Dr Ildiko Ridley

Profession: Practitioner psychologist

Registration Number: PYL26094

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 19/11/2019 End: 13:00 19/11/2019

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

Panel: Conduct and Competence Committee
Outcome: No further action

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Allegation

The following allegation was considered by a panel of the Conduct and Competence Committee at the substantive hearing on 20-23 November 2018.

Whilst registered as a Practitioner Psychologist with the Health and Care Professions Council (HCPC) and employed by Lancashire Teaching Hospitals NHS Foundation Trust, between December 2014 and August 2016, you:


1) Breached professional boundaries, in that you:


a) Continued to work with Service User 1 despite a recognition that, and/or, in the knowledge that, you were developing romantic feelings towards him;

b) Did not declare any potential conflict and/or raise in supervision and/or seek management advice regarding Service User 1;

c) Engaged in a sexual relationship with Service User 1, during and/or shortly after, your treatment of him had ceased.


2) Did not maintain accurate and/or contemporaneous records of your work with Service User 1, including on, or around:


 a) 30 October 2015;
 
 b) 4 December 2015;
 
 c) 15 January 2016; and/or

 d) 4 March 2016.


3) The matters set out in paragraphs 1 and 2 constitute misconduct.


4) By reason of your misconduct, your fitness to practise is impaired.

The substantive hearing panel found particulars 1c) (in part) and 2 (in part) proved, that they amounted to misconduct, and that the Registrant’s fitness to practise was currently impaired. The substantive hearing panel imposed a Conditions of Practice Order for a period of 12 months.

 

Finding

Preliminary Matters:

Application for part of the hearing to be in private

1. At the outset of the hearing, Mr Jordon made an application for part of the hearing to be in private because the Registrant would be referring to health matters. Ms Ktisti supported the application.

2. The Panel accepted the advice of the Legal Assessor and agreed that where matters of health were raised they would be dealt with in private in order to protect the private life of the Registrant.


Background:

3. The Registrant qualified as a Clinical Psychologist in 2010. She commenced her employment with the Lancashire Teaching Hospitals NHS Foundation Trust (“the Trust”) on 1 November 2010. The Registrant was employed by the Trust as a Band 8a Principal Clinical Psychologist (Physical Health), working in Oncology, Plastics, and Surgery at the time the concerns came to light in 2015/2016.

4. In August 2016, the Registrant took up a more senior role as a Band 8b Principal Clinical Psychologist (Medicine). The Registrant was responsible for service users with complex psychological presentations who were struggling to cope with the demands of diagnosis, treatment, and end of life issues. She saw inpatients and outpatients in a general hospital setting and supported primary carers and close family.

5. The partner of Service User 1 had her first session with the Registrant in January 2013. Her last session with the Registrant was on 5 November 2014, before she died in December 2014. Service User 1’s partner brought Service User 1 with her to her final appointment on 5 November 2014. Following his partner’s death, Service User 1 requested bereavement support from the Registrant. From 30 January 2015, the Registrant saw Service User 1 on a one-to-one basis for bereavement support.

6. In late 2015, the Registrant spoke to her colleague, Witness 1, Principal Clinical Psychologist, about a patient she was seeing, Service User 1. She told Witness 1 that she was developing feelings for Service User 1. Witness 1 advised the Registrant to discharge Service User 1 from her service.

7. In early 2016, the Registrant told her colleagues, Witness 1 and Witness 2, Principal Psychotherapist, that she was having an extra-marital affair. In June 2016, Witness 1 became suspicious that the person the Registrant was seeing was Service User 1.

8. Witness 1’s suspicions led her to check the patient records of Service User 1 and she found that a number of records were missing when she cross-referenced them with the Registrant’s diary.

9. Witness 1 and Witness 2 discussed their concerns with each other and raised them with Witness 3, Head of Psychology, on 18 August 2016. Witness 3 appointed Witness 4, Professional Lead Occupational Therapy, to investigate the concerns in October 2016.

