Miss Karen Bennetts

Profession: Occupational therapist

Registration Number: OT60373

Interim Order: Imposed on 26 Nov 2018

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 29/11/2019 End: 12:00 29/11/2019

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 4 December 2018:

 

Between April 2013 and December 2016, whilst registered as an Occupational Therapist:
1. Your clinical reasoning and/or recording of your clinical reasoning for the recommendations made in respect of the following Service Users and/or the clinical reasoning was inadequate:
a. Service User 1
b. found not proven
c. found not proven
d. Service User 13
e. Service User 15
f. Service User 22
g. found not proven
2. In relation to Service User 2, you:
a. Did not provide Service User 2 with a copy of the final Therapy Review.
b. Assessed the suitability of a property without Service User 2 being present.
c. Did not promptly send a letter to Homechoice regarding the bathing assessment you conducted for Service User 2
d. Did not include the results of a bathing assessment in a letter to Homechoice, as was directed in supervision.
3. In relation to Service User 3, you:
a. Recorded contradictory statements within the assessment.
b. Did not make a case recording of the assessment visit carried out on 6 July 2015.
4. In relation to Service User 4, you:
a. Did not make a case recording of the home visit carried out on 31 July 2015.
b. Recorded an assessment which lacked sufficient detail and/or was contradictory in places
5. In relation to Service User 5, you:
a. found not proven
b. Did not make a case recording of the assessment visit carried out on 9 July 2015.
c. Recorded an assessment which lacked sufficient detail and/or was contradictory in places.
6. In relation to Service User 6, you recommended equipment that did not match the needs of Service User 6 and/or provided the service user
with an assessment document which was inadequate.
7. In relation to Service User 7, you:
a. Did not make a case recording of the assessment visit carried out on 15 July 2015 in a timely manner.
b. Recorded an assessment which lacked sufficient detail and/or was contradictory in places.
c. Recorded an assessment that lacked clinical analysis of Service User 7’s situation.
8. In relation to Service User 8, you did not make a case recording of the joint home visit carried out on 29 July 2015 and/or the further actions to be taken in the case.
9. In relation to Service User 9, you:
a. Did not consider adequately, or at all, the service user’s bathing needs.
b. Did not schedule a review of Service User 9.
c. Did not make a case recording of the assessment visit carried out on 15 June 2015.
d. Did not promptly submit the major adaption request
10. In relation to Service User 10, you did not undertake and/or record undertaking a review before closing the case.
11. In relation to Service User 11, you did not undertake and/or record undertaking a review.
12. In relation to Service User 11, you sent a housing letter instead of a housing support statement.
13. In relation to Service User 13, you did not adequately record the bathing assessment.
14. In relation to Service User 15, you ordered equipment which was not suitable for Service User 15.
15. In relation to Service User 16, you did not submit the major adaptation paperwork in a timely manner.
16. In relation to Service User 17, you:
a. Acted outside the scope of your practice, in that you provided Service User 17 with dietary advice.
b. Did not record a risk assessment within the therapy assessment in relation to a straight stair-lift.
17. In relation to Service User 18, you did not record an adequate risk assessment within the therapy assessment.
18. found not proven
19. In relation to Service User 20, you did not submit the major adaptation paperwork in a timely manner.
20. In relation to Service User 23:
a. You did not make a case recording of the home visit carried out on 31 July 2015.
b. The assessment form you completed lacked sufficient clinical reasoning for the recommendations made.
21. In relation to Service User 24, you:
a. Did not make a case recording of the assessment visit carried out on 30 July 2015 in a timely manner.
b. found not proven
22. In relation to Service User 26, you:
a. Did not make a case recording of the disclosure of abuse by Service User 26 and/or the safeguarding alert raised in relation to the disclosure in a timely manner.
b. Did not submit the recommendation for a Disabled Facilities Grant in a timely manner.
23. The assessment form you completed in relation to Service User 29 lacked sufficient detail and/or was contradictory in places. 
24. The matters described at particulars 1 to 23 constitute misconduct and/or lack of competence.
25. By reason of your misconduct and/or lack of competence you fitness to practise is impaired.

