Miss Susan Glaiser
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Whilst registered with the HCPC as an Operating Department Practitioner:
- On 20 December 2017 you took Ketamine.
- On 23 December 2016 you took Ketamine whilst at work.
- The matters set out at paragraphs 1-2 amount to misconduct.
- By reason of your misconduct, your fitness to practise is impaired.
1. The Panel determined that the entire hearing should take place in private, apart from the announcement of any sanction that might be imposed, on the basis that the case related to the Registrant’s health and her domestic circumstances at the time of the allegation.
2. The Registrant is registered with the HCPC as an Operating Department Practitioner (ODP). She was employed in that capacity by the Pennine Acute Hospitals Trust (the Trust).
3. In the course of her employment as an ODP with the Trust, the Registrant was on night shift duty at Royal Oldham Hospital beginning on 23 December 2016. The Registrant’s colleague, TS, noticed her to be behaving strangely and that there was white powder around her nose. It is alleged that the Registrant admitted to a colleague that the white powder around her nose was ketamine. She was sent home before completing her shift. On 5 January 2017 the Registrant resigned from her employment with the Trust, despite being encouraged to stay by her employer.
4. On 20 December 2017 an ambulance crew attended a 999 call in relation to the Registrant being seen to act strangely in a Debenhams department store. The Registrant admitted to the ambulance crew that she had taken ketamine. She refused to be admitted to hospital. She told the ambulance crew that she worked as an ODP.
5. On 22 December 2017 a referral was made by North West Ambulance (NWAS) to the HCPC in relation to the incident on 20 December 2017. The investigator at NWAS contacted SA at Royal Oldham Hospital as a result of which the incident on 23 December 2016 came to light. This was then notified by the NWAS investigator to the HCPC.
6. The referral by NWAS to the HCPC resulted in these proceedings.
The evidence on behalf of the HCPC in support of the allegation
7. The HCPC presented a bundle of documents which included the statements and exhibits of three of the Registrant’s former colleagues who had worked with her on the night shift at Royal Oldham Hospital on 23 December 2016 and the statement and exhibits of JK, an Emergency Medical Technician, who, as an ambulance crew member, had attended the emergency call in relation to the Registrant on 20 December 2017.
The Registrant’s evidence
8. The Registrant provided the Panel with a bundle of documents, including a 74 page statement in response to the particulars of allegation, her reflection on the events and her present circumstances.
The Panel’s assessment of the witnesses
9. The Panel called SR, AB and TS in relation to particular 2 of the allegation relating to the incident at the Royal Oldham Hospital on 23 December 2016 and JT, an Emergency Medical Technician, in relation to particular 1.
10. The Panel found that each of these witnesses was truthful and gave evidence to the best of their recollection. Their evidence was consistent with their written statements.
11. The Registrant also gave oral evidence and the Panel found her to be an honest and credible witness. Her evidence was consistent with her written statement.
12. The Panel considered that the Registrant’s questioning of the HCPC witnesses was fair, pertinent and not in any respect confrontational or accusatory.
Burden and standard of proof
13. The Panel was mindful that the burden of proof is on the HCPC and that the civil standard of proof applies, so the particulars of the allegation must be proved on the balance of probabilities.
Findings of fact
14. At the outset of the hearing the Registrant admitted particular 1.
15. The Registrant’s admission was consistent with, and supported by, the evidence of JK. He stated that on 20 December 2017 he was a member of an ambulance crew who responded to a call concerning an incident at Debenhams in The Rock Bury shopping centre, where a woman had allegedly collapsed.
16. On arrival at Debenhams, JK was introduced to the Registrant, as the person to whom the emergency call had related, in the first aid room. He noticed that the Registrant had white powder around her nose. On being asked what it was, she stated that it was ketamine. She said that she had taken approximately 1 gram and that she had snorted it. He noted she also said that she had been taking ketamine once or twice a week for the past two years to relieve stress. He stated that she presented as fully alert and orientated but appeared anxious. JK and his Paramedic colleague carried out a full set of clinical observations on the Registrant, all of which were within normal parameters. JK recorded the incident on a Patient Referral Form, which the Registrant signed.
17. In cross-examining JK, the Registrant did not challenge his evidence in any significant respect.
18. When giving her evidence to the Panel, the Registrant confirmed that she had taken ketamine on 20 December 2017 and that she had admitted as much to JK.
19. On the basis of JK’s evidence, and the Registrant’s admission, as confirmed in her evidence, the Panel found particular 1 proved.
20. With regard to particular 2, the witnesses SR, AB and TS gave evidence that they were on night duty with the Registrant at the Royal Oldham Hospital on 23 December 2016.