10. On 27 October 2016, at a meeting conducted by Witness 4 (the Investigating Officer appointed by the Trust), the Registrant admitted that whilst Service User 1 was receiving therapy from her, she developed “feelings” for him. She said that she had discussed it with two colleagues in supervision. She further said that she had “discharged” Service User 1 in March 2016. She said that after that date, the relationship between herself and Service User 1 became a sexual one. With regard to the records that are identified in particular 2 of the Allegation, she accepted that the formal records were written up in August 2016 and were not contemporaneous with the sessions to which they related. She said that the records had been written up from handwritten notes which were contemporaneous with the relevant sessions. Subsequently the Registrant went on sick leave. She was then dismissed by the Trust.

11. The Registrant submitted to the substantive hearing panel a written statement dated 20 November 2018. In that statement the Registrant stated “While working with Service User 1, I became aware of a degree of attraction towards him; we had developed an easy rapport and I found him physically attractive. When I realised this I discussed the matter with my supervisor [Witness 2] and also took it to peer supervision with [Witness 1]. However I gave no indication to him of my attraction and I anticipated to continue and close the therapeutic relationship as I otherwise would have done.” With regard to the allegation of a sexual relationship with Service User 1, she said “I partially accept the charge. I would like to highlight that no unprofessional conduct occurred during the time of Service User 1 attending therapy.” She said that the relationship started some weeks after the termination of the therapy: “we developed a close relationship which continues to this day.” With regard to the allegation that she did not maintain accurate or contemporaneous records, the Registrant said “I partially accept this charge. I understand that my patient records were not complete, though I cannot clearly recall the details of this.” In summary, she said that she typed up the written records from hand written notes that she had made at the time “as soon as I could.”

12. The Registrant gave oral evidence at the substantive hearing. She adopted the contents of her written statement. In summary, her evidence, both oral and written, was as follows:

• She confirmed the accuracy of her written statement.

• She accepted that she commenced a sexual relationship with Service User 1 some few weeks after she had terminated therapy with Service User 1 in March 2016. She confirmed that the relationship was still ongoing.

• She said that Service User 1 was not a “vulnerable Service User” and that she never regarded him as such.

• She said that she did discuss her feelings of attraction to Service User 1 with both Witness 1 and Witness 2 during the time that the therapy was continuing. She could not recall whether the discussion was in a formal or in an informal setting.

• She accepted that she did not discuss having a sexual relationship with a former service user with either Witness 1 or Witness 2. However, she accepted that after the discharge of Service User 1 in March 2016, she did reveal to both Witness 1 and Witness 2 that she was in an extra-marital relationship, albeit without mentioning that the relationship was with a former service user. She emphasised that these discussions occurred after the discharge of Service User 1 in March 2016.

• She emphasised that during the period of the therapy her relations with Service User 1 were entirely proper. She did not allow her feelings of attraction to impact on her conduct. She did not anticipate that a relationship would develop and the subsequent meeting with Service User 1 was entirely by chance. With regard to providing therapy to a partner of a deceased service user to whom she had been providing clinical services, she said that such provision was infrequent but not unusual. She accepted that a breach of professional boundaries by a psychologist could impact on the confidence that the public would have in the profession.

• She emphasised the lessons that she had learnt from what had happened and how she would now act; in particular, seeking the advice of her line manager.

• She accepted that the relevant records were typed up in August 2016. She said that they were typed up from the handwritten notes that she had prepared at the end of the sessions to which they related. She accepted that this was not good practice but said that the delay did not impact on the care of Service User 1. She explained the reasons for the delay.

• She said that she had not worked since leaving employment with the Trust. She described what she had done to maintain her professional knowledge. She confirmed that she was very anxious to return to work as a psychologist.

