Mrs Daniela Ionescu

Profession: Hearing aid dispenser

Registration Number: HAD02985

Interim Order: Imposed on 14 Mar 2017

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 21/01/2019 End: 12:30 21/01/2019

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

As found proven at the final hearing on 29 January 2018:

 

While registered as a Hearing Aid Dispenser and employed at Scrivens Opticians and Hearing Care between 19 December 2016 and 1 February 2017:

  1. You did not demonstrate the core competencies required to work safely and effectively as an autonomous practitioner, namely that you were unable to demonstrate that you could competently complete and/or complete parts of the following independently:

 

  1. Pure Tone audiometry
  2.  Aural impression taking
  3. Hearing aid programming and/or fitting
  4. conducting a clinical case history
  5. explaining the results of assessments to patients

    2. The matters set out in paragraph 1 constitute a lack of competence.

 

    3. By reason of your lack of competence, your fitness to practise is impaired.

Finding

Background

  1. The Registrant was employed as a registered  Hearing Aid Dispenser with Scrivens Opticians and Hearing Care from 19 December 2016 until 1 February 2017.
  2. During the course of her employment, concerns were raised in relation to her  ability to demonstrate the core competencies of a Hearing Aid Dispenser.
  3. Scrivens Opticians referred the Registrant to the HCPC on 17 February 2017.
  4. At a hearing on 29-30 January 2018, the Registrant did not attend and was not represented. A panel found that the failings identified in her professional practice were wide-ranging, relating to fundamental and basic skills as a Registered Hearing Aid Dispenser, and that they constituted lack of competence. The panel identified the following mitigating and aggravating features of the case:

Mitigating factors

  • The Panel received no evidence to suggest that there were attitudinal failings or indifference to outcome;
  • The Registrant had demonstrated very limited insight in recognising the need for more training;
  • The Panel received no evidence that the Registrant had previously been brought before her regulator in respect of any other matters.

Aggravating factors

  • The basic and fundamental nature of the deficiencies in respect of a wide range of core competencies;
  • The persistence of the failings, even after assistance, training and advice had been provided;
  • Errors occurring despite direct and close supervision;
  • Patients were put at unwarranted risk of harm.

5.     The panel had received no evidence of any steps that the Registrant may have taken   since the time of the allegation to remediate her failings. The panel found that the Registrant’s fitness to practise was impaired by reason of her lack of competence, both on the grounds of public protection and in the public interest.

  1. That panel made a number of suggestions to the Registrant in relation to the sort of information that might be helpful to a future reviewing panel:

“The Panel considered that a reviewing panel would be likely to be assisted by:
• The Registrant’s attendance;
• A reflective piece from the Registrant with regard to the failings found;
• Evidence from the Registrant as to any steps she may have taken in order to remediate her failings, including her lack of proficiency in the English language.”
 

  1. This is the first review of the Suspension Order imposed on 30 January 2018.

Evidence

  1. The Registrant attended the hearing and gave oral evidence to the Panel. She told the Panel that she qualified in 2007 and practised for 3 and a half years with no issues arising. She then took a 6-year career break; she acknowledged that she did not undertake CPD training during that time. The Registrant stated that she returned to work as a registered Hearing Aid Dispenser to Scrivens Opticians and, although she was open with her manager about this being her first role since her career break, she was not afforded the time to get to grips with new systems and processes. The Registrant told the Panel that she made mistakes because she felt under pressure.

 

  1. The Registrant told the Panel that she would like to return to practice and provided information around the efforts she made prior to the final hearing in January 2018 to continue working as a registered Hearing Aid Dispenser under the terms of her Interim Conditions of Practice Order. She stated that, following initial interest from prospective employers, they did not pursue any employment with her once they became aware of the Interim Conditions of Practice Order.

 

  1. The Registrant told the Panel in private session of the impact of the Suspension Order on her well-being and of the strain that this had placed upon her. She said that, until the summer of 2018, she had almost given up thinking that she might be able to return to practise. The Registrant said that she tried to find relevant training courses but that these were expensive. She told the Panel that she is working currently as a receptionist, with no connection to her field of professional practice.

