impaired and concluded that it did for the following reasons:
I. Whilst the Registrant had provided a reflective piece, recorded in the document dated 17 October 2018, and the document demonstrated some positive insight, the review panel found the reflection to be incomplete in two ways. First, by referring to his own personal life, the review panel believed the Registrant failed to accept full responsibility for his actions. Secondly, the review Panel found that the Registrant had failed to acknowledge how his actions had impacted Service User A or the reputation of the profession.
II. The review panel was satisfied that the wider public interest required a finding of impairment of fitness to practise given the risk of repetition and the absence of full acknowledgement on the part of the Registrant.
15. The review panel therefore decided that the appropriate sanction would be upon the expiry of the earlier period of suspension to impose a further 6-month period of suspension.
16. The review panel also made suggestions as to how a future review panel might be assisted. The review panel’s suggestions were as follows:
I. The Registrant to consider attending a future hearing;
II. The Registrant should consider preparing a further reflective piece addressing the reasons why the Panel has concluded that his fitness to practise remained impaired;
III. The Registrant should consider providing evidence that he had undertaken focussed professional study or training on maintaining proper professional boundaries, indicating what steps he has taken, or would take, to prevent such failings occurring again;
IV. The Registrant should consider providing up-to-date information concerning any paid or unpaid employment; and
V. Professional and personal testimonials might also assist the future review panel.
17. The Registrant gave evidence before the Panel and provided a further reflective piece, which he had provided to the HCPC on the 26 April 2019.
18. The Registrant accepted the previous Panel’s findings in respect of his conduct, stating that he suffered with “severe embarrassment and horror” in respect of his actions. When further questioned by the HCPC and the Panel, regarding the Substantive Hearing panel’s findings, the Registrant also stated that at the time of the incident and findings he “hadn’t fully grasped the situation fully” and that it was “completely all my fault”.
19. In response to questions regarding remediation and what steps he had taken since the last hearing, the Registrant informed the Panel that he had taken some steps. He informed the Panel that he had changed his living accommodation; was meeting with an informal supervisor on a fortnightly basis; and was in the last few weeks starting “to feel like myself again”.
20. The Registrant informed the Panel that he had not completed any training courses in person, because he was focussed on “trying to live”. However, he also informed the Panel that he was meeting with an informal supervisor and, that they had discussions regarding professional boundaries, but he did not furnish the Panel with any documentary evidence to support this.
21. Miss Knight submitted, on behalf of the HCPC, that the Registrant’s fitness to practice remained currently impaired and that the current Suspension Order should be extended for a period of not less than 6 months.
22. Miss Knight submitted that the misconduct was serious and concerned a lack of professional boundaries. She submitted that whilst the Registrant had made some progress, by engaging with the hearing and providing a reflective piece, the reflective piece lacked any specificity in respect of the effect of his conduct on the service user and was focussed, primarily, on how the matter had impacted him.
23. Miss Knight submitted that whilst it was recognised that the Registrant is taking steps towards remediation, he was not there yet because of the lack of training undertaken and the lack of insight in the reflective piece.
24. The Registrant opted not to make any final submissions to the Panel.
The Panel’s Approach
25. The Panel took into account the documents furnished to it by the HCPC and the Registrant and had regard to the parties’ evidence and submissions.
26. The Panel considered the relevant Practice Note issued by the HCPTS, ‘Finding that Fitness to Practise is ‘Impaired’’, together with the HCPC’s Standards of Conduct, Performance and Ethics and the HCPC’s Standards of Proficiency Occupational Therapists in England.
27. The Panel accepted the advice of the Legal Assessor.
28. In making its decision, the Panel had regard to both the personal and public elements of impairment.
29. The Panel found the Registrant to be candid and genuine when giving his evidence. The Panel also found the Registrant’s responses to questions were honest.
30. Whilst the Panel recognised that the regulatory process had been a salutary one for the Registrant, and commended the Registrant for engaging and attending the hearing, the Panel was not satisfied that the Registrant had demonstrated full insight into his misconduct.
31. The Panel was not convinced by the Registrant’s explanation and understanding of appropriate professional boundaries and was not satisfied that should he find himself in another difficult or stressful situation again, that he had learned from his mistakes.
32. The Panel was also concerned that the Registrant’s reflective piece, which they noted made some concessions, did not fully address how the Registrant’s conduct had impacted the Service User. However, the Panel was of the view that the Registrant’s oral evidence demonstrated more understanding and acceptance of the impact on the Service User.
33. The Panel was also troubled by Registrant’s lack of insight in respect of his actions and how they have effected the profession and the wider public. Noting that he chose to focus primarily upon how the finding had impacted him.
34. The Panel did recognise that the Registrant had taken some steps towards demonstrating insight, for example having discussions and ‘informal supervision’ with an Occupational Therapist and providing a further reflective piece. Whilst the Panel did not have documentary evidence of the Registrant’s discussions or learning, it accepted the Registrant’s evidence in this regard.
35. However, notwithstanding these steps, the Panel found that there was a lack of insight on the Registrant’s part. Whilst the Registrant had shown developing insight into his conduct, the Panel were concerned that it was very recent, and therefore the Panel was not satisfied that the Registrant had full insight into his conduct.
36. The Panel considered that they could not yet be confident that the Registrant has the required insight and that he has remediated his failings and therefore could not be confident that the behaviour would not be repeated. The Panel is satisfied that in all the circumstances the Registrant may still pose a real and on-going risk to the public and that public confidence in the profession would be undermined should the Registrant be permitted to return to unrestricted practice.
37. Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the personal and public components.
38. The Panel has borne in mind that sanction is a matter for its own independent judgment and that the purpose of a sanction is not to punish the Registrant but to protect the public. Further, that any sanction must be proportionate, so that any order must be the least restrictive order that would protect the public interest, including public protection.
39. The Panel considered the option of a Caution Order however, decided that it would not provide adequate protection for the public.
40. The Panel next considered the option of replacing the existing Suspension Order with a Conditions of Practice Order. However, the Panel decided that conditions would not be appropriate or sufficient because of the Registrant’s failure to demonstrate sufficient insight.
41. The Panel next considered extending the current Suspension Order versus imposing a Striking-off Order. The Panel noted the Registrant’s engagement and the relatively recent steps taken to reflect on his behaviour and also noted the Registrant’s limited, but developing, progress in respect of insight.
42. The Panel considered a Striking-off Order, but decided that this would be disproportionate at this time. Taking into account the reasons and circumstances outlined by the Substantive Hearing panel; namely that the Registrant could go on to make a valuable contribution to the Occupational Therapist profession, the Panel decided that he should be afforded an opportunity to satisfy a future panel that his fitness to practise is no longer impaired.
43. The Panel therefore decided that the appropriate and proportionate Order is to extend the current Suspension Order. The Panel decided that this should be for a period of six months to allow the Registrant time to reflect further and to demonstrate insight into his misconduct.
44. The Panel also considered that a review panel may be assisted by the following:
I. a written reflective piece focussing on the decision of the Panel and the impact of the Registrant’s actions on others and the wider profession;
II. written evidence that the Registrant has kept his skills and knowledge up to date such as any continuing professional development courses undertaken;
III. written evidence of any reading or reflection regarding professional boundaries and what impact not maintaining professional boundaries may have on service users; and
IV. written evidence concerning any formal or informal discussions that he may have had with an informal supervisor.
ORDER: The Registrar is directed to suspend the Registration of Mr Paul Perrett for a further 6 months from the date of the expiry of the current Order.
The Order imposed today will apply from 28 May 2019.
This Order will be reviewed again before its expiry on 28 November 2019.