13. The substantive hearing panel found some of the facts proved as follows:

“With regard to the allegation in Particular 1 c), the Panel concludes that the allegation is proved in part. In summary its reasons are as follows. The Registrant has admitted, in her statement, in her oral evidence to the Panel, in the meetings held on 1 September 2016 … and on 27 October 2016 with Witness 4, that she had a sexual relationship with Service User 1. She said that this began after her treatment of him had ceased in March 2016. There was no evidence called by the HCPC to establish that the Registrant had a sexual relationship with the Service User 1 whilst he was receiving treatment from the Registrant. Accordingly Panel determines that the allegation that the Registrant had a sexual relationship with Service User 1 during her treatment of him was not proved, but that the allegation that she had a sexual relationship with him after treatment had ceased was proved.

In respect of the allegation in Particular 1 c) that it has found proved, the Panel determines that the HCPC has proved that such conduct was a breach of “professional boundaries’. In coming to that conclusion the Panel notes that the relationship began, on the Registrant’s own admissions, within a few weeks of the treatment of Service User 1 having ceased. The Panel notes that Witness 1 and Witness 2, both fellow practitioners of the Registrant, regarded such conduct as being unacceptable. The Panel also notes that this view was shared … The Panel took into account the relationship of a psychologist to service users and the duty of a psychologist not in any way to abuse that relationship. The Panel also took into account the fact that Service User 1 was grieving for the death of his partner and sought bereavement support for this, and could thus be regarded as being vulnerable. The Panel further noted the document dated 21 September 2007 in the bundle adduced by the HCPC which stated that as a trainee at the University of Liverpool, the Registrant had read the BPS [The British Psychological Society] Professional Practice Guidelines [1995] and BPS Code of Ethics and Conduct [2006]. The former document states that “psychologists must not enter into a sexual relationship with former clients for at least two years after discharge and the ending of services”. The latter document states that psychologists should “recognise that conflicts of interest and inequity of power may still reside after professional relationships are formally terminated” and “should refrain from engaging in any form of sexual or romantic relationship with persons to whom they are providing professional services, or to whom they owe a continuing duty of care or with whom they have a relationship of trust. This might include a former patient”. The Panel concludes that in all the circumstances the conduct which it has found proved was a breach of the Registrant’s “professional boundaries.

With regard to the allegations in particular 2 of the Allegation, the Panel concludes that the allegation has been proved in part. There was no evidence that the records maintained by the Registrant were inaccurate and accordingly the Panel finds that part of the particular not proved. However the Panel concludes that the Registrant did not maintain contemporaneous records of her work with Service User 1 in respect of the sessions held on the dates that are specified in the particular. In summary its reasons are as follows. The Panel concludes that the handwritten notes which the Registrant said that she had made following the sessions with Service User 1, could not be regarded as records for the purpose of the particular. Those handwritten notes were not accessible to fellow practitioners. Moreover the Registrant herself, in her statement described those handwritten notes as “aides memoire for typing up later”. The Panel determines that the only relevant notes for the purposes of the Allegation are those entered into the electronic record. The Registrant accepted, both in her oral evidence and in her statement, that she entered those handwritten notes into the electronic record at a later date. In her oral evidence the Registrant accepted the evidence adduced by the HCPC that she had done this between 4 August 2016 and 18 August 2016. The Panel notes and accepts the evidence of Dr Seddon that this delay was unacceptable. Accordingly the Panel finds proved the part of this particular which alleges that the Registrant did not maintain contemporaneous records of the work done on the specified dates.”

14. The substantive hearing panel concluded that the matters found proved were a serious departure from the standards of conduct and performance that could properly be expected of the Registrant and that they amounted to misconduct. In its decision on impairment, the Panel stated:

“In respect of the allegation found proved in particular 1c), the Panel considers that the Registrant has not developed full insight into the importance of observing proper “professional boundaries”. The Panel is not persuaded that the Registrant fully understands the imbalance that exists between a psychologist and a service user, and that this imbalance can survive beyond the termination of the professional relationship. In her witness statement and evidence before the Panel, the Registrant stated that she did not consider Service User 1 to be vulnerable when their relationship began. Further, she did not consider there to be a power imbalance because she quickly divulged information about herself. The Panel is unable to exclude the possibility that the Registrant’s failure to fully understand the importance of maintaining proper professional boundaries could lead to breaching these boundaries in her relations with future service users. In coming to this conclusion, the Panel kept in mind that the Registrant told the Panel that she has undertaken a two-hour accredited course which deals with maintaining professional boundaries. However she said that this course did not cover dual relationships and was “mainly about current clients.

