Mr Adam Stenning

Preliminary Matters:

Service

1. On or about the 23 March 2020 and acting in accordance with Government recommendations concerning the COVID-19 pandemic, the HCPC decided to suspend all public hearings. The HCPC also decided that during the period of suspension, there would be a new process whereby Notice of hearings would be sent by email.

2. The Panel has seen an email dated 16 July 2020 which was sent to the Registrant at the email address that appears on the Register for the Registrant. This letter gave notice of the date and time of today's hearing and that it would be conducted remotely. The Panel is satisfied that proper notice of these proceedings has been served on the Registrant.
Proceeding in the absence of the Registrant

3. The Panel has considered whether to proceed in the Registrant’s absence and has decided that it is in the interests of justice to proceed today in his absence. The Panel has taken care in reaching this decision and has considered the various matters set out in the HCPTS Practice Note on Proceeding in the Absence of the Registrant. It has also had regard to the submissions of Mr Lloyd for the HCPC and has received and accepted legal advice.

4. The Panel has seen a communication dated 28 January 2019 sent by the Registrant from his registered email address to the HCPC. It is satisfied that Notice of this hearing was sent by email to the Registrant at the same email address. The Panel understands that this is the only time the Registrant has engaged with these proceedings. The Panel notes that the HCPC bundle of documents for this hearing was sent by post to the Registrant’s registered address on 25 August 2020 and that this appears to have been returned undelivered. The Panel also notes that it is incumbent on a registrant to inform the HCPC if he or she changes their registered address.

5. The Panel has concluded that, in the absence of any explanation from the Registrant as to why he is not present and to his lack of engagement, the Registrant has voluntarily waived his right to be present at today’s hearing.

6. The Panel has also considered whether an adjournment would result in the Registrant’s attendance at another date. It notes the Registrant has not asked for an adjournment. It is satisfied that the Registrant’s lack of engagement with these proceedings means that he would not attend on any future date and that any adjournment would, therefore, serve no useful purpose. The Panel has also considered the effect of an adjournment on the two witnesses who are ready and due to give evidence. It has decided that although these witnesses will be able to rely on contemporaneous documentation when giving their evidence, an adjournment of these proceedings might still have an adverse effect on their memories of events, which took place some time ago.

7. The Panel is also of the view that there is a clear public interest in substantive hearings proceeding on the date on which they have been fixed to be heard, particularly where, as here, this is a serious matter.

Background:

8. The Registrant is a registered Operating Department Practitioner (ODP) who was a Mayday Healthcare agency worker at the time of the allegation.

9. On 21 December 2018, the Registrant worked a shift at the Tunbridge Wells Hospital as an agency ODP. On 2 January 2019, it was discovered that there was a discrepancy in the controlled drug (CD) book, where the drug administrations are recorded. A review of the CD book showed one ampoule of remifentanil as being “wasted”, one ampoule was shown as having been given to Patient 1, and the remaining ampoule was unaccounted for. Patient 1’s medical records showed no reference to remifentanil having been administered by the anaesthetist.

10. At the beginning and end of each shift, the ODP on duty is required to count the controlled drugs in front of a witness and make a record. At the beginning of the shift on 21 December 2018, RA witnessed the Registrant counting the controlled drugs. It would appear that there was no similar count of the controlled drugs by two professionals at the end of the day.

11. The next time that there was a count of the controlled drugs was on 2 January 2019. The Hospital had been closed for operations between 21 December 2018 and 2 January 2019. During this count, a discrepancy of 5mg of remifentanil had been discovered and the matter was investigated. During the course of the investigation, two entries made on 21 December 2018 by the Registrant were found to be incorrect. When the Registrant was interviewed about the matter, he confirmed that he had drawn up the drugs before becoming aware that they were not required. He claimed that he had disposed of the drugs. However, the entries in the CD book showed one ampoule of remifentanil as “wasted”, one ampoule as having been given to Patient 1. The remaining “missing” ampoule remained unexplained.

12. On 4 January 2019, the HCPC received a referral from Nuffield Health, Tunbridge Wells Hospital (the Hospital) regarding the 3 ampoules of remifentanil that were unaccounted for from 21 December 2018.