21. TS and AB were in the coffee room with the Registrant at about 11:00 pm. Following the break, the Registrant could not be found. TS went to look for her and found her in the changing room. The Registrant appeared to TS to be unwell. She appeared vacant and “out of it”. She had a white substance under nose. She said that she felt sick and went into the toilet cubicle. TS was concerned that she might be under the influence of some substance. By this time, AB had arrived on the scene. TS asked AB to stay with the Registrant so that TS could go and consult SR, who was in charge of the shift that evening.
22. AB’s evidence was that, after TS had left, she talked to the Registrant through the door of the toilet. She asked the Registrant whether she had taken anything (i.e. any drug), which the Registrant denied. She continued talking to the Registrant when she came out of the toilet. She said that the Registrant seemed normal to her.
23. Upon receiving information from TS, SR also went to see the Registrant in the changing room. She noticed that the Registrant’s nose and top lip appeared red and quite burnt. She observed that the Registrant seemed unable to focus or make eye contact. She asked the Registrant whether she had taken anything but the Registrant denied having done so. She stated the Registrant was able to walk without difficulty but hung her head and appeared submissive.
24. The Registrant’s evidence in relation to particular 2 was consistent with her written statement. Prior to the coffee break at about 11:00 pm her duties had involved heavy lifting for approximately two hours. After having some food during the coffee break, she felt sick and went to the changing room where she vomited.
25. She did not dispute that she might have had some white substance around her mouth when seen by TS, but explained that this could have been the residue from vomiting, or paper which she had used to clean herself up or prescribed steroid cream for a skin condition.
26. She was adamant that she had not taken ketamine that evening.
27. The Panel noted that there was no forensic evidence to the effect that the Registrant had ingested ketamine on 23 December 2016. Further, contrary to the HCPC’s opening statement, none of the witnesses gave evidence to the effect that the Registrant admitted taking ketamine to them. Indeed, each witness credited one of their colleagues with mentioning ketamine.
28. The Panel also noted that the Registrant’s behaviour on 23 December 2016, as described by TS and SR, was markedly different from her behaviour on 20 December 2017 as described by JK when, by her own admission, she had recently snorted ketamine.
29. SR, when asked by the Panel whether on the balance of probabilities she considered the Registrant’s behaviour on 23 December 2016 to be symptomatic of someone who had taken ketamine, she said ‘no’.
30. Mr Bridges submitted that the Registrant’s admission to JK on 20 December 2017 that she had been in the habit of taking ketamine once or twice a week for the past two years enabled the Panel to infer that she had taken ketamine on 23 December 2016 and that her appearance and behaviour, as witnessed by TS and SR, was, on the balance of probabilities, attributable to her having taken ketamine that evening.
31. The Panel was unable to accept that submission. On the contrary, the Panel found the Registrant’s explanation of her appearance and demeanour on 23 December 2016, as described by the HCPC witnesses, to be plausible.
32. Accordingly, the Panel found particular 2 not proved.
33. The Panel went on to consider whether the facts found proved in relation to particular 1 amounted to misconduct, as alleged in particular 3. The Panel accepted the advice of the Legal Assessor.
34. The Panel was mindful that this is a matter for the Panel’s professional judgement, there being no burden or standard of proof.
35. The Panel took into account that misconduct was defined in Roylance v General Medical Council (no 2)  1 AC 311 as:
“a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances”.
36. It is clear from case law that misconduct must be sufficiently serious that it can be properly described as misconduct going to fitness to practice.
37. The Panel found the Registrant to be in breach of paragraph 9.1 of the HCPC’s Standards of conduct, performance and ethics (2016), which states:
“You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.”
38. Whilst there was no evidence that the Registrant’s use of ketamine had affected her performance as an ODP, the Panel concluded that particular 1 of the allegation, which involved taking an illegal substance, constituted misconduct.
Decision on Impairment:
39. The Registrant gave further evidence at this stage in which she referred to the documents in her bundle. In summary:
• She had undergone testing for substance abuse and the results of those tests, as seen by the Panel, demonstrated that she was no longer taking ketamine and had not done so for an extended period.
• She provided a number of supportive references from senior professional colleagues, who, whilst aware of the current proceedings, spoke highly of her character and professionalism as an ODP.
• She referred to testimonials from members of her family who confirmed that her private life was now stable and no longer a cause for concern.
40. The Panel carefully considered the submissions of Mr Bridges on behalf of the HCPC and those of the Registrant.
41. The Panel accepted the advice of the Legal Assessor and considered the HCPTS Practice Note on Finding that Fitness to Practise is Impaired.
42. In determining whether the Registrant’s fitness to practise is impaired, the Panel took into account both the “personal” and “public” components of impairment. The “personal” component relates to the Registrant’s own practice as an ODP, including any evidence of insight and remorse and efforts towards remediation. The “public” component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.