In respect of the allegation found proved in particular 2, the Panel does not consider that the Registrant fully understands the importance of maintaining contemporaneous records. The Registrant did not appear to appreciate that service users could be placed at risk when records were not completed contemporaneously. Further, the Panel was not convinced by the explanations that the Registrant gave as to why she had not completed the records contemporaneously. For example, the Registrant accepted that she overran her sessions with Service User 1 into a second hour, but that this was only by 10 minutes. The Registrant’s explanation that she had other administrative tasks to do for the remainder of that hour demonstrates that she did not prioritise record-keeping. The Panel also noted the explanations advanced by the Registrant as to the lack of relevant support were not consistent with the evidence given by … and were also inherently unconvincing. Accordingly, the Panel is unable to exclude the possibility that the Registrant might in the future fail to maintain contemporaneous records. If she did fail to do so, future service users could be put at risk.

The Panel further concluded that having regard to the considerations set out above public confidence in the profession and in the HCPC as its regulator would be undermined by a finding that the Registrant’s fitness to practise was not impaired. Moreover in the opinion of the panel a finding of present impairment is necessary in order to sustain proper standards within the profession.”

15. When deciding on the appropriate sanction, the panel said:

“The Panel also took into account the relevant aggravating and mitigating factors. As regards the former, the Panel noted that the Registrant’s sexual relationship with Service User 1 was a serious breach of professional boundaries and an abuse of her professional position and obligations. Moreover the Registrant’s insight into her misconduct is limited. In respect of the mitigating factors, the Panel kept in mind that the Registrant was of previous good character, had engaged fully with the HCPC and has made partial admissions.

The Panel has concluded that to take no action would be wrong. Such an outcome would be inappropriate having regard to the facts of the case. It would not protect the public or maintain public confidence in the profession or in the HCPC as its regulator.

In view of the submissions made by Mr Smith the Panel has given very careful consideration to imposing a Caution Order. In its consideration, the Panel took full account of the guidance given in the Policy Document published by the HCPC and in particular to paragraphs 28 and 29 of that document. It has concluded that a Caution Order was not appropriate. In coming to this conclusion the Panel noted that that the Registrant’s misconduct was not minor and there was a risk that she would in the future transgress professional boundaries. The Panel also noted that the Registrant’s insight into her misconduct was not complete and there was only evidence of limited remediation.

The Panel next considered making a Conditions of Practice Order. It has taken into account the guidance in the Indicative Sanctions Policy and in particular paragraphs 30-38 of that document. It has concluded that a Conditions of Practice Order was proportionate and would protect the public and address the public interest. In coming to this conclusion the Panel noted in particular that the Registrant’s misconduct was capable of correction and that it was isolated. The Panel also considered that the Registrant would comply with the conditions imposed, which the Panel considers to be workable, relevant, proportionate and enforceable. Accordingly the Panel has decided to make a Conditions of Practice Order in the terms set out below for a period of 12 months. The Panel considers that such a period would be sufficient enable the Registrant to address the risks which have been identified and to take the appropriate remedial action.”

16. The substantive hearing panel did consider making a Suspension Order but concluded that given that an appropriate Conditions of Practice Order could be formulated to address the risks identified, a Suspension Order would be unnecessary and disproportionate.

17. The conditions imposed were as follows:

1) You must renew your registration and update your practice in accordance with the HCPC ‘Returning to Practice’ requirements.

