Miss Karen Dhanjal
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1. The Panel determined to permit the hearing to go partly into private session, whenever matters relating to the Registrant’s private and family life were discussed, under Rule 10(1)(a) of the HCPC’s Consolidated Fitness to Practise Rules 2019, as amended (the Rules).
2. The Registrant was employed as a Locum Biomedical Scientist (BMS) at the Health Service Laboratories LLP (the Employer) from July 2017 to March 2018. On 5 March 2018 concerns were raised by a laboratory manager at the Employer about an invoice from the Registrant’s agency which indicated that more hours had been claimed by the Registrant on her timesheet than those that she had worked. The agency’s invoice to the hospital was based on the Registrant’s timesheets.
4. A Fitness to Practise panel of the HCPC heard the Registrant’s substantive case on 30 May 2019 and found the facts in Particulars of Allegation 1, 2, and 3 proved. It found that the facts found proved amounted to misconduct and that the Registrant’s fitness to practise was impaired on the grounds of protection of the public against fiscal impropriety and was also in the public interest in order to declare and uphold proper standards of conduct and behaviour and to maintain confidence in the profession and in the regulatory process.
5. That panel determined that the Registrant’s actions had consisted of serious acts of dishonesty that had occurred on several occasions over a number of months. They had occurred in the course of the Registrant’s locum work, when she had been in a position of trust, self-reporting her hours worked. That panel concluded that the Registrant had demonstrated a degree of insight by reason of her various admissions to the dishonesty, but that she had not indicated an understanding that her dishonesty had the potential to deprive the NHS of funding or of the effect that it could have upon the reputation of her profession. That panel also noted that the Registrant had repaid the dishonestly-acquired money. However, that panel could not be satisfied, in the absence of a greater degree of insight, that dishonest misconduct of this nature would not be repeated.
6. The substantive hearing panel determined that the sanction was one of a 12 months’ Suspension Order. The substantive hearing panel had found aggravating factors that this had been a planned, deliberate and dishonest set of actions perpetrated by the Registrant over a period of time, in a situation of a breach of trust against her employer involving several thousand pounds of public money, with limited insight shown by the Registrant and the risk of repetition.
7. That panel also found that the fact that the Registrant had no previous findings against her, that she had made early admissions and that she had cooperated with the HCPC process, with remorse expressed by her in her written representations and some limited insight, had been mitigating factors. It also considered as mitigating factors the fact that the Registrant had repaid the stolen monies, that she had personal difficulties at the time of the misconduct and that she had been considered to be clinically very competent and hard working.
8. The previous panel also considered a Striking Off Order. However, it stated that it had been aware that a Striking Off Order was a sanction of last resort and should only be used where there was no other way to protect the public, where there was a lack of insight and where a lesser sanction lacked a deterrent effect. That panel concluded that, although dishonesty frequently resulted in a Striking Off Order, such an order would have been disproportionate in all the circumstances.
9. The Review Panel has read all the documentation in the Review bundle, including information in email form, dated 20 April 2020, from the Registrant. The Panel took into account the evidence given by the Registrant who had attended this virtual hearing on this occasion. The Panel noted the submission from Ms Simpson. It accepted the Legal Assessor’s advice and took note of the HCPC’s Practice Note on Impaired Fitness to Practise. The Panel accepted that, whilst it should pay respect to the previous panel’s decision, its role today was to review the case in its entirety with the documents before it and assess the matters of impairment and sanction entirely independently of the previous panel’s decisions on these two aspects of the case, but not to re-visit their findings of fact or misconduct.
10. The Panel was minded that impairment must be judged in the present day, as the language of the Order was clear that the test is whether the Registrant “is” impaired today.
11. The Panel considered that the Registrant has still not sufficiently addressed in particular the concerns held by the original Panel, including the limited level of insight identified by that Panel and the commensurate risk of repetition. These concerns related, and continue to relate, to the deficiencies of insight identified in detail by the last Panel, being: i) an understanding by the Registrant that her dishonesty had the potential to deprive the NHS of funding and ii) of the effect that it could have upon the reputation of her profession.