Decision on Facts:

Evidence:

13. The Panel heard evidence from two witnesses called by the HCPC.

14. Colleague A was the Consultant Anaesthetist at the Hospital at the relevant time. The Panel found that he had a good recollection of the events on 21 December 2018. He was a consistent and reliable witness who gave his evidence in a direct and forthright manner. If he did not know something, he said so.

15. At the relevant time, CP was the Clinical Services Manager at the Hospital. Part of her responsibilities included day to day organisation and management of the care provision of the operating department and co-ordinating the theatre staff. The Panel found her evidence to be consistent with her witness statement and the contemporaneous documents. She was reliable and had a clear understanding of the role of the theatre staff.

Particular 1a) was found proved

16. The Panel is satisfied on the evidence that the Registrant was working a shift as an agency ODP at the Hospital on 21 December 2018. The Panel accepts the evidence of CP that the Operating Department in the Hospital closed for the Christmas and New Year holidays on that date and did not re-open until 2 January 2019 when a discrepancy in the Hospital’s CD book concerning the drug remifentanil was discovered. It also accepts her evidence that she then conducted an internal investigation which included interviewing the Registrant on the same date. The Panel has seen a typed copy of her notes of that interview but not the handwritten notes from which it was taken. The Panel accepts that this is not a verbatim account of the interview.

17. The Panel has seen the entries in the CD book which relate to 21 December 2018. These show that on that date two 5mg ampoules of remifentanil were signed out from the controlled drugs cupboard. The Panel accepts the evidence of CP that she has examined the relevant entries and is able to identify that it was the Registrant who signed for the two ampoules on that date.

18. The Panel accepts the evidence of Colleague A that on 21 December 2018 he had not prescribed remifentanil for any of the four patients who were listed for surgery that afternoon. He explained that remifentanil was a strong opiate drug which was used rarely for shoulder procedures and was not required by him for these four patients. The Panel is satisfied that there was no clinical justification for signing out the two 5mg ampoules of remifentanil.

19. The Panel has seen the handwritten self-referral sent by the Registrant to the HCPC dated 2 January 2019 in which he referred to working an afternoon shift on 21 December 2018 and to having prepared incorrect drugs. Although the Registrant does not specifically refer to the drug as having been remifentanil, the Panel is satisfied that he was referring to that drug. The Panel has also seen an account of what the Registrant told CP when she asked him about the events of 21 December 2018.

20. The Panel therefore finds Particular 1a) proved.

Particulars 1b)i and 1b)ii were found not proved

21. In reaching its decision in relation to Particulars 1b)i and 1b)ii, the Panel notes that the relevant page of the CD book only shows the two 5mg ampoules of remifentanil referred to in Particular 1a) being signed out. This took the stock of that drug from an opening balance of 12 down to a balance of 10 at the end of 21 December 2018. The next entries are dated 2 January 2019. On this date, a stock control check was conducted on the controlled drugs cupboard and a discrepancy of 5mg of remifentanil was discovered. The Panel accepts the hearsay statement of GA, an ODP who carried out that stock control check. He went on duty that day and took over from another ODP (JS). GA took a 5mg ampoule of remifentanil from the controlled drugs cupboard as this was required that day. As he was doing this, he noticed that JS had already taken out a 5mg ampoule of remifentanil which was on the work surface. He returned the ampoule which he had removed to the controlled drugs cupboard. As JS had handed GA the keys to the controlled drugs cupboard, he asked her to conduct a controlled drug check with him on the stock in the cupboard. It was during this drugs check that a discrepancy of 5 mg of remifentanil was discovered and later reported to CP.

