Dr Katherine Palmer

Profession: Practitioner psychologist

Registration Number: PYL23702

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 11/10/2019 End: 17:00 11/10/2019

Location: Cardiff Marriott Hotel Mill Lane, Cardiff, South Glamorgan, CF10 1EZ

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

During the course of your employment as a Band 8b Practitioner Psychologist with Aneurin Bevan University Health Board:

1. Following an audit undertake of approximately 68 patients you had seen between February 2012 and September 2015, it was found that you:
a. Did not record last contact and/or any contact in EPEX between February 2012 and September 2015 in approximately 64 cases;
b. Did not record any and/or keep up to date notes between February 2012 and September 2015 in approximately 67 cases;
c. Did not undertake and/or record Care and Treatment Planning and/or WARRN risk ssessments between February 2012 and September 2015 in approximately 51 cases.

2. The matters described in paragraphs 1(a) - (c) constitute misconduct and/or lack of ompetence.

3. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.

Finding

Allegation (as amended at the substantive hearing):

During the course of your employment as a Band 8b Clinical Psychologist with Aneurin Bevan University Health Board, you:

1. Did not record last contact, and or all your patient contact, on EPEX between March 2015 and September 2015 in approximately 27 cases, namely:

a. Patient 1;

b. Patient 2;

c. Patient 4;

d. Patient 6;

e. Patient 7;

f. Patient 8;

g. Patient 9;

h. Patient 10;

i. Patient 11;

j. Patient 12;

k. Patient 13;

l. Patient 14;

m. Patient 15;

n. Patient 16;

o. Patient 17;

p. Patient 18;

q. Patient 19;

r. Patient 21;
 
s. Patient 22;

t. Patient 23;

u. Patient 24;

v. Patient 25;

w. Patient 26;

x. Patient 27;

y. Patient 28;

z. Patient 29; aa. Patient 30.
2. Did not complete, and/or place on file, paper notes in respect of all your contact with:

a. Patient 1 between around August 2011 and February 2015;

b. Patient 2 between around January 2015 and September 2015;

c. Patient 3 between around October 2014 and February 2015;

d. Patient 4 between around March 2011 and September 2015;

e. Patient 5 between around March 2011 and January 2015;

f. Patient 6 on 1 September 2015;

g. Patient 9 between around May 2014 and September 2015;

h. Patient 10 between around January 2015 and August 2015;

i. Patient 11 between around December 2013 and September 2015;

j. Patient 14 between around January 2013 and September 2015;

k. Patient 17 between around June 2014 and August 2015;

l. Patient 18 between around September 2013 and September 2015;

m. Patient 19 between around December 2014 and September 2015;

n. Patient 20 between around July 2014 and March 2015;

o. Patient 22 between around December 2014 and September 2015;

p. Patient 29 between around June 2011 and August 2015.
 
3. Did not undertake, and/or record undertaking, Care and Treatment Planning, as required, in respect of:

a. Patient 2;

b. Patient 3;

c. Patient 5;

d. Patient 6;

e. Patient 7;

f. Patient 8;

g. Patient 9;

h. Patient 10;

i. Patient 11;

j. Patient 12;

k. Patient 13;

l. Patient 14;

m. Patient 16;

n. Patient 19;

o. Patient 22.

4. Did not undertake, and/or record undertaking, Wales Applied Risk Research Network (WARRN) risk assessments, as required, in respect of:

a. Patient 2;

b. Patient 3;

c. Patient 5

d. Patient 6;

e. Patient 7;

f. Patient 8;

g. Patient 9;

h. Patient 10;
 
i. Patient 11;

j. Patient 12;

k. Patient 13;

l. Patient 14;

m. Patient 16;

n. Patient 19;

o. Patient 22.

5. The matters described in paragraphs 1 – 4 constitute misconduct and/or lack of competence.

6. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.