2) You must promptly inform the HCPC if you obtain employment or if you commence any self-employment.

3) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

4) You must inform the following parties that your registration is subject to these conditions:

A. Any organisation or person employing or contracting with you to undertake professional work;

B. Any agency you are registered with or apply to be registered with (at the time of application)

C. Any prospective employer (at the time of your application).

5) You must provide a detailed written reflective piece regarding the Panel’s findings, to be forwarded to the HCPC 28 days before this order is reviewed.

6) Before returning to practice you must undertake courses on maintaining professional boundaries and record-keeping, and evidence of this to be forwarded to the HCPC 28 days before this order is reviewed.

7) You must supply details of your clinical supervisor to the HCPC within 14 days or your return to work.

8) You must allow your clinical supervisor to provide a written report to the HCPC about your adherence to maintaining professional boundaries and how you have complied with the requirement to maintain accurate and contemporaneous records. This report is to be forwarded to the HCPC 28 days before the order is next reviewed.

18. The Registrant gave oral evidence to the review panel (see below).


Substantive Review Hearing 19 November 2019:

Submissions

19. Ms Ktisti submitted that the Registrant was now on the Register and could fulfil the return to practice requirements once employed, so to that extent Condition 1 had been complied with. Ms Ktisti said the Registrant had complied in part with Condition 6, by completing a training course on record-keeping, but she had yet to provide evidence of having attended a course on professional boundaries. She had provided a reflective piece and all other conditions had been compiled with in so far as the Registrant was able to, having not yet returned to practice. Ms Ktisti said that the HCPC remained neutral on the question of whether the Registrant’s fitness to practice remained impaired.

20. Mr Jordan, on behalf of the Registrant, submitted that the Registrant was no longer impaired and he invited the Panel to allow the order to lapse on its expiry, or sooner if felt appropriate. He said the Registrant had learnt a stark lesson, but added it was significant that three years later Service User 1 attended the hearing in support of her. Mr Jordan said the Registrant was “keen to wipe the slate clean and get back to being a professional.”


Decision:

21. The Panel considered with care the Registrant’s oral evidence, together with the documentation she provided and the submissions of both parties. The Panel accepted the advice of the Legal Assessor and, in reaching its decisions, referred to the HCPTS’s Practice Note on “Finding that Fitness to Practise is ‘Impaired’”. The Panel carried out a comprehensive review of the current order in light of the circumstances as they existed today.

22. The Panel first considered the issue of current impairment. The Panel took account of the principle set out in Abrahaem v GMC [2008] EWHC 183 (Admin) that there is, in practical terms, a persuasive burden at a review hearing for the Registrant to demonstrate that he has “fully acknowledged why past performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.”

23. The Registrant provided a reflective piece and a Certificate to show successful completion of an online training course on “Documentation & Record-keeping” dated 12 September 2019.  In her reflective piece she fully acknowledged the unacceptability of entering into a relationship with someone so recently discharged from her care and that her actions “transgressed the founding rules of my profession.” She also acknowledged the importance of record-keeping and her failing in this regard.

24. In her oral evidence the Registrant told the Panel she had lost both her jobs at the end of 2017 as a result of these matters and she had not worked during the period of the Conditions of Practice Order because she did not want to “place a mark on my practice.” Accordingly, she had received no income for over two years. She said she would like to go into private practice in the future but felt she could not start the rest of her professional life with that mark against her name and the need to notify referrers of the order. As well as describing the “deep shame” she felt on a personal level, she added that there was a certain amount of professional shame attached to being under a Conditions of Practice Order and she said she wanted a clean break before returning to practice. She regretted her past actions in transgressing professional boundaries and she said there was no risk of it happening again.

25. The Registrant said she had done some training courses and personal learning and engaged with discussion with professional colleagues in order to maintain her skills.

