Mr Peters O Aremu
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As found proven at the Substantive review on 15 June 2018:
Service of notice of review hearing
1. The Notice of this hearing was sent to the Registrant at his address as it appeared in the register on 7 May 2019 by post and email. The Notice contained the date, time and venue of today’s hearing. The Panel accepted the advice of the Legal Assessor, and is satisfied that Notice of today’s hearing has been served in accordance with Rule 6(1) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules).
2. Ms Ktisti made an application for parts of the hearing to be conducted in private, as reference would be made to the Registrant’s health. Having received and accepted the advice from the Legal Assessor, the Panel granted that application in view of the provisions of Rule 10 of the HCPC’s procedural Rules and the principles set out in the HCPTS Practice Note “Conducting Hearings in Private”. The Panel determined that those parts of the hearing that concern the Registrant’s health should be conducted in private.
Proceeding in the absence of the Registrant:
3. The Panel then went on to consider whether to proceed in the absence of the Registrant pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Ms Ktisti on behalf of the HCPC. She submitted that the HCPC has taken all reasonable steps to serve the Notice on the Registrant, as best it could in light of the lack of information from any relative or carer of the Registrant. She further submitted that the Registrant has not personally engaged with the HCPC since May 2017, and that the Registrant was unlikely to attend any adjourned hearing. The Registrant’s last personal contact with the HCPC on 2 May 2017 was by way of an email, which did not address the allegation against him nor provide any representation or evidence on his behalf. In addition, an email dated 6 December 2018 provided to the Panel today indicated that the Registrant’s daughter had informed the HCPC that the Registrant was “still in…” There has been no update on the Registrant’s medical condition since. Ms Ktisti remind
ed the Panel that there was a public interest in this matter being dealt with expeditiously in light of this being a mandatory substantive review, with the existing Suspension Order due to expire on 20 July 2019.
4. In reaching its decision, the Panel accepted the advice of the Legal Assessor and also took into consideration the HCPTS Practice Note entitled “Proceeding in the Absence of a Registrant”. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel weighed its responsibility for public protection and the expeditious disposal of the case with the Registrant’s right to a fair hearing.
5. The Panel noted the Registrant’s apparent health issues, the Panel had no information as to the detail of any health condition from which he is, was, or may be suffering or any treatment he may be receiving or has received, save that the Registrant had received some inpatient treatment for an illness in 2017. The Panel did not consider this to be a satisfactory situation, as the Registrant has been prevented by a Suspension Order from practising his profession for 22 months to date.
6. The Panel learned that the Registrant’s daughter, in the recent past, has been in contact with solicitors acting for the HCPC in matters not relating to the regulatory hearing process, but yet no further contact has been made with her to establish the exact nature of the Registrant’s health condition, including whether he is able, or has an intention, to continue practising as a Biomedical Scientist.
7. The Panel has some further concern in this case about the identity of the person signing for, and therefore receiving, the Notices of Hearing and the HCPC bundles sent to the Registrant’s last known address. Ms Ktisti stated that there has been no “return to sender” status of those missives. She stated that she would ensure that the HCPC administration and legal team would look again at how to obtain more information about the Registrant’s current status and his ability to engage with proceedings.
8. However, the Panel has taken into account that neither the Registrant nor any representative on his behalf has made an application to adjourn today’s hearing. In those circumstances, the Panel determined that it would be unlikely that the Registrant would attend an adjourned hearing. The Panel concluded that the Registrant’s right to a fair hearing can be upheld by both the Panel and Legal Assessor being vigilant to his interests. This contrasts with the risk of adjourning the matter, where it would severely imperil the expiry date of the sanction in this case. If this review is not heard by 20 July 2019, then the Registrant will be free to return to unrestricted practice. In the Panel’s judgement, this places the public’s health, safety and wellbeing at considerable risk of harm, in light of the level of misconduct relating to the Registrant’s un-remediated clinical failings identified by this case. The wider public interest would also be seriously undermined if the date of 20 July 2019 was reached, without a further decision on impairment and sanction.