Preliminary matters:

1. At the commencement of the hearing the HCPC’s Presenting Officer applied to amend the factual particulars of the allegations. Details of the application had been communicated to the Registrant by a letter dated 2 March 2018. The Panel was satisfied that the proposed amendments provided proper particularisation and clarification of the case that had been referred by the Investigating Committee on 3 August 2017. The proposed amendments did not extend the case against the Registrant in either scope or seriousness. No objection was made to them by or on behalf of the Registrant and the Panel acceded to the proposed application. The allegation set out at the head of this document is in the amended form.

2. When given an opportunity to respond to the allegations as amended, Mr Bousfield on behalf of the Registrant stated that:
 
• Particular 1 was admitted with regard to all sub-particulars.
• Particular 2 was admitted with regard to all sub-particulars so far as not placing the paper notes on the file, but not admitted so far as completion of those notes was concerned. However, in his closing submissions, Mr Bousfield stated that the Registrant admitted particular 2 without reservation.

• Particular 3 was admitted with regard to all sub-particulars in so far as recording Care and Treatment Planning, but not admitted so far as undertaking that activity was concerned.

• Particular 4 was admitted with regard to all sub-particulars in so far as recording WARRN risk assessments, but not admitted so far as undertaking that activity was concerned.

3. It was likely from the HCPC’s hearing bundle that there would be mention of detail of the Registrant’s ill health during the hearing. In the event, there were numerous occasions when it was necessary for the Panel to direct that evidence given should be treated as having been given in private.


Background:

4. The matters alleged against the Registrant occurred during her employment by the Aneurin Bevan University Health Board (“the Board”). The Registrant was first employed as a Clinical Psychologist by the Board in 2005. In January 2010 she was appointed to a Band 8b role as a Principal Clinical Psychologist working in the Torfaen Mental Health Team, which is a secondary mental health service. That team worked with adults with mental health needs. The Registrant typically worked with patients who had severe or complex mental health needs. She acted as the Care Coordinator for several patients. Part of the Care Coordinator’s role was to ensure that Care and Treatment Planning and WARRN risk assessments were completed and updated when there was a change in the patient’s circumstances. She was required to undertake assessments of patients with a view to the provision of psychological interventions, either the provision of direct psychological input or the sign-posting of patients to appropriate services. She was also required to work with other professionals to address the needs of patients.

5. During a period in the autumn of 2015, when the Registrant was on sick leave, the Board received a query from a patient who believed that they should have been contacted for psychological input, but who had not been contacted. This resulted in an audit being undertaken of the Registrant’s caseload. That audit allegedly revealed deficiencies in the Registrant’s record keeping that resulted in a disciplinary process being
 
undertaken by the Board and subsequently a referral to the HCPC on behalf of the Board. The Registrant’s employment by the Board was terminated on grounds of ill health in August 2016.


Decision on Facts

6. In reaching its decisions on the facts the Panel accepted the advice of the Legal Assessor, and in particular proceeded on the basis that disputed facts were to be proved by the HCPC against the Registrant, the standard of the burden of proof being the balance of probabilities. In reaching its decision the Panel had regard to all the evidence. In addition to the oral evidence of the witnesses who gave evidence before the Panel, the HCPC introduced a very substantial bundle of documentary exhibits extending to over 1,000 pages. Included in this bundle were patient notes, records of audits undertaken on behalf of the Board and also Board protocols.

7. The Registrant gave evidence in support of her case. Although there was no reason to doubt the basis upon which she had made the admissions, the Panel considered it to be prudent to examine the details of the HCPC’s case as advanced by the evidence of the witnesses and the documentary exhibits in order to be satisfied that the admissions should be accepted.

8. The HCPC relied upon the evidence of three witnesses, namely:

• Mrs JK, a Senior Nurse employed by the Board. Mrs JK worked in a different Directorate to the Registrant, and her involvement in the case was to undertake the Board’s disciplinary investigation to which reference has already been made.

• Mr PH, also a Senior Nurse at the time employed by the Board. Mr PH was the Registrant’s line manager and in that role responsible for her operational management.

• Dr LA, a Consultant Clinical Psychologist and Head of Adult Psychology and therefore the Registrant’s professional lead. She did not, however, directly manage the Registrant nor did she undertake her clinical supervision, but the Registrant did report on professional matters to her from November 2014.