22. The Panel is not satisfied on the evidence that it is more likely than not that it was the Registrant who took the 5mg ampoule of remifentanil from the controlled drugs cupboard on or around 21 December 2018. The Panel accepts that this amount of the drug was found to be missing on 2 January 2019, and that CP asked the Registrant about it on the same date. CP made handwritten notes during what appears to have been a short interview with the Registrant. The handwritten notes were not produced in evidence, but the Panel has seen a typed version of those notes. The notes are not a verbatim account of the interview, but a summary of the questions asked, and answers given. The Registrant approved the handwritten notes. According to CP’s typed notes of the interview, she asked “What happened with the remifentanil? 1 missing, 1 shown as wasted in the CD book, 1 shows as given to Patient 1 in the CD book. On checking both these patients notes, no remifentanil was given, this makes a total of 3 missing?” The Panel notes that while CP did ask about three ampoules of remifentanil, she also incorrectly referred to checks being carried out on two patients’ notes. The Registrant’s answer as recorded in the notes was “Drawn them and disposed of them”. The Panel takes the view that due to the rolled-up nature of the question and the inaccuracy contained within it, the Registrant’s answer is ambiguous. The Panel also notes that CP’s evidence was that the Registrant was in a “jittery” state during the interview and appeared to want to leave to go home. CP also gave evidence that the Registrant had kept telling her that he did not remember what he had done that day and apologising. She recorded this in an Incident Report on the 2 January 2019. In the absence of clarification from the Registrant as to what he meant by his answer, the Panel takes the view that it cannot rule out that by his answer, the Registrant intended to admit only the two 5mg ampoules which he had drawn up and recorded in the CD book: one being “wasted” and one as having been administered to Patient 1. The Panel notes that the Registrant did not correct CP when she referred to have checked “both patients notes” which appears to be incorrect as there was only one patient referred to in the CD book. The Panel therefore finds itself being unable to say precisely when the ampoule went missing and cannot exclude the possibility that someone other than the Registrant removed it.

23. The Panel having decided that it is not satisfied that the stem of Particular 1b) is proved, did not have to consider the sub-paragraphs 1b)i and 1b)ii. Accordingly, the Panel takes the view that the HCPC has not discharged the burden of proving Particulars 1b)i or 1b)ii.

Particular 1c) was found proved

24. The Panel has seen the relevant page of the CD book which purports to show that on 21 December 2018, 5mg of remifentanil was taken from the controlled drugs cupboard and administered to Patient A. It accepts the evidence of CP that it was the Registrant who made this entry in the CD book. CP was familiar with his signature and identified this against the relevant entry. The Panel also accepts CP’s evidence that she had checked Patient 1’s medical notes which did not show that any remifentanil had been administered on 21 December 2018. The Panel also accepts the evidence of Colleague A that he had not administered remifentanil to Patient 1 on that date.

25. The Panel therefore finds that Particular 1c) is proved.

Particular 1d) was found not proved

26. The Panel has seen the relevant page in the CD book and reviewed the entry which purports to show that 5mg of remifentanil had been administered to Patient 1. It has already found in relation to Particular 1c) that it was the Registrant who recorded and signed that entry, and that no remifentanil had been administered to Patient 1 on the 21 December 2018. The Panel notes that there is a squiggle against the relevant entry which purports to indicate that someone had witnessed what had happened to the 5mg ampoule. The Panel is not satisfied that it is more likely than not that the Registrant recorded the signature of Colleague A to confirm what had happened to the 5mg ampoule of remifentanil. In his evidence, Colleague A stated that he had reviewed the relevant page of the CD book and confirmed that he had not signed as witness to a different entry and that the signature which appeared against that different entry was nothing like his signature. The Panel has also seen an email dated 3 January 2019 sent by Colleague A to CP in which he refers to “the signature in the CD book is not mine”. The Panel is satisfied that Colleague A only identified one witness signature as not being his and it was not the one against the entry in relation to Patient 1.

27. The Panel therefore finds that the HCPC has not discharged the burden of proving Particular 1d) and finds it not proved.

Particular 1e) was found proved

28. The Panel has seen the relevant page in the CD book and reviewed the entry which shows that 5mg of remifentanil had been wasted. The Panel accepts the evidence of CP that it was the Registrant who made the entry in the CD book in relation to this 5mg ampoule of remifentanil. The Panel accepts the evidence of Colleague A that he has reviewed the relevant entry and that it is not his signature in the column headed “Witness”. The Panel also accepts Colleague A’s evidence that he had not witnessed the Registrant “wasting” any remifentanil on 21 December 2018. He had not prescribed that drug for any patient and so there should have been none to be “wasted”.