26. With reference to the conditions, the Registrant said she had done her utmost to comply with them. She said she had done a two-hour online course on professional boundaries prior to the order, but that thereafter the only specific course on the topic at the right level she had been able to find was prohibitively expensive. She said that instead she bought some literature which she studied, focusing on the points relating to her case. In addition she wrote a reflective journal. She said the journal was highly personal and so she had not submitted that to the panel, but the main things that she had considered were the protection of patients, the power imbalance between professional and patient, and the therapeutic efficacy linked to the effect on patients.

27. She said she remained in a stable relationship with Service User 1, who she had now been with for three years and who was, today, present at the review hearing.

28. With reference to record-keeping, the Registrant said she attended a verified Continuing Professional Development (CPD) online course, which took her through the legalities of maintaining clinical records and the ethical issues around maintaining records. She said she accepted that a record was not complete until entered into the computer system and that she had always known that. She referred to some departmental issues at the time which led her to be “more lax with the records than I should have been”. She said she used to be the audit lead at the hospital where she worked and that one of her duties was to oversee the clinical records within the department, so she was always very aware of the importance of records.

29. The Registrant said she wrote her reflective piece hoping it would be a sincere account of the process she had been through over last 12 months and she very much hoped it underlined her dedication to satisfy the requirements of the order with the hope that she could “return to the profession I enjoy very much.”

30. With reference to Condition 1, the Registrant said she had renewed her registration on, she thought, 31 August 2019. She said she was familiar with the Return to Practice requirements and the need to do 30 hours’ CPD, but thought she only had to do that once she returned to work.

31. In response to Panel questions, the Registrant provided more detail about the record-keeping failures which, she said, extended beyond those relating to Service User 1. She explained how there had been departmental issues which included heavy workloads and the loss of secretarial staff. The Registrant said how she would often have to see service users back-to-back, six or seven at a time. She had no computer in her office and so had to keep handwritten notes to be entered into the computer when possible. The loss of secretarial support meant that she could no longer dictate her notes to a typist, but rather had to input them herself. These factors combined meant that she fell behind with her record-keeping. She fully recognised that this was not adequate and she explained how she would not allow this to happen in future. The Panel found her account to be both plausible and credible and was satisfied that she was fully aware of the need to keep accurate records and that it was unlikely she would repeat such failings.

32. Although the Registrant had not attended a higher level training course on professional boundaries, she had at least attended a course prior to the substantive hearing and she had taken appropriate steps to research professional boundaries. She was able to satisfy the Panel that she understood the importance of maintaining professional boundaries and the error that she had made, and the Panel was satisfied that she was unlikely to breach them in the future.

33. When considering the question of proportionality, the Panel took into account the fact that the Registrant had now been out of work for some considerable time and the financial impact resulting.

34. In all the circumstances, the Panel concluded that the Registrant had demonstrated sufficient insight and remediation to satisfy it that she no longer represented a risk to the public. Accordingly, her fitness to practice was no longer impaired on public protection grounds. The Panel was also satisfied that the public interest element of the sanction meant that her fitness to practice was no longer impaired on public interest grounds.

35. The Panel therefore determined that the Registrant’s fitness to practice was no longer impaired on either ground and that, on the expiry of the current order, she would be fit to return to unrestricted practice. The Panel decided not to revoke the order with immediate effect in order to reflect the public interest element of the sanction imposed at the substantive hearing.

 

Order

No information currently available

Notes

The order made by the substantive hearing will be allowed to lapse upon it's expiry, namely, 21 December 2019.

Hearing History

History of Hearings for Dr Ildiko Ridley

Date Panel Hearing type Outcomes / Status
19/11/2019 Conduct and Competence Committee Review Hearing No further action
20/11/2018 Conduct and Competence Committee Final Hearing Conditions of Practice
23/08/2018 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice
01/08/2018 Conduct and Competence Committee Interim Order Review Adjourned
06/04/2018 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice
08/01/2018 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice
18/07/2017 Investigating committee Interim Order Application Interim Conditions of Practice