9. The Panel began its deliberations by forming a general view of the witnesses who gave oral evidence at the hearing. The following is a summary of the Panel’s assessments:

• Mrs JK. Mrs JK gave her evidence in a clear manner and the Panel was satisfied that she tried to assist the Panel by the evidence she gave. She displayed no evidence of bias against
 
the Registrant. Accordingly, the Panel found her to be a credible witness.

• Mr PH. Mr PH’s recollection was not complete, but when he could not recall something, or could not assist with the detail of events, he acknowledged that he could not. Again, the Panel found that he sought to assist the Panel by the evidence he gave. The Panel found him to be a credible witness.

• Dr LA. The Panel found Dr LA to be an impressive witness who demonstrated good recall and clarity of thought. In the limited instances where she could not recall she stated so. She was very helpful to the Panel.

• The Registrant. The Registrant was clear in her account of events. However, the Panel found that on some occasions there were inconsistencies in her evidence.

10. The factual particulars alleged against the Registrant by the HCPC concern the undertaking and recording of patient assessments and contacts. The Panel has set out below the Board’s recording systems at the relevant time. There was a paper file kept for each patient. It was expected that any contact or meeting with patients would be recorded on handwritten notes, by the clinician having contact with the patient. These notes would be placed in the paper file. It was expected that documents and forms such as the Care and Treatment Plans (CTP) and the WARRN risk assessments, when completed, would be included in the paper file.

11. In addition to the paper file that was kept for each patient, the Board had an electronic recording system known as EPEX. EPEX was used to log contact by clinicians with patients, and included the identity of the patient’s Care Coordinator. The system also allowed for formal documents such as the CTP to be uploaded onto the database. The detail of what occurred during sessions and phone calls was not included on EPEX, that being something expected to be included in the handwritten paper file.


Particular 1 – Did not record last contact and/or all your patients contact on EPEX between March 2015 and September 2015 in 27 cases ….

12. When the Board decided to undertake an audit of the Registrant’s caseload, the Registrant’s secretary was asked to go though the Registrant’s diary and the electronic EPEX records and list every patient with whom the Registrant had been actively working with or assessed in the preceding 12 month period. Dr LA, Mr PH, and another Psychologist
 
who has not been a witness in this case, undertook the audit. A copy of the audit document was included in the exhibits bundle. The first two columns identify the patient, the third column identifies whether or not the patient was then on the Registrant’s caseload. The third column describes whether or not the EPEX electronic record includes contacts. The Panel accepts that the audit document accurately reflects the electronic recording undertaken by the Registrant. Accordingly, the Panel is satisfied that the last contact is not recorded for any of the 27 patients included in the sub-particulars to particular 1, and for at least three of those patients, e.g. Patients 21, 27 and 30, there were no contacts at all recorded.

13. In her evidence the Registrant accepted that it was her responsibility to record all contacts on EPEX, and the Panel finds that she should have done so.

14. For these reasons the Panel accepts the Registrant’s unqualified admission of particular 1 with the consequence that particular 1 is proven with regard to all particulars.

Particular 2 - Did not complete, and/or place on file, paper notes in respect of all your contact with …..

15. From the audit document and from its own perusal of patient notes provided in the documentary exhibits, the Panel is satisfied that paper notes were not placed on file.

16. When she was interviewed by Mrs JK, the Registrant stated that she had rough patient notes on a pad at home, but that they were illegible. However, no notes were provided by the Registrant to Mrs JK. It was also the evidence of Mrs JK that the Registrant said to her that she had various notepads in the drawer of her desk which contained rough notes. However, PH stated that no notes were found.

17. With regard to particular 2, the Panel went through the entries in the audit document produced by Dr LA and Mr PH, and cross-referenced the contentions made by that document with the patient notes in the exhibits bundle provided to the Panel. The Panel found that with regard to each patient, save for Patient 17, the audit was corroborated by the notes. With regard to Patient 17, particular 2(k) alleges the period “between around June 2014 and August 2015”. The patient notes include a handwritten entry made by the Registrant on 2 July 2014. However, the Panel is satisfied that there were no further entries made by the Registrant in the patient notes despite EPEX showing a number of patient contacts after that date.