9. For these reasons, the Panel concluded that, on the grounds of public protection and in the wider public interest, this mandatory review hearing should proceed expeditiously and, hence, the Panel determined to proceed in the Registrant’s absence.
10. The Registrant joined the Croydon NHS Hospital Trust (the Trust) in 2010 and became a full-time member of staff in 2011. He was employed as a Biomedical Scientist in the Cytology Department. He was responsible for Cytology screening for hospital and General Practitioner (GP) services. As the lead Biomedical Scientist, the Registrant was in charge of the day-to-day functioning of the Cytology Department, maintaining Standard Operating Procedures (SOPs) and Policies, conducting audits and ensuring only controlled documents were being used in the laboratory. One of his key roles was preparation for the Clinical Pathology Accreditation assessment.
11. From approximately 2011, the Registrant’s relationship began to break down with some of his colleagues. As a result, there were a number of internal investigations and concerns about the Registrant’s practice throughout his employment period 2011-2013.
12. The issues with the Registrant’s practice did not resolve and these matters were referred to the HCPC. At the substantive hearing on 19 to 22 June 2017, the Panel found that the Registrant did not follow the SOPs in relation to reporting on cases; that he did not discharge his responsibilities to use the IPassport system for quality control; and that he did not perform the Quality Management System audit assignment as scheduled, or act upon reminders to do so. The Panel found that the Registrant’s omissions had put patients at risk of harm and brought the profession of Biomedical Scientist into disrepute and that the facts found proved amounted to misconduct. The Panel determined that the Registrant’s fitness to practise was impaired by reason of his misconduct and imposed a 12-month Suspension Order.
13. The Suspension Order was reviewed on 15 June 2018 and that Panel found that the Registrant’s fitness to practise was still impaired. The first review Panel noted his health issues, which seemed to be severe, but it had limited information on that matter.
14. This is the second review of the Suspension Order imposed at the substantive hearing on 22 June 2017. Ms Ktisti submitted that this case has not moved in relation to the status of the Registrant’s impaired fitness to practise since the substantive hearing or the first review, a period of 22 months. She submitted that there is a potential complication of the Registrant’s poor health, which has arisen since the first the substantive hearing in 2017, but with no further information on this.
15. Ms Ktisti therefore submitted that the Registrant’s fitness to practise continues to be impaired, as there has been no engagement by the Registrant himself, any next of kin and/or any representative and no apparent opportunity, potentially due to ill health, for the Registrant to demonstrate his insight by evidence of reflection and remediation.
16. In reaching its decisions, this Panel accepted the Legal Assessor’s advice. The Panel carefully considered the HCPTS Practice Note on “Finding that Fitness to Practise is Impaired” and all the evidence before it. The Panel took into account that it must first decide if a finding of current impairment is necessary to protect the public from any risk of harm, maintain public confidence in the profession, and/or to declare and uphold the proper standards of conduct or behaviour. This is a matter for the Panel’s independent judgement, after assessing the evidence before it at this review. The Panel noted the decision of the previous Panels at the substantive hearing and at the first review that the Registrant’s fitness to practise remained impaired on the grounds of public protection and being otherwise in the public interest. It gave respect to those decisions, but approached its decisions today independently.
17. There had been no meaningful engagement from the Registrant throughout his regulatory proceedings with the HCPC, including prior to, and during, the substantive hearing in June 2017 and at, and after, the first review on 15 June 2018. There has been no new information or evidence since that which was given at the substantive hearing, save for the historical information from Dr S regarding the Registrant’s health, which has not been updated by the Registrant. In addition, the Registrant has not provided the information suggested by the two previous Panels and that situation has not changed today.
18. In the Panel’s judgement, the Registrant’s misconduct involved a wide range of failings in his clinical practice over a significant period of time. The substantive Panel found that “the main cause of the Registrant’s misconduct involves attitudinal issues.” There has been no evidence of the Registrant addressing this since that hearing on 22 June 2017, including on and after the first review on 15 June 2018. Therefore, the Panel has concluded that, as there is no evidence that the concerns underpinning the Registrant’s impaired fitness to practise have been overcome by reflection, remorse and remediation, the risk of repetition remains high and the public’s health, safety and well-being remain at risk of harm if the Registrant was to be declared fit to practise.