12. In giving oral evidence today, the Panel noted the Registrant’s description of not “sugar-coating”, as she called it, the fact that she had been dishonest and that on several occasions in her oral evidence the Registrant expressed her motive as having been “pure greed”. She also stated that, at the time, she had not needed to act in that way for financial reasons.
13. The Panel concluded that the Registrant had demonstrated complete candour when describing her feelings in this respect. She stated that she was still struggling to understand why she had acted dishonestly in this way, but that the Minerva Counselling Group, a Group she had found to help her deal with these matters, had been assisting her to develop her understanding and she stated that she hoped that she could eventually reach the answer to that question. In the Panel’s opinion, the Registrant, in appearing at the hearing and giving evidence today, has made inroads into commencing remediation relevant to a finding of dishonesty, which although difficult to remediate, has been recognised as remediable.
14. However, even though the Registrant candidly referred to being “embarrassed" about her actions, she was unable to fully articulate, when asked, about her understanding of the effect of her actions, with the commensurate lack of integrity of a BMS, on her profession and from the public perspective. In the Panel’s opinion, the Registrant had been unable to fully answer how she felt about regaining the trust of her profession and the public and restoring her own integrity, in the situation where, on a number of occasions, she had falsified records, signed off as authorised on a number of occasions, and where she had benefited from her dishonesty.
15. The Panel concluded that the Registrant’s emphasis in her oral evidence had been on the physical measures that had been set in place by her employers and by her agency to provide what could be checks and balances against further dishonest acts. The Panel took into consideration that the Registrant had paid back the monies she took and gave evidence today that she had been doing some relevant and self-motivated charity work to help to repay her debt to Society and to the NHS, as she saw it. The Panel considered this to be evidence that she has moved a fair distance forward from her position at the substantive hearing and, overall, the Panel was impressed by her efforts. However, without any concrete proof in documentary form of this, of how, for example, her various employers and her agency had implemented the checks and balances against further dishonesty of which she spoke, the Panel could only give this less weight than if there been that type of evidence before it.
16. The Registrant had stated in her 20 April 2020 email that she was extremely sorry for her actions, which level of dishonesty she recognised as having no excuse, and which, overall, took the time from the people who were concerned: her former employer, the agency involved and the HCPC. The Registrant also stated that she felt that she had learned her lesson as “I looked into why and what happened.” She also referred to the fact that her employer managers and her agency would “be happy” to give references or answer questions about her work and performance. However, the Panel felt that this missed the point; the Registrant herself should have arranged all the documentary proof that she wished to rely upon to be before the Panel today, and how exactly she “looked into why and what happened” at the time of the events. This was another example of the Panel’s concern of the Registrant’s lack of insight into what remediation in full actually means. In the Panel’s judgement, despite considerable efforts during the hearing today at obtaining that information from her, this reflective email was not expanded upon, explained or enlarged upon sufficiently by the Registrant today in her oral evidence so as to establish if she has achieved full insight.
17. For these reasons, this Panel was not satisfied that the Registrant has adequately dealt with all aspects of insight that would allow her to be declared fit to practise. If genuine, relevant and proven remediation could be demonstrated, this, in turn, if achieved, could remove the risk of repetition and could put the Registrant on a potential path to full remediation. In the Panel’s judgement, this has yet to be addressed by the Registrant, who, the Panel concluded, was unable to fully understand the effect on her profession and on the public of her dishonest misconduct. In the Panel’s judgement, the Registrant’s written and oral evidence fell short of sufficient reflection into the reasons why she had acted dishonestly and what she had done/was doing to prevent it in the future, so as to avoid repetition. It would also have been beneficial, for example, to have supporting documentary evidence from the Minerva Counselling Service and references and testimonials from all her employers and from her agency.
18. The Panel was concerned that, without a full reflective piece along the lines of the Gibbs’ model, or other, in written form, addressing the continuing shortfall in the Registrant’s understating of, and insight into, her dishonest misconduct, including her attitude of mind, at the time, and now, to the breach of the Standard in relation to a lack of integrity and how that could be remediated, there would be a risk of repetition. In the Panel’s judgement, a declaration today that the Registrant was no longer impaired and was fit to practise would undermine the trust and confidence of the public in the profession and in the regulatory process and it would also fail to uphold the standards of the profession.