18. It has already been stated that by the time the Panel retired to consider its decisions the Registrant admitted this particular without reservation. The Panel finds that the admission accords with the evidence produced
 
(in the case of Patient 17 for a slightly shorter period than alleged), and accordingly particular 2 is proven.

Particular 3 - Did not undertake, and/or record undertaking, Care and Treatment Planning, as required, in respect of ….

19. This particular is relevant to those patients in respect of whom the Registrant was the Care Coordinator. The Panel is satisfied that it has been factually established that the Registrant was indeed the Care Coordinator for the patients included in the sub-particulars, and was so for a sufficient length of time that the undertaking of a CTP was required. The requirement was to update the CTP frequently, or each time the patient’s situation changed, and in any event at least annually.

20. The Registrant admitted that she did not record undertaking Care and Treatment Planning (“CTP”), and the Panel finds that this acceptance on the part of the Registrant accords with the HCPC’s evidence as reflected in the audit document that CTPs were not on the patient files. However, the Registrant’s case is that she undertook care and treatment planning as an integral part of her work and that the patients knew what the treatment was. The Panel accepts that the Registrant would have spoken to her patients about the treatment she proposed to offer, but there is no evidence in the documentary exhibits seen by the Panel that the CTPs were undertaken, or recorded in the patient notes.

21. The Panel finds that from June 2012, in Wales the undertaking of a CTP was a legal requirement. It was a specific element of that legal requirement that the CTP should be in writing, and that requirement was reflected in the Board’s protocols.

22. In the judgement of the Panel the absence of any documented CTP has the consequence that the CTPs were not “undertaken”. It follows that with regard to all the patients identified in the sub-particulars, particular 3 is proven not only in relation to recording but also undertaking this activity.

Particular 4 - Did not undertake, and/or record undertaking, Wales Applied Risk Research Network (WARRN) risk assessments, as required, in respect of …..

23. As with particular 3, this particular is relevant to those patients in respect of whom the Registrant was the Care Coordinator. As with particular 3, the Panel is satisfied that the Registrant was required to undertake a risk assessment for each of the patients alleged.

24. The Registrant’s case in relation to WARRN risk assessments is similar to that in relation to CTPs, namely that she did not contend that they were produced in writing, but that completing a risk assessment was an on-going consideration whenever she saw patients. The Panel finds that
 
the Registrant’s acceptance that there was no written risk assessment is supported by the audit document. The Registrant’s case is that she did consider risks with the patients and took appropriate action having considered the matter.

25. The Panel accepts the evidence of Dr LA that at the relevant time the Board’s policy in relation to WARRN risk assessments was that they were to be completed as part of the initial assessment and then updated at least yearly.

26. Having carefully considered the matter, the Panel finds that the actions undertaken by the Registrant were insufficient to satisfy the requirement that she should undertake a WARRN risk assessment. It follows that with regard to all the patients identified in the sub-particulars, that particular 4 is proven not only in relation to recording, but also undertaking this activity.


Decision on Grounds

27. The task of the Panel has been to decide if the proven facts amount to misconduct and/or lack of competence.

28. The conclusion of the Panel is that this is not a case of lack of competence. The Panel is satisfied that the Registrant knew what she was required to do and had the ability to do them. Included in the exhibited patient notes are examples of clear and detailed case records. Similarly, although few in number, there are examples of satisfactorily completed CTPs and WARRN risk assessments.
29. In deciding whether the proved facts amounted to misconduct the Panel has taken full account of the context in which the failings occurred. One was that the Registrant found her working environment difficult, having, in the relevant period, several managers to whom she reported in different capacities. The Panel finds that there were aspects of the management structure which were unclear. This may well have contributed to difficulties for the Registrant in raising her health issues and how this was impacting on her work.