43. With regard to the “personal” component of impairment, the Panel accepted the Registrant’s evidence She realised that her use of ketamine had been misguided and wrong and had serious implications for her status and reputation as a member of her profession.
44. The Panel accepted the evidence of the Registrant that the stresses in her private life that had led to her use of ketamine were no longer present. The Panel considered that the Registrant had acquired insight into the concerns about her behaviour, which had resulted in the referral to the HCPC. The Panel found that the Registrant had taken effective steps to address the issues. She had provided medical evidence, including hair sample test results, showing that she has abstained from the use of ketamine.
45. The Registrant had also provided the Panel with a number of very positive testimonials from senior work colleagues concerning her practice as an ODP since December 2017 and letters from former employers who expressed regret at her decision to leave their employment.
46. In all the circumstances, the Panel was satisfied that the Registrant no longer uses ketamine and there is little risk that she will revert to it in future.
47. The Panel was satisfied that the Registrant’s fitness to practise is not currently impaired with regard to the “personal” component.
48. The Panel went on to consider whether the Registrant’s fitness to practise is currently impaired on public interest grounds. The use of an illegal drug by a health care professional was a serious breach of the standards of personal conduct to be expected of her. Whilst the Panel considered that members of the public, with full knowledge of the facts, would have sympathy for the Registrant, they would nevertheless consider her use of an illegal substance to be wrong and unacceptable as a member of her profession. A message needed to be sent out to members of the profession and the public that such behaviour could not be tolerated and could adversely affect the right to practise. In the Panel’s judgement, public confidence in the profession and in the Regulator would be undermined if there were no finding of impairment.
Decision on Sanction
49. The Panel took into account the submissions of Mr Bridges and the submissions of the Registrant.
50. The Panel took into account the HCPC’s Sanctions Policy and accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of a sanction is not to punish the Registrant but to protect the public and the wider public interest in upholding proper standards of conduct on the part of registrants and maintaining public confidence in the profession and the Regulator. The Panel applied the principle of proportionality, balancing the interests of the Registrant with those of the public, and considered the available sanctions in ascending order.
51. The Panel took into account the following mitigating factors:
• She had admitted particular 1 of the allegation prior to, and at the outset of, the hearing and that was the only particular found proved.
• She had fully engaged with the HCPC. This included her compliance with interim conditions of practice and, on her own initiative, undergoing additional hair strand testing to show that she had remained free from substance abuse.
• She had provided excellent references and testimonials from current and former senior work colleagues and employers which attested to her good character and work record both before and since the relevant incident.
• She had expressed remorse and demonstrated insight into the causes of her use of ketamine, the negative implications for her both personally and professionally and the potential damage to the reputation of her profession.
• She had taken appropriate and effective remedial steps to prevent any recurrence of her misconduct.
52. There were no aggravating factors for the Panel to take into account.
53. The Registrant’s misconduct in taking an illegal drug was too serious for the Panel to take no further action.
54. The Panel considered that a Caution Order was the appropriate sanction in circumstances where the Registrant’s misconduct had not adversely affected her practice as an ODP or constituted a risk to the safety of patients or the public. The purpose of a sanction in this case was to act as a deterrent against the use by members of the profession of illegal drugs and to send a message to the profession and the public that such conduct was unacceptable and would not be tolerated. A Caution Order would also serve the public interest in permitting a valued member of the profession to continue in practice. Given that the Panel considered the Registrant’s misconduct to be at the lower end of the scale, the Caution Order would be for a period of two years.
55. The Panel would further observe that there is also a strong public interest in supporting registrants in remaining or returning to safe practice particularly where they have experienced difficulties as a consequence of domestic abuse.
56. The Panel had considered whether a Conditions of Practice Order would be appropriate but was satisfied that, as the Registrant had already been subject to an Interim Conditions of Practice Order with which she had complied, there were no issues relating to her practice that needed to be addressed by the further imposition of conditions.
57. For completeness, the Panel considered that a Suspension Order would be altogether disproportionate in all the circumstances of the case.
That the Registrar is directed to annotate the register entry of Miss Susan Glaiser with a caution which is to remain on the register for a period of two years from the date this order comes into effect.
A hearing of the conduct and competence committee took place at the Pullman London St Pancras Hotel from Tuesday 16 July 2019 to Friday 19 July at 10:00am on day 1 and 09.30 am between days 2-4. A Caution order was imposed.
History of Hearings for Miss Susan Glaiser
|Date||Panel||Hearing type||Outcomes / Status|
|16/07/2019||Conduct and Competence Committee||Final Hearing||Caution|
|31/07/2018||Investigating committee||Interim Order Review||Interim Conditions of Practice|
|02/02/2018||Investigating committee||Interim Order Application||Interim Conditions of Practice|