Mrs Susan J Leech

Profession: Chiropodist / podiatrist

Registration Number: CH17977

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 09/09/2019 End: 17:00 09/09/2019

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

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Allegation as amended at Substantive Hearing: 

Whilst registered as a Chiropodist / Podiatrist, you:

  1. Provided receipts for treatment to Patient A which were signed by you and/or included your registration number regarding treatment provided on some or all of the occasions listed in Schedule A. 
  1. Your actions at 1 above gave the impression that you had treated Patient A. 
  1. During a telephone conversation with an employee of Simply Health on 19 October 2016 you claimed that only four treatments had been provided to Patient A by a colleague rather than yourself. 
  1. During a telephone conversation with an employee of Simply Health on 17 August 2016 you stated that you ordinarily provided treatment to Patient A. 
  1. Found Not Proved.
  1. Your actions described at paragraphs 1-5 were dishonest. 

    6. The matters set out in paragraph 1 - 6 constitute misconduct. 

  1. By reason of your misconduct your fitness to practise is impaired. 

Facts proved: 1,2,3,4 and 6 (insofar as 6 relates to 1,2,3 and 4), Facts not proved: 5

Finding

Preliminary Matters

Service

1. The Hearings Officer provided the Panel with details of service of the Notice of Hearing and bundle upon the Registrant to her registered address and email address, confirming that following the initial Notice of Hearing, an amended Notice of Hearing had been served on the Registrant on 29 August 2019.

2. The Panel had regard to the HCPTS Practice Note in relation to Service of Documents and received advice from the Legal Assessor. It noted that incorrect dates for the hearing were referred to by both the Case Manager (email of 22 August 2019 referencing a hearing on 2 September 2019) and Presenting Officer (email of 2 September 2019 referencing 9 August 2019). However, the Registrant was notified of the date and time of the hearing via a letter dated 9 August 2019 (the “Notice of Hearing”) which was sent by first class post to her registered address and to her email address. Neither communication had been returned as undeliverable, and the Registrant had subsequently communicated with the HCPC in relation to the hearing. An amended Notice of Hearing was also sent to the postal and email address on the Register for the Registrant on 29 August 2019, and again neither communication was returned as undeliverable. Further, the Registrant was in regular communication with the HCPC in relation to the hearing. Notwithstanding the potential confusion caused by the references to incorrect dates, the Panel was satisfied that the HCPC had discharged its duty to serve documentation on the Registrant in accordance with the Health and Social Work Professions Order 2001 and the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003. 

Proceeding in Absence of the Registrant

3. The Presenting Officer submitted that it was in the public interest for the hearing to proceed in the absence of the Registrant. She outlined the chronology of the matter, noting that a substantive hearing took place on 10 – 11 September  2018, following which the panel imposed a Suspension Order, which is due to expire on 9 October 2019. The Presenting Officer invited the Panel to exercise its discretion to proceed with the case in the absence of the Registrant, stating that the Panel had already found good service and the Registrant was clearly aware of the proceedings, having informed the HCPC by an email dated 20 August 2019 that she would neither attend nor be represented at the hearing, which position was confirmed by an email from the Registrant dated 5 September 2019.  

4. The Panel noted the provisions of the HCPTS Practice Note in respect of Proceeding in the Absence of the Registrant, and took account of the advice provided by the Legal Assessor. The Registrant had been offered the opportunity to attend via video or telephone link but declined. The Registrant had not indicated any desire to be represented at the hearing, nor had she sought an adjournment. Included in the Notice of Hearing was confirmation that the hearing could proceed in the absence of the Registrant.  She was therefore on notice that the hearing could proceed.

5. The Panel was satisfied that it was appropriate for it to exercise its discretion to hear the matter in the absence of the Registrant.  Although proceeding in absence may disadvantage the Registrant, it was satisfied that she was aware of the hearing (the Panel having already found that there had been good service in relation to the Notice of Hearing) and given her email of 5 September 2019. The Registrant had chosen not to be represented. It considered that the public interest in proceeding outweighed any potential prejudice which may be suffered by the Registrant. It was satisfied that the Registrant had voluntarily absented herself from the proceedings.