30. Another relevant issue is that the Registrant was experiencing very difficult circumstances in her private life as well as a number of health problems which extended over several years. This resulted in lengthy periods of sick leave and, on the Registrant’s evidence, affected her performance during the periods when she worked. The Panel has taken full account of these factors, as it has of the fact that the Registrant was not the only practitioner whose compliance with the Board’s expectations was less than complete.
 
31. Whilst acknowledging that the management structure was less than ideal, the Panel finds that the Registrant did not make it clear to Mr PH, her operational line manager, that she was struggling with her workload. Furthermore, the Panel finds that the real personal and health difficulties that were being experienced by the Registrant cannot amount to an excuse for the shortcomings the Panel has found because of the clear HCPC obligation to limit work or stop practising if performance of judgement is affected by health. This was an obligation the Registrant had as an autonomous practitioner. In fact the Registrant continued to see and treat patients when she was not performing to a satisfactory standard, not least by failing to undertake CTPs and WARRN risk assessments. The evidence before the Panel is that the Registrant sought to shift responsibility to others for ensuring all managers were aware of her health issues. She felt that her managers should have made appropriate arrangements to accommodate her health needs. The Panel considered that the onus was on the Registrant to take action if she felt that the working environment needed to change so that she could practise safely and effectively.

32. The Panel finds that the facts proved by them demonstrate that there were breaches of the following standards of the HCPC’s Standards of conduct, performance and ethics, namely:
• Standard 1, “You must act in the best interests of service users”;
• Standard 7, “You must communicate properly and effectively with service users and other practitioners”;

• Standard 10, “You must keep accurate records”; and,
• Standard 12, “You must limit your work or stop practising if your performance of judgement is affected by your health”.

Furthermore, the manner in which the Registrant practised at the relevant time was inconsistent with a level of performance that would be expected as stated in the HCPC’s Standards of proficiency for Practitioner psychologists.

33. The Panel is satisfied that the matters found were serious. The HCPC’s case is not advanced on the basis that tangible physical harm resulted to any of the Registrant’s patients, but given that the shortcomings related to CTPs and risk assessments there was clearly a risk that they might have done so. There was also scope for patients to lose confidence in the treatment process they were undergoing and for the Board’s reputation to be tarnished. Although the Panel was not provided with contemporaneous documentary evidence relating to the matter, the Panel did receive some evidence that one of the patients included in the particulars being considered by the Panel was sufficiently distressed or
 
annoyed by knowledge of the Registrant’s lack of case records that legal proceedings were threatened.

34. Having given the matter very careful consideration the Panel finds that the threshold for categorising the factual findings as misconduct has been reached.


Decision on Impairment

35. In her evidence given to the Panel in January 2019, the Registrant acknowledged that she had been wrong to act as she did and expressed regret for her actions. The Registrant also demonstrated that she was able to reflect on what may have contributed to her misconduct, for example the various health and other personal problems that had contributed to her feeling overwhelmed. She also accepted that she recognised that the responsibility for completing the required records was her personal responsibility. It is also significant that after her employment with the Board was terminated, the Registrant ceased to practise as a Psychologist. She took time while her health stabilised and then tested her ability to work in a setting that did not require her HCPC registration before resuming work as a Psychologist in a more specialist and structured environment. All of these matters are positive and are to the Registrant’s credit.

36. When the Panel reconvened in May 2019, for the purposes of completing its determination on the issues of facts, statutory grounds and current impairment of fitness to practise, the Registrant submitted further documentary evidence and gave further oral evidence relating to the issue of current impairment of fitness to practise.

37. Taking into account the Registrant’s most recent evidence, the Panel finds that she has made significant progress regarding insight and remediation. As regards remediation, the Registrant has, in her current role, set an objective around record keeping in her Personal Development Review process. She submitted evidence of the objective, and her progress as demonstrated by the records of regular supervision. The supervision records comment positively on record keeping and case notes. She also submitted evidence of successfully completing an online training course entitled “Documentation & Record keeping Level 2” undertaken in early May 2019.