Finding

Background

1. The Registrant has been at all material times, registered as an Occupational Therapist with the HCPC.

2. The Registrant was employed by Cornwall Council (the Council) as a Band 5 Occupational Therapist from April 2013 until December 2016. Concerns around the quality of the Registrant’s work initially arose during her probation period. Towards the end of that Probation period, 6 months after the Registrant had joined the Council, those concerns remained. During her second probation Review, on 24 October 2013, the Registrant disclosed a health condition. Upon learning of this, the manager directed the Registrant to contact ‘Access to Work’ (ATW) for the purposes of a referral. The manager also arranged for one to one supervision to continue on a fortnightly basis and for the Registrant’s probation period to be extended for a further 3 month period.

3. The ATW assessment took place on 3 December 2013 and special equipment and training was approved on 6 December 2013. These reasonable adjustments were then put in place to support and assist the Registrant in her practice. She was also provided with extensive supervision for nearly three years.

4. The Registrant successfully passed her probation period on 15 January 2014. However, on 18 March 2015, a complaint was received from a service user (unconnected to these proceedings) about the quality of an assessment conducted by the Registrant. As a consequence of that complaint, the Registrant’s caseload was audited. The audit identified further areas of concern and an Improvement Plan was put in place effective from 13 April 2015, for a period of eight weeks.

5. On review of the improvement plan on 10 June 2015, there remained on-going concerns about the Registrant’s capability and standards of practice. The formal capability procedures were invoked, effective from 30 June 2015. In order to support the Registrant through this process she was allocated a new supervisor who would hold weekly supervisions with her, in addition to checking all her assessments and providing feedback.

6. Notwithstanding the additional support, by 27 January 2016, the Service Manager in Adult Social Services at the Council remained concerned that the Registrant’s ‘assessment of cases contained too many errors and omissions & lacked clinical reasoning’. For that reason a Stage 2 Capability warning was issued. In order to support the Registrant through this process she was assigned a mentor/clinical supervisor who was to assist the Registrant with all assessments for a 3 month period.

7. By April 2016 the mentor/clinical supervisor was of the view that “it would not be feasible to allow Karen to work without a high degree of supervision, much more than would normally be the case for a Band 5 OT with three years’ experience within this service (i.e. one session every six weeks would be the norm). In my opinion our service does not have the capacity to be able to continue to offer this intensive supervision.”

8. A capability review was held on 17 May 2016, in which it was decided to replace the mentor/clinical supervisor with a different supervisor. The Service Manager commented: “Following this 3 month period of intensive support, I propose that you now be allowed to work more independently and that I review your cases over the next 3 months. If there is not a significant enough improvement, I may need to convene a stage 3 hearing…’”

9. On 3 October 2016, Stage 3 Capability proceedings were initiated. The areas of on-going concern were identified as “a lack of clarity of clinical reasoning, omissions in service users assessments, poor recording in assessments including unprofessional language & statements that do not make sense, failure to follow supervisors instructions.”  The Registrant left the Council’s employment in December 2016. 

10. The matter was referred to the HCPC and at a substantive fitness to practice hearing that concluded on 4 December 2018 the Registrant was found to be impaired by reason of a lack of competence. The sanction imposed was a twelve-month Suspension Order.

Preliminary issue: proceeding in private

11. At today’s hearing the HCPC applied for those parts of the hearing that dealt with the private life of the Registrant to be in private but not for the entirety of the hearing to be held in private.  The Registrant applied for the whole of the hearing to be in private on the basis that the matters found proved were linked with health conditions and there are on-going health matters.
The Panel has the power to direct that this hearing is held in private.  A substantive hearing would normally be held in public. However, matters may be heard in private where this is necessary to protect the private life of the Registrant.

12. The Panel decided to allow the application in part.  Given that this is a hearing where the Panel must review the position of the Registrant and consider whether deficiencies have been remedied, it did not consider that these matters were inextricably linked with the Registrant’s health condition.  For any reference to a health condition or disability, the Panel would go into private session.  The matter of competence could be separate to this.  This decision was considered fair and in the interests of justice, enabling the public and other registrants to be aware of how the Regulator addresses matters found proved, while protecting the private life of the Registrant.

13. The Panel was aware form the information within the bundle of a variety of issues/ complaints which had been raised by the Registrant with regard to the HCPC’s handing of the case. The Panel reminded itself that it was not its role to deal with these issues and put them firmly form its mind in considering the review of the Order.