Background

6. The Registrant is a Chiropodist / Podiatrist registered as such with the  HCPC. She was the Director of SLA Healthcare Ltd (SLAH Ltd), which  provided footcare services to individuals. Some individuals reclaimed  the cost of these services under healthcare plans, but the healthcare  plans required that the services be provided by HCPC registered healthcare professionals.

7. In 2016 it came to light that a patient had reclaimed the cost of  professional  services said to have been performed by the Registrant  which had in fact been provided by an unregistered colleague of hers.

8. Following a hearing of the Conduct and Competence Committee on 10 – 11 September 2018, which was not attended by the Registrant, a number of particulars alleged were held to be well-founded as set out above, and to amount to misconduct. The Registrant’s fitness to practise was assessed as being impaired on the personal and public components. A Suspension Order was imposed by that panel, of which this is the first mandatory review. That panel indicated that a reviewing panel may be assisted by:
- The personal attendance of the Registrant.

-  Evidence from the Registrant as to what she has learnt from these proceedings and the steps that she has taken to ensure such misconduct would never happen again.

-  How she would in the future, organise her business operations, so as to avoid a repetition of the matters found proved.

-  Evidence from between the date of the order and the review of the order, as to her honesty and integrity. 

9. Following the imposition of a Suspension Order, the Registrant requested voluntary removal from the Register. The HCPC had notified the Registrant that it was minded to accept voluntary removal, however it did not receive the required information in support of this application from the Registrant. In August 2019, having listed this matter for consideration of the voluntary removal application, the HCPC received information which suggested that the Registrant had in fact been working as a Chiropodist registered with the HCPC whilst suspended.

10. As well as being provided with the bundle of documents submitted by the HCPC for the review hearing, the Registrant was contacted by the Presenting Officer via email in respect of the hearing. She requested information from the Registrant in support of her request for voluntary removal from the Register, and also sought a response to the allegation that the Registrant had been working as a Chiropodist while subject to a Suspension Order.

Evidence and Submissions

11. The Presenting Officer outlined the chronology of the matter to the Panel and called Witness 1, Administrator at a care home, to give evidence to the Panel in respect of the services provided by the Registrant to the care home. The Panel found Witness 1 to be credible, consistent and knowledgeable about the matters which were being considered. She had a thorough grasp of the relevant documentation and answered questions from the Panel in a straightforward manner, identifying when she was unable to assist. The Panel was grateful to her for her assistance.

12. The Presenting Officer submitted that the Panel could not go behind the original findings but were tasked with assessing the level of impairment of the Registrant. She invited the Panel to consider whether, on the information available to it, the Registrant is fit to practise and determine what, if any, sanction is appropriate. She confirmed that it was the HCPC’s position that the Registrant was either certifying that she had provided chiropody services when in fact she was acting as a foot health professional, or she was providing chiropody services when suspended – neither scenario being satisfactory. The Presenting Officer noted that the panel at the substantive hearing had determined that the Registrant was impaired on the personal and public elements of the test for impairment and had indicated the information which the Registrant may wish to provide to assist a reviewing panel. It was the HCPC’s position that the Registrant remained impaired.

13. If the Panel found the Registrant to still be impaired, the Presenting Officer confirmed the powers available to it, and that the HCPC would encourage the Panel to strike the Registrant from the Register in view of her lack of insight or remorse and the risk of repetition. She referred the Panel to the Registrant’s acceptance of the serious nature of the failings and her repeated statements that she no longer wished to be registered.

14. The Panel listened carefully to the submissions made by the Presenting Officer, and considered all of the documentation provided to it. It accepted and applied the advice of the Legal Assessor in relation to the proper approach to determining this matter. It also had regard to the policies adopted by HCPC in relation to the approach to take to Fitness to Practise proceedings. It also noted and applied the following Practice Notes adopted by the HCPTS:
a) Review of Article 30 Sanction Orders;

b) Unrepresented Registrants;

c) Finding that Fitness to Practice is Impaired;

d) Drafting Decisions;
 
 as well as the Standards of Conduct, Performance and Ethics issued by the HCPC to all registered professionals.