38. As regards insight, the Panel has taken into account her most recent reflection document entitled, “Overview of reflections and learning from the experience” and her oral evidence. The Panel finds that the Registrant had reflected on the misconduct found proved and clearly identified the steps she would take were she to become unwell in the future, for example, she would notify her managers and she would take
 
time off work. However, whilst the Registrant has stated that she takes full responsibilities for her actions, nevertheless in that recent statement she stated, “I strongly feel that there would have been a very different outcome if my requests for help at work had been responded to, adequate support had been offered and sickness absence processes had been followed by my line manager.” The Panel finds that this statement reflects the Registrant’s continuing belief that others shared her personal responsibility for her to be able to practise safely and effectively.

39. In addition, whilst the Registrant has stated that she recognised the impact of her misconduct on “her clients continuity of care”, she has not fully acknowledged the impact that not completing risk assessments and care planning could have had on those patients.

40. The Panel has considered whether there is continuing impairment of fitness to practise by reference to the professional activities that the Registrant’s HCPC registration would entitle her to undertake, and not simply by reference to the work in the specialist, structured environment to which she has recently returned to practise. Accordingly, the Panel concluded that there was some, albeit low, risk of repetition. For this reason the Panel has concluded that upon considering the personal component, the Registrant’s fitness to practise is currently impaired.

41. So far as the public component of current impairment of fitness to practise is concerned, the Panel is of the view that it is also necessary to reach a finding of current impairment of fitness to practise on that ground. The reasons for this finding are as follows:


• The need to keep accurate and up-to-date notes and records is central to safe and effective practice in all circumstances. It was particularly important in the case of the patients included in the Registrant’s caseload in view of the vulnerability of those patients and the importance of the documents in question, which included CTPs and risk assessments.

• The risks to which patients were exposed were not only of physical harm, but also the risk that they would become less receptive to psychological intervention.

• The Panel considers that the public would be concerned to know that a Principal Psychologist failed to undertake and record assessments for a large number of patients over a protracted period of time.

These facts require a finding of current impairment of fitness to practise.

42. The consequence of these findings is that the allegation that the Registrant’s fitness to practise is impaired by reason of misconduct is
 
well founded. Accordingly, it is necessary for the Panel to consider the issue of sanction.


Decision on sanction

43. The Panel made its decision on current impairment of fitness to practise on 17 May 2019. By that time the Registrant had submitted various documents, including a reflection document, supervision records and a certificate confirming attendance at a training course on documentation and record keeping. When the Panel reconvened on 11 October 2019 to consider the issue of sanction, the Registrant provided further documents, including a further reflection document. A recent email from the Hospital Director confirmed that during management supervision he had reviewed two patient records selected by the Registrant and had found them to be detailed, relevant and clear, being of a very good standard and causing him to have no concerns. In addition a further record of supervision undertaken on 18 July 2019 (i.e. following the decision of the Panel on current impairment of fitness to practise) was presented to the Panel. The supervision record disclosed that the case notes of two patients were selected at random. They were both described as “good, clear and contemporaneous”, and the comment “Well done Katherine” was added by the supervisor. Finally, the Registrant submitted twelve positive testimonials and character references from friends and former colleagues. Those from former colleagues spoke of her professionalism before the matters that underpinned this case.

44. On behalf of the HCPC, the Presenting Officer reminded the Panel of the proper approach to the imposition of a sanction and he urged the Panel to have regard to the HCPC’s Sanctions Policy. He identified mitigating factors, including the apology tendered by the Registrant and the insight demonstrated by her reflections. He also referred the Panel to the relevant paragraphs in the Sanctions Policy regarding aggravating factors. He did not advance any particular sanction.

45. On behalf of the Registrant, Ms Harris reminded the Panel of the information concerning the steps taken by the Registrant to address the shortcomings identified by the case, and the positive evidence that had been submitted on her behalf. Ms Harris submitted that the appropriate sanction would be a caution order, but that if the Panel did not feel able to impose such a sanction, no more restrictive outcome than a conditions of practice order should be decided upon.