Decision

14. The Panel has been convened to undertake a review of a substantive suspension order imposed on 4 December 2018.

15. The Registrant attended this hearing by telephone but was not represented. Ms CJ Navarro presented the case on behalf of the HCPC.

16. The HCPC set out that at the substantive hearing, a Panel of this Committee found the Registrant to be impaired by reason of a lack of competence.  The finding was made on both the grounds of public protection and the public interest.  In public protection terms, the Panel considering the substantive case, recognised that the Registrant showed some insight in admitting that she had made some errors in record keeping, but it found that her clinical reasoning was not adequate and her failures had continued over a significant period of time.  Given that no remediation had occurred there was a risk of repetition and a risk to the public.  In terms of the public interest, the fact that the lack of competence was shown to have continued over a significant period of time, and include different failures, the public would have no confidence in a profession or regulator should such a Registrant be permitted to practice.

17. It was submitted the current order would expire on 1 January 2020 and that while the Registrant had attended this hearing, there was no evidence submitted of any of the matters which the previous panel had indicated might be helpful.  The HCPC therefore submitted that the Registrant remains impaired.  The basis of their submission was that nothing had been evidenced as changed from December 2018.  Further to the case of Ibrahim v GMC, it was said that it is the Registrant who has a persuasive burden to demonstrate that the matters which previously subsisted have been addressed.  No such evidence was before the Panel.

18. The Registrant professed herself to be dissatisfied with how long proceedings had taken.  The requirements for Voluntary Removal from the Register had been communicated to her via email and telephone.  The Panel noted that she had not practiced as an Occupational Therapist for three years and did not intend to pursue this career in the future.

19. After careful consideration of all the relevant factors, which include the evidence given by the Registrant today, the Panel has concluded that her fitness to practise remains impaired.  This is both on the basis of public protection and the public interest.  A healthcare professional identified as having a lack of competence over several areas, who has presented no evidence of remediation is not fit to practise. 

20. The reason for this decision is that the Panel in conducting a substantive and fresh review considered what the previous panel had said and identified no evidence of a change in circumstance. There was no evidence of change in insight in hearing the Registrant’s submissions.  The deficiencies identified have not been addressed by evidence of remediation. The suggestions made by the previous panel in terms of what might be helpful in terms of: evidence had not been taken up. There was no evidence of continuing professional development (CPD), including relevant training, online or otherwise, reading and/or shadowing; a reflective statement; demonstrating how any CPD undertaken relates to the findings made at this hearing and demonstrating insight into those findings; relevant up-to-date testimonials from any paid, or unpaid, employment in any area of activity.

21. The Panel next went on to consider sanction, taking into account the Sanctions Policy.  The Panel is mindful that a sanction is a matter for its own judgement and not to punish the Registrant but to address the public and public interest.  It acknowledged that an order should be appropriate and sufficient to protect the risks identified.

22. The Panel was aware that it has powers to confirm, vary, revoke or change the current order of suspension.  It took into account what had been said both by the HCPC and the Registrant.  It acknowledged that the Registrant stated that she has no desire to practice as an Occupational Therapist and had not been working in this field for the last three years. 

23. It was not suitable to take no action.  The Registrant is currently subject to an order that prevents her from practicing as an Occupational Therapist.  Without evidence that the deficiencies have been remedied, she could not be permitted to practice without restriction.

24. Given the Registrant’s stance, compliance with Conditions of Practice were neither appropriate nor proportionate.

25. While it acknowledged that an order should be proportionate in balancing the Registrant’s interests with that of the public, it appeared to be in the interests of both that an order of suspension be extended.  No lesser sanction would protect against the risks identified. 

26. The Panel did acknowledge that the Registrant might pursue voluntary removal from the Register.  This was a separate matter and not within the powers of the Panel. It was made clear to the Registrant that a Striking Off Order was only available after there was two years of suspension. 

27. The Panel therefore decided to impose a further Suspension Order for a period of 12 months which will come into effect on the expiry of the current Order.

Order

The Registrar is directed to suspend the Registration of Miss Karen Bennetts for a further period of 12 months upon the expiry of the current order.

Notes

This Order will be reviewed again before its expiry on 1 January 2021.

Hearing History

History of Hearings for Miss Karen Bennetts

Date Panel Hearing type Outcomes / Status
29/11/2019 Conduct and Competence Committee Review Hearing Suspended
26/11/2018 Conduct and Competence Committee Final Hearing Suspended