 

  1. In terms of the failings identified by the original panel, the Registrant said that she did recognise that there were failings on her part but that she did not agree with all of them. She stated her intention to secure training, to reach and maintain the required standards to do her job in the right way and to remediate her failings. She stated, “I have to have the chance to do that” and that she would consider doing two days of training each week, even without pay.

 

  1. In terms of her English language proficiency, the Registrant considered that there was now a significant difference in her level of English and that she “did not speak much English before the Scrivens job.” In answer to a question from the Panel in relation to further training, the Registrant said that the English language courses she had researched were of a basic level and that the higher level courses were too expensive. An English conversation class that she had considered changed its location and she was not able to attend due to competing work commitments.

 

  1. The Registrant accepted that she had not acted in accordance with the suggestions made of her by the original panel in January 2018. She had not provided a written statement as a piece of reflection and had not provided any evidence in relation to any training she had undertaken.

 

  1. In answer to a question from the Panel, the Registrant stated that the opportunity to work as an Assistant or Technician to a Hearing Care Professional, a role that does not require registration with the HCPC, “would be like gold for me.”

Submissions

  1. Mr Harrison submitted that this case has not moved forward since the final hearing in January 2018. There has been little engagement from the Registrant, the only engagement consisting of two emails in January and May 2018, in which the Registrant asked questions of her Case Manager. Mr Harrison submitted that, although it is encouraging that the Registrant has attended today, she has not yet demonstrated full insight into her failings. Further, Mr Harrison submitted that there is no evidence of the Registrant’s compliance with suggestions made to her by the initial panel, no evidence of any remediation and, as such, there is a risk of repetition of the failings identified at the substantive hearing.

 

  1. Mr Harrison submitted that the Registrant’s fitness to practise continues to be impaired in relation to both the personal and public components and that a further, perhaps shorter, period of suspension would be appropriate in this case. He submitted that, although the Registrant has stated her willingness to work with conditions imposed on her professional practice, a Conditions of Practice Order would not be workable or practicable in this case in the absence of an identified employer.

 

  1. The Registrant did not agree that her fitness to practise is currently impaired. In relation to sanction, she reiterated the difficulties that she would face if her practice continued to be suspended, in that she would not be able to demonstrate remediation and that she would continue in the challenging “cycle” that she has already experienced. The Registrant stated that she would like the opportunity to return to practice and have a chance to receive training and to practise her profession.

Decision

  1. This Panel considered the advice of the Legal Assessor and had regard to the HCPTS Practice Note entitled “Review of Article 30 Sanction Orders”. It is carrying out a comprehensive reconsideration of the Suspension Order in light of the current circumstances. The Legal Assessor advised that, in practical terms, there was a persuasive burden on the Registrant to show that her fitness to practise is no longer impaired and that all the shortcomings which led to the original finding of impairment have now been overcome.

 