15. The review process is to consider whether the Registrant’s fitness to practise remains impaired and if so, whether the existing order or another order needs to be in place to protect the public. The key issue which needs to be addressed is what, if anything, has changed since the current order was imposed. The factors to be taken into account include:
a) the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decision;

b) the degree of insight shown and whether this has changed;

c) the steps which the Registrant has taken to maintain or improve her professional knowledge and skills;

d) whether any other fitness to practise issues have arisen;

e) whether the Registrant has complied with the existing order. 

16. The Panel was obliged to consider whether the concerns which led to a finding of impairment at a hearing in September 2018 remain. As the decision in Abrahaem v GMC [2008] EWHC 183 (Admin) indicates, in practical terms this places a “persuasive burden” on the Registrant to demonstrate at a review hearing that she has fully acknowledged the issues which led to the original finding and has addressed them sufficiently, “through insight, application, education, supervision or other achievement...”.

17. The Panel reminded itself that when reviewing sanctions under Article 30 of the Health and Social Work Professions Order 2001, a reviewing panel may:
a) confirm the order;
 
b)  extend, or further extend, the duration of the order; 
  
c)  reduce the duration of the order;

d) replace the order with any other order which the Panel could have made (to run for the remaining term of the original order); or
 
e) revoke the order or revoke or vary any condition imposed by it.

18. The decision reached by the Panel must be proportionate, striking a fair balance between interfering with the Registrant’s ability to practise and the overarching objective of public protection. Of particular relevance to the Panel is whether the concerns raised in the original finding of impairment had been sufficiently addressed, with the burden on the Registrant to demonstrate that she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently.

19. The Panel was concerned that the Registrant was not engaging with the HCPC in a meaningful way save in respect of her desire to be voluntarily removed from the Register. Her assertion to the HCPC, that she had retired, was not consistent with the information received by the HCPC which indicated that she continued to provide chiropody services to patients at a care home. The Panel was grateful to Witness 1 for confirming that the care home only became aware of the regulatory proceedings as a consequence of asking the Registrant for her professional qualifications and registration in compliance with a request from the head office of the care home group. Witness 1 confirmed that if the Registrant had notified the care home of the regulatory proceedings, and the outcome thereof, at the time, it was likely that she would still have been retained to provide services to the residents. It was the Registrant’s failure to tell them of the issue that was of concern and resulted in them suspending her from the provision of services to residents.

20. The limited information provided to the Panel by the Registrant did not mitigate the risks identified by the substantive panel. The Registrant had communicated with the HCPC in relation to potential voluntary removal, however she had not attended the review hearing or made substantive submissions to the Panel, save for asserting in her email of 3 September 2019 that “there was no intention on my part to be considered to be operating as a Chiropodist but that the misunderstanding was on the part of the administrator [Witness 1] who did not check the records provided within her office”. The Registrant did not accept that she was in any way responsible for the lack of clarity about the provision of her services to residents of the home, nor did she provide any of the information which the substantive panel helpfully outlined as being information which would be of assistance to the Panel. It appeared to the Panel that the Registrant was aware that the title of Chiropodist was protected and that there were benefits to registration, as evidenced by her renewal of her registration every two years. At renewal, every registered professional is required to confirm that they comply with the Standards relevant to their profession and to the Standards of Conduct, Performance and Ethics adopted by the HCPC. The Panel considered that the Registrant had breached the following standard:
9.  Be honest and trustworthy - specifically
9.1 - You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

21. Having conducted an assessment of the risks identified in this matter, the Panel was satisfied that the Registrant would continue to pose a risk to the public if allowed to return to unrestricted practice at this point; as although she had informed the HCPC that she was retired, there was information to suggest that she had not been open with the care home which secured her services for their residents as to the regulatory proceedings, merely telling them when they accidentally found out she was suspended that it was “an ethical issue”. She had not provided any evidence of insight into the failings identified during the substantive hearing, or any evidence as to what steps she had taken to remediate her conduct. Further, a reasonable and well-informed member of the public would be concerned if no action was taken to restrict the Registrant’s practice - public confidence in the profession and the regulatory process would be seriously undermined given the nature and gravity of the Registrant’s shortcomings.