46. The Panel accepted the legal advice it received as to the imposition of a sanction. Accordingly, a sanction is not to be imposed to punish a registrant against whom findings have been made. Any sanction decided upon should be no more restrictive than that required to protect the public, to maintain public confidence, to declare and uphold proper professional standards and to operate as a deterrent to other professionals who might stray from proper professional standards. As a finding that a registrant’s fitness to practise is impaired does not of itself require the imposition of a sanction, the first question to be answered is whether the particular findings in this case require the imposition of any sanction. If the answer to that first question is that a sanction is required, then the available sanctions must be considered in an ascending order of seriousness until one that addresses the proper sanction considerations is reached.

47. The Panel began its deliberations by identifying the aggravating and mitigating factors in the case. The aggravating factors were the number of service users in relation to whom required steps were not taken and the length of time over those defaults occurred. So far as mitigating factors are concerned, the Panel concluded that at the present time the Registrant has now demonstrated by her reflections that she has recognised her failings and shown insight. The Panel noted that the Registrant has used the time between adjournments to further develop her insight, reflection and remorse. The Panel notes that the Registrant has taken remedial action to address the deficiencies found. This has been through a combination of appropriate training, clinical supervision and clinical practice.

48. The Panel took note of the Registrant’s evidence in relation to how she has dealt with management changes at her current place of work, where she works as a lead psychologist in eating disorders in a hospital which is part of the Priory Group. The management changes she has experienced there are to some extent similar to that which she experienced at the Board. The Panel is reassured that the Registrant has responded to these changes proactively in that she has sought help by taking additional professional supervision to manage the changes. The Registrant has also arranged therapy sessions with a counsellor, as a result of her reflective practice. The Panel considered that these actions demonstrate her learning from the HCPC proceedings.


49. The Panel accepted that the shortcomings identified by its findings occurred against a background of a peculiar set of adverse circumstances at the time. The Panel took account of the positive testimonials relating to the Registrant’s performance before the events occurred, and the fact that has been no previous findings against her.

50. In its decision on current impairment of fitness to practise made in May 2019, the Panel identified the risk of repetition as low. It would now identify this as even lower. The Panel accepts as genuine, the Registrant’s stated desire to practise safely and effectively. Whilst the Registrant has made good progress in remedying her practise deficiencies, the Panel decided that a sanction is required so that the Registrant is reminded of the importance of complying with expected standards. It is also important that the public is reassured, and other professionals reminded, that serious shortcomings will not be overlooked. These are the factors that the Panel considered should determine its sanction decision.

51. The Panel concluded that the findings against the Registrant are too serious to result in no sanction being imposed. When the Panel then considered the range of sanctions and first considered a caution order, it decided that such an outcome would address the factors that have just been identified as of importance in this case. Although the Registrant’s failings could not be described as “minor”, it is relevant to record that they occurred some years ago, and, more importantly, have not been repeated. The Panel is satisfied that a caution order will serve to remind the Registrant of the importance of maintaining proper professional standards. It will also reassure the public that serious professional omissions will not be overlooked, just as it will warn other professionals who might feel tempted to ignore professional standards.

52. The Panel finds that a caution order is a necessary but sufficient outcome. Before confirming that a caution order should be made, the Panel considered whether a conditions of practice order would be appropriate. The fact that the Registrant has already voluntarily undertaken what she might have been required to do by such an order, the Panel concluded that a conditions of practice order would be both unnecessary and disproportionate.

53. As to the length of the caution order to be imposed, the Panel decided that it should be for three years. A shorter length would not be appropriate because of the seriousness of the findings. A longer period would fail to acknowledge the passage of time since the failings occurred and the fact that the Panel finds that they are unlikely to be repeated.

 

Order

ORDER: That the Registrar is directed to annotate the register entry of Dr Katherine Palmer with a caution which is to remain on the register for a period of three years from the date this order comes into effect.

Notes

A hearing was concluded on 11 October 2019 and a Caution Order for a period of 3 years was imposed.

Hearing History

History of Hearings for Dr Katherine Palmer

Date Panel Hearing type Outcomes / Status
11/10/2019 Conduct and Competence Committee Final Hearing Caution
16/05/2019 Conduct and Competence Committee Final Hearing Adjourned part heard
14/01/2019 Conduct and Competence Committee Final Hearing Adjourned part heard