29. The Panel also relies on the admission of the Registrant as set out in his handwritten self-referral letter to the HCPC dated 2 January 2019 in which he stated “I then failed to dispose of the drugs with a witness present and “double signed” the CD register”. The Panel also notes that in his interview with CP on the same date, the Registrant had been asked by CP “why was it ok to forge a signature” and the Registrant had responded “I knew it wasn’t right. I won’t sit here and justify it”. The Registrant also stated in that interview that Colleague A had not been present when he “wasted” the drug. The Panel is satisfied that in recording the signature of Colleague A in the “Witness” column the Registrant was confirming that the 5mg of remifentanil had been wasted and that that this had been witnessed by Colleague A when it had not been.

30. The Panel therefore finds Particular 1e) proved.

Particular 1f) was found not proved

31. The Panel has considered Particular 1f) only in relation to Particular 1a), there being no need to consider it in relation to Particular 1b)i or 1b)ii which it has found not proved. The Panel notes that in his closing submissions, Mr Lloyd for the HCPC conceded that there was no evidence that the Registrant had signed out the two 5mg ampoules referred to in Particular 1a) for his own personal gain and/or use. The Panel has considered all the documentation very carefully and finds that it is left in the position where it does not know what happened on 21 December 2018 when the Registrant signed out those two ampoules. According to CP, the Registrant kept telling her that he could not remember what had happened on that day and told her that he had disposed of the ampoules “I squirted into a sharps bin, not sure”. There is no evidence that anyone witnessed the Registrant removing the ampoules from the premises or even witnessed what he did with them once he had signed them out. The Panel has concluded that it cannot rule out that the Registrant did simply “waste” the two ampoules.

32. In these circumstances, the Panel is not satisfied that the HCPC has discharged the burden of proving that it is more likely than not that the Registrant removed the two ampoules referred to in Particular 1a) for his own personal gain and/or use. The Panel therefore finds Particular 1f) not proved.

Particular 2 was found proved in relation to paragraphs 1(c) and 1(e).

33. The Panel having found Particulars 1d) and 1f) not proved, has only considered Particular 2 in relation to Particulars 1c) and 1e).

34. The Panel has considered the submissions of Mr Lloyd for the HCPC on the issue of dishonesty. It has received and accepted legal advice as to how it should approach the issue of dishonesty. The Panel has considered both of the Particulars it has found proved and applied the test for dishonesty as set out in the case of Ivey v. Genting Casinos [2017] UKSC 67 (at para 74) [the Ivey test]. In applying the Ivey test, the Panel has first decided the Registrant's knowledge or belief as to the factual circumstances of his conduct in relation to both Particulars of the Allegation. The Panel understands that the Registrant’s belief does not have to be reasonable, so long as it is genuinely held. The Panel has then considered whether, based on the factual circumstances as it has found the Registrant believed them to be, his conduct was dishonest by the (objective) standards of ordinary decent people. The Panel understands there is no requirement that the Registrant must appreciate that what he has done is, by those standards, dishonest.

35. In relation to Particular 1c): the Panel finds that the factual circumstances on 21 December 2018 when the Registrant recorded the entry in the CD book that 5mg of remifentanil had been administered to Patient 1 when it had not been were that (i) the Registrant knew he was making a false entry and did so intentionally, (ii) he knew that he should not be saying that a patient had received a controlled drug when they had not, and iii) as an experienced ODP dealing with controlled drugs as a central part of his role, he knew that he was breaching the Hospital’s procedures and policies. The Panel is satisfied that it can rule out any confusion on the part of the Registrant who claimed in interview with CP that he had been distracted on 21 December 2018.

36. In these circumstances, and applying the Ivey test, the Panel has no hesitation in finding that the Registrant was dishonest when he made the entry in the CD book. The entry was false and pre-meditated, and it is satisfied that an ordinary, decent person would judge the Registrant’s conduct to be dishonest.