19. Balanced against his own ill health and possible inability to remediate by reason of this, the Panel concluded that, without the Registrant’s engagement in this process to date, be that by instructing others to speak for him or by written representation, the need to protect the public and the upholding of the wider public interest (public confidence in the profession and its reputation) outweigh the Registrant’s presumed interest of being declared fit to practise.
20. For these reasons, it is the Panel’s decision that the Registrant’s fitness to practise remains currently impaired
21. The Panel carefully considered matters, including the HCPC “Indicative Sanctions Policy”. It has borne in mind that any sanction must be proportionate and fair and that the primary purpose of a 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.
22. Having considered these issues, the Panel has determined that the misconduct issues in this case are too serious to be met with either no further action or a Caution Order. A Caution Order requires demonstrable insight and relevant and reflective remediation, without which, by its nature, this sanction would allow the Registrant to return to unrestricted practice. The Panel considered that to be a risk to the health, safety and well-being of the public.
23. The Panel next considered imposing a Conditions of Practice Order but determined that it was not possible to devise appropriate, workable and realistic Conditions of Practice that would protect the public, in light of the Registrant’s continuing lack of engagement and there being no new information about his health condition before this Panel.
24. The Panel noted the recommendations given to the Registrant at the first review and noted that he has not engaged in any respect as to those matters. In this Panel’s judgement, this indicates a continuing lack of insight, with the commensurate risk of repetition and danger to the health, safety and well-being of the public, as well as continuing to undermine the confidence that the public is entitled to expect in the profession and its reputation.
25. For these reasons, the Panel has therefore determined that the only fair, appropriate and proportionate sanction is to extend the current Suspension Order by a period of 6 months. In the Panel’s judgement, there are potentially unknown health circumstances that make it fair and proportionate to arrive at this conclusion, rather than going to the highest sanction of Strike Off.
26. To that end, the Panel considered that a period of 6 months is appropriate to allow the Registrant a realistic period of time to engage with these regulatory proceedings and to inform the HCPC and a future review Panel, by himself or through others, of his health status and/or his intention in the future as to the status of his registration. It also allows the HCPC sufficient time to establish if it can obtain more information about the Registrant’s registration aspirations for the future, whether or not that includes his health condition.
27. For the reasons, set out, the Panel concluded that this Order protects the public, is in the wider public interest and is also in the Registrant’s own interests, as the medical information before the Panel to date remains scant.
28. The Panel considered the fairness, efficacy and appropriateness of a Striking Off Order at this time and determined that the health element of this case requires the need to establish, for a further shorter period of time, if possible, the latest situation about his health. Therefore, the Panel considered that it would be disproportionate to impose a Striking Off Order at this time.
29. A future review panel may be assisted by the following:
• The attendance of the Registrant at the hearing or by other means, if he is well enough, and/or by a representative and/or by a written submission;
• An updated medical report/GP correspondence, whether or not the Registrant attends the next hearing, on his current state of health;
• An indication as to his future plans and whether he wishes to remain in the profession;
• A reflective piece by the Registrant, concentrating on:
i) what led to his misconduct; and,
ii) how his actions impacted, or could have impacted, on patients and his colleagues;
• Information about any employment, paid or unpaid, since these events;
• Evidence of the Registrant keeping his practice and skills up-to-date either by attending CPD courses (which may include online courses), or being employed in any other capacity in allied and relevant roles;
• Up-to-date testimonials from colleagues and/or persons who are aware of these proceedings in relation to the Registrant’s communication skills, work practices, work standards, and adherence to work protocols.
Order: The Registrar is directed to suspend the registration of Mr Peters O Aremu for a further period of 6 months on the expiry of the existing order.
This Order will be reviewed again on or before its expiry.