  1. The Panel bore in mind that it must first decide if a finding of current impairment is necessary to protect the public from any risk of harm (assessing the extent of that current or future risk), maintain public confidence in the profession, or to declare and uphold the proper standards of conduct or behaviour. This is a matter for the Panel’s independent judgment and is essentially a risk assessment in light of all the information before the Panel today.
  1. In the Panel’s view, the Registrant’s lack of competence was serious and involved breaches of her professional standards. There has been no evidence of change since the final hearing in January 2018 nor any evidence that the concerns underpinning the Registrant’s impaired fitness to practise have been overcome. The Panel considered the wide-ranging failings identified by the previous Panel and the evidence at the original hearing that the Registrant was unable to follow instructions effectively. It also bore in mind the Registrant’s own evidence today that, neither during her six-year career break nor during her period of suspension, had she undertaken CPD training. The Panel was also concerned that, in evidence today, the Registrant stated that she did not accept all of the failings identified by the panel at the substantive hearing.
  2. The Panel has determined that, in light of all the evidence before it, the Registrant’s fitness to practise continues to be impaired. In the absence of any persuasive evidence of remediation, the Panel remained concerned that there was the risk of repetition of the failings identified. The Panel therefore concluded that the Registrant remained liable to put patients at unwarranted risk of harm in the future and that the Registrant remained impaired on public protection grounds.
  3. The Panel also considered the wider public interest in the case. The Registrant has not worked as a Hearing Aid Dispenser since her dismissal in February 2017 and, in the absence of remediation, members of the public would be concerned if such a Registrant were able to practise without restriction. In those circumstances, the Panel was of the view that the need to uphold confidence in the profession and the regulator would be undermined if a finding of impairment were not made. The Registrant is not safe to practise unrestricted given her current impairment and the public interest requires that she should not be in a position to practise unrestricted.
  4. The Panel next considered the issue of sanction, and had in mind the HCPC’s Indicative Sanctions Policy. The Panel was aware that sanction is a matter for its own professional judgement. It has borne in mind that any sanction must be proportionate and that the primary purpose of sanction is protection of the public. Any sanction it imposes must protect the public but must be the least restrictive sanction that achieves that aim. It accepted the advice of the Legal Assessor that it does not, at this stage, have the power to make a striking-off order in a lack of competence case such as this, as the Registrant has not been continuously subject to a conditions of practice or suspension order for two years or more.
  5. The Panel first considered a Caution Order and decided that this would not be appropriate because it would not place any actual restriction on the Registrant’s practice which would address the public protection concerns. Further, the Panel was of the view that the lack of competence found proved was too serious and that the public interest would not be served by such a sanction.
  6. The Panel next considered whether a Conditions of Practice Order would be appropriate, to enable the Registrant to proactively seek employment as a Hearing Aid Dispenser and demonstrate to a future panel that she is a safe practitioner. Despite the Registrant’s expressed commitment to return to work as a Hearing Aid Dispenser, the Panel considered that there has been a real lack of progress by the Registrant for the last year while she has been subject to a suspension order. The imposition of a conditions of practice order requires a registrant to engage fully with the fitness to practise process to protect the public and improve her professional practice, with a view to returning her to safe and unrestricted practice. In light of this Registrant’s failure to engage at all with the two key suggestions made to her by the previous panel, the length of time in which she has had to engage, and the nature and seriousness of the core failings identified, the Panel determined that the imposition of a Conditions of Practice Order would serve no useful purpose, either in relation to public protection or the public interest. 
  7. The Panel therefore determined that the appropriate and proportionate sanction is to extend the current Suspension Order by a period of 12 months. The panel was of the view that a further suspension order would provide sufficient public protection while leaving open the possibility of future training and remediation taking place. It was of the view that 12 months would allow the Registrant ample opportunity to reflect fully and to demonstrate her attempts to remediate her professional practice.
  8. The Panel considered that a future reviewing panel would be assisted by:
  • A diary of continuous learning and reading undertaken by the Registrant in relation to her professional practice, including but not limited to evidence of any continuing professional training or refresher courses;
  • Documentary evidence of any continuing professional training or refresher courses undertaken by the Registrant;
  • Evidence that she has read the: British Academy of Audiology Guidelines for Audiologists; British Society of Audiology Recommended Procedure Ear Examination; British Society of Audiology Recommended Procedure Pure – tone air-conduction and bone-conduction threshold audiometry with and without masking; British Society of Audiology Recommended Procedure Determination of uncomfortable loudness levels; British Society of Audiology Recommended Procedure Taking an aural impression;
  • A written reflective piece addressing each of the core competencies that the Registrant was found to have failed in in relation to allegations 1(a)-(e) and by reference to the Standards of Proficiency expected of a registered Hearing Aid Dispenser.
  • References and testimonials from the Registrant’s employer, in relation to any paid or voluntary role;
  • Evidence that the Registrant has undertaken a course which demonstrates her effective verbal communication in English;
  • Evidence that the Registrant has experience in a role as an assistant or technician to a Hearing Care or Audiology professional (where registration is not required) in the NHS or private sector.

Order

ORDER

The Registrar is directed to suspend the registration of Mrs Daniela Ionescu for a further period of 12 months on the expiry of the existing order.

Notes

A review was held in London on 21 January 2019.  The reviewing Panel imposed a Suspension Order for a period of 12 months.

Hearing History

History of Hearings for Mrs Daniela Ionescu

Date Panel Hearing type Outcomes / Status
21/01/2019 Conduct and Competence Committee Review Hearing Suspended
29/01/2018 Conduct and Competence Committee Final Hearing Suspended