37. In relation to Particular 1e): the Panel finds that the factual circumstances on 21 December 2018 when the Registrant recorded the signature of Colleague A to confirm that 5mg of remifentanil had been wasted and witnessed as being wasted when this was not the case were (i) the Registrant intentionally recorded the signature of another person and knew that this was wrong, (ii) knew that he was breaching the Hospital’s procedures and policies in doing so, and (iii) he knew that by doing so, he was potentially implicating another person in his wrongdoing. The Panel notes that in his interview with CP, the Registrant acknowledged that he knew what he was doing was wrong and had not sought to justify it.
38. In these circumstances, and applying the Ivey test, the Panel has no hesitation in finding that the Registrant was dishonest when he recorded the signature of Colleague A in the CD book as witness to the “wasting” of the drug. The Registrant’s conduct was pre-meditated, and the signature was false, and the Panel is satisfied that an ordinary, decent person would judge the Registrant’s conduct to be dishonest.

Decision on Grounds:

39. In reaching its decision on the statutory ground of misconduct, the Panel has taken into account the submissions of Mr Lloyd for the HCPC and has received and accepted legal advice.

40. The Panel is satisfied that the Registrant’s conduct in relation to each of the Particulars which it has found proved, fell far below the high standards to be expected of an ODP.

41. In relation to Particular 1a), the Registrant should not have been signing out controlled drugs without either a prescription and/or any clinical justification for doing so. The drug in question was a very strong opiate. The Registrant would have known that this required a prescription and there is no evidence of any clinical circumstances that day which might have required the remifentanil without any prescription. As an experienced ODP, the Registrant would have been well aware of the importance of proper procedures being adhered to in relation to controlled drugs. The Panel considers that the Registrant’s conduct in this regard amounts to misconduct.

42. In relation to Particular 1c), the Registrant made a false entry in the CD book which suggested that a very strong opiate had been administered to Patient 1 when this was not the case. There was the potential that this could have impacted on the care of that patient in some way. The making of any false entry in relation to a controlled drug falls far below the standards expected of an ODP as it strikes at the heart of their role which is to properly manage controlled drugs. The Panel considers that this was a serious failing and therefore finds it amounts to misconduct.

43. In relation to Particular 1e), the Registrant recorded the signature of a colleague as a witness to “wasting” controlled drugs in the CD book and in doing so, implicated another professional. The Panel has already indicated that accurate recording of entries in the CD book is fundamental to the role of an ODP and it is satisfied that the Registrant’s action in relation to this entry in the CD book to be a serious failing and therefore finds it amounts to misconduct.

44. In relation to Particular 2, the Panel takes the view that the level of dishonesty involved in each of Particulars 1c) and 1e) amounts to misconduct. To make false entries in a legal record such as the CD book is particularly serious, and the Panel has no hesitation is finding this to amount to misconduct.

45. In reaching its decision on misconduct, the Panel has had in mind the HCPC Standards of Conduct, Performance and Ethics (2016) and has concluded that the following standards are engaged and have been breached:

Standard 9 - Be honest and trustworthy
Personal and professional behaviour

9.1 - You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

Standard 10
Keep accurate records

10.1 - You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

46. The Panel takes the view that the Registrant failed to make sure that his conduct justified the public’s trust and confidence in him and the ODP profession when he dishonestly made false entries in the CD book, including recording the signature of a fellow professional. The Panel also takes the view that by making those false entries, the Registrant did not ensure that he kept accurate records of the controlled drugs which he handled on 21 December 2018.

Decision on Impairment:

47. In reaching its decision on impairment, the Panel has considered the submissions of Mr Lloyd for the HCPC and has had regard to the HCPTS Practice Note “Finding that Fitness to Practise is Impaired”. It has received and accepted legal advice. The Panel has borne in mind that the purpose of this hearing is not to punish the Registrant for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise.

Personal component

48. In relation to the personal component, the Panel first considered whether the Registrant’s misconduct has put patients at unwarranted risk of harm and whether, looking forward, the Registrant is liable to put patients at unwarranted risk of harm. It has concluded that this is not a case where patients were put at risk as a result of the Registrant’s misconduct. There does not appear to be any evidence of concerns as to the Registrant’s clinical competence as it relates to patients.