19. For these reasons, the Panel had determined that the Registrant’s fitness to practise remains impaired today.
20. In reaching its decision today, the Panel paid regard to the submission made by Ms Simpson and the Registrant. It accepted the advice of the Legal Assessor and also took note of the HCPC’s Indicative Sanctions Guidance. The Panel also accepted that it must approach sanction in ascending order of severity.
21. The Panel identified the following aggravating factors in this case today:
• The misconduct was planned, deliberate and dishonest;
• The misconduct was perpetrated by the Registrant over a period of time; The misconduct was in breach of trust;• The misconduct involved several thousand pounds of public money.
22. The Panel identified the following mitigating factors in this case today:
• The Registrant had repaid the stolen monies;
• The Registrant had personal difficulties at the time of the misconduct;
• The Registrant had been considered to be clinically very competent and hard working;
• The Registrant had no previous findings against her;
• The Registrant had made early admissions;
• The Registrant had cooperated with the HCPC process;
• The Registrant had attended today’s hearing and given evidence, which included information regarding charitable work she is currently undertaking in her own time;
• The Registrant has displayed remorse at all times;
• The Registrant has some developing insight.
23. The Panel first considered whether to take no action, mediation or impose a Caution Order, but determined that the serious nature of the dishonest misconduct required a sanction that enabled the Registrant to be answerable to her regulatory body in the future. In the Panel’s judgement, without such checks and balances, public confidence in the profession and in the regulatory process would be undermined, and where the standards of the profession would not be upheld and maintained.
24. The Panel next considered replacing the existing Suspension Order with a Conditions of Practice Order. The Panel took into account all mitigating factors, including that, soon after the events of the misconduct, the Registrant made full admissions to her dishonest misconduct and the reasons for it and she expressed remorse. Furthermore, she had repaid in full the dishonestly-acquired monies. It also noted that the Registrant has made some inroads into remediation since her final hearing. The Panel considered that the Registrant appears to have begun the journey to make a return to safe and effective practice. However, in the absence of documentary evidence supporting this, and the need to see further development of her insight and remediation, means that it is not appropriate to impose a Conditions of Practice Order at this time. The Panel understands that the Registrant is unrepresented, but, nevertheless, the onus is on her to satisfy any future Review panel that she has made sufficient inroads to fully remediate her dishonest acts, such as to restore the trust and confidence of the public and of the profession of Biomedical Scientists in her, and to ensure that the risk of repetition can be shown as low or removed.
25. Therefore, the Panel has concluded that the only appropriate, and proportionate sanction is that the existing Suspension Order be extended. The Panel considered a Striking Off Order. However, in the Panel’s judgement, this is a sanction of last resort and should be used only where there is no other way to protect the public, where there is a lack of insight and where a lesser sanction would lack a deterrent effect. The Panel concluded that, in all the circumstances, such an order would be punitive, unfair and disproportionate, as there is a way to protect the public and uphold the wider public interest with the lesser sanction of an extended Suspension Order. In addition, the insight that the Registrant has demonstrated to date allows for the potential for a staged return to safe and effective practice by way of the extended Suspension Order, if that addresses the matters of concern set out in this Determination.
26. The period of the Suspension order will be for the period of 3 months. The 3 month period will give the Registrant a chance, if she chooses (and it is she who must initiate this if she wishes), to provide further evidence of any existing and continuing insight and remediation on her part, so as to continue her path to full fitness to practise status, if she so choses. A future Review panel might find useful documentary evidence from the Registrant’s employers and her agency about the efforts made by her to deal with her past dishonest misconduct, and her current working practices in this regard, documentary references and testimonials from any employer, agency personnel or others, such as in relation to her charity work, and relevant documentary evidence from the Minerva Counselling Service.
A review was held on 22 May 2020 and the Panel decided to extend the Suspension Order for a further three months.
History of Hearings for Miss Karen Dhanjal
|Date||Panel||Hearing type||Outcomes / Status|
|22/05/2020||Conduct and Competence Committee||Review Hearing||Suspended|
|30/05/2019||Conduct and Competence Committee||Final Hearing||Suspended|