22. The Panel considered that she had abused her position of trust as a registered professional providing services to vulnerable service users, and that she had not been open with the care home.

23. The Panel was satisfied that the Registrant remained impaired on both the personal and public components and it therefore went on to consider what, if any, order was necessary and proportionate with regard to the protection of the public and in the wider public interest. It had regard to the recently revised HCPC Sanctions Policy.

24. The Panel identified the following mitigating factors in this matter:
(a)     the Registrant had accepted the majority of the allegations from an early point in the regulatory process;
(b)     no patients had been directly affected by the Registrant’s conduct;
(c)      the Registrant had an unblemished regulatory record prior to these proceedings;
(d)      the Registrant engaged to a limited extent with the regulatory process. 

and the following aggravating features of this case:-

(e)     the Registrant’s failings related to fundamental aspects of practice of registered professionals – the requirement to be honest and trustworthy;
(f)       the period of time over which the Registrant had continued her misconduct and its repetitive nature;
(g)      the lack of insight, particularly in respect of the impact of her conduct on her fellow professionals and the wider community.

25. Given the serious nature of the failings identified, which had been repeated over a sustained period, the Panel considered it would be inappropriate to take no further action or issue a Caution to the Registrant.

26. Although it was possible for a registrant to remediate dishonest conduct, the Panel did not believe that, given the information available to it, an adequate level of protection could be achieved through the imposition of a Conditions of Practice Order at this time. Further, the Registrant had indicated that she had no desire to return to practice. The Panel concluded that on the current information available to it, conditions would be insufficient to address the issue of trust and confidence in the profession and the requirement to uphold the integrity of the regulatory process. However, a Conditions of Practice Order may have been appropriate in the event that the Registrant indicated a wish to return to practice and provided information as to the level of her insight, remorse and remediation.

27. The Suspension Order imposed in September 2018 was appropriate to try to facilitate the Registrant’s return to the profession, given that the misconduct was serious but capable of being remediated. The Panel had regard to the consequential impact a further Suspension Order would have on the Registrant, and the fact that she appeared to have failed to comply with the terms of the existing Suspension Order. It noted her repeated assertions that she had retired from the profession, and that this seemed to be at odds with the fact that she had provided services categorised by the care home as “chiropody” as recently as 5 August 2019. It was conscious that Witness 1 was unable to assist with the precise nature of the services provided, however, the sheet the Registrant signed to obtain payment for the provision of services to residents of the care home was entitled “Chiropody”, and she had only amended that description on one occasion to “Foot Care” – 28 May 2019 which was after the date when the Registrant had been questioned about her registration with the HCPC by Witness 1. The Panel therefore concluded that the imposition of a Suspension Order would not be appropriate or proportionate in the circumstances of this case.

28. The Panel then considered an order striking the Registrant from the Register. It was satisfied that this was the only sanction which would afford the appropriate protection of the public given the Registrant’s current lack of remorse, insight and remediation.

29. It considered that the Registrant’s interests were outweighed by the Panel’s duty to give priority to the public interest and maintain confidence in the Regulator. It would be wrong to maintain the Registrant in a cycle of mandatory reviews given her repeated assertions that she no longer wished to be a registered professional, and that she had no intention of returning to practice. It was satisfied that no lesser sanction would be appropriate in the particular circumstances of this case.

30. Given the Panel’s findings in relation to the Registrant’s attitude towards the regulatory proceedings, in particular the failure to comply with the Suspension Order, the Panel determined that it was appropriate and proportionate for the Suspension Order imposed on 11 September 2018 to be revoked with immediate effect and replaced with a Striking Off Order.

 

Order

That the Registrar is directed to strike the name of Mrs Susan J Leech from the Register with immediate effect.

Notes

No notes available

Hearing History

History of Hearings for Mrs Susan J Leech

Date Panel Hearing type Outcomes / Status
09/09/2019 Conduct and Competence Committee Review Hearing Struck off
10/09/2018 Conduct and Competence Committee Final Hearing Suspended