49. The Panel then considered whether the Registrant’s misconduct has in the past brought the ODP profession into disrepute. The Panel is satisfied making false entries in a legal record and the signing out controlled drugs without clinical justification and/or a prescription can only bring the ODP profession into disrepute.

50. The Panel is also satisfied that the Registrant’s misconduct has breached fundamental tenets of the ODP profession which requires accurate and honest records to be kept and practitioners to be honest and trustworthy. In this case, the Panel has found the Registrant to have dishonestly made false entries in the CD book.

51. The Panel has also considered whether, looking forward, the Registrant is liable in the future to bring the ODP profession into disrepute, breach fundamental tenets of that profession or act dishonestly. In reaching its conclusion on these matters, the Panel has considered evidence of insight, remorse, reflection, and the likelihood of repetition of the misconduct involved in this case.

52. The Panel is satisfied that the misconduct in this case is capable of being remedied. The Registrant, as he made clear in his interview with CP, knew the correct procedures for recording the removal of controlled drugs in the CD book. He did not seek to justify his misconduct by suggesting otherwise. It would appear from the evidence of CP, that the Registrant repeatedly stated that he was sorry for what he had done. The Panel notes that the Registrant made admissions to CP and also in his self-referral letter to the HCPC. However, as it is not clear to the Panel why he signed out the two ampoules in the first place and then falsely recorded what had happened to them in the CD book, the Panel cannot find that the Registrant has shown any insight into his misconduct. Simply to say, as he did, that he did not seek to justify his actions is not evidence of insight. There is no evidence that the Registrant has reflected in any way on his misconduct.

53. While the Panel considers that the misconduct is capable of being remedied and recognising that it is difficult but not impossible to demonstrate remediation in cases involving dishonesty, the Panel takes the view that there is no evidence that the Registrant has taken any steps towards remediation. Accordingly, the Panel is not able to exclude the risk of repetition of the misconduct in this case.

Public component

54. In relation to the public component, the Panel is satisfied, given the findings of fact in this case which involve false entries in a legal record and dishonest conduct, that public confidence in the ODP profession and its regulatory body, would be undermined if there was no finding of impairment in this case. The Panel is also satisfied that it would be failing in its duty to declare and uphold proper standards of conduct and behaviour in that profession if it did not find impairment in this case. It considers that a reasonable and informed member of the public would be very concerned if there was no finding of impairment in a case where a registrant’s misconduct involved dishonesty and false entries in relation to controlled drugs by a practitioner who knew what was required of him but did not put this into practice.

55. The Panel therefore finds, on the public component, that the Registrant’s fitness to practise is impaired.

56. Accordingly, the Panel finds, on both the personal and public component grounds, that the Registrant’s fitness to practise is impaired and the Allegation is well founded.

Decision on Sanction:

57. In considering the appropriate and proportionate sanction in this case the Panel has considered the guidance set out in the HCPC Sanctions Policy. The Panel has received and accepted legal advice. The Panel is aware that the purpose of any sanction it imposes is not to punish the Registrant, although it may have that effect, but it is to protect service users and to maintain confidence in the ODP profession and to uphold its standards of conduct and behaviour. It has also taken into account that any sanction it imposes must be appropriate and proportionate bearing in mind the misconduct involved.

58. The Panel has considered mitigating and aggravating factors. The Panel first looked at the mitigating factors. It notes that until the 21 December 2018, the Registrant had practised as an ODP without there being any previous regulatory proceedings against him. The Panel also notes that the Registrant made admissions when first asked about the matter by CP on 2 January 2018, and in his handwritten self-referral letter to the HCPC of the same date. The Panel considers that the misconduct in this case was a one-off incident. The only personal mitigation appears in CP’s notes of her interview with the Registrant when he told her that he had been distracted that day due to personal issues with regard to his phone having been cut off and his mortgage repayments. While the Panel does not find being distracted to be a mitigating factor, it does accept that there may have been some personal circumstances at play in the background.

59. The Panel then looked at the aggravating factors. The Panel considers that (i) its finding of dishonesty, and (ii) the implication of a fellow professional to be aggravating factors. In relation to the Registrant’s dishonesty, the Panel has had in mind the following paragraphs from the HCPC Sanctions Policy:

“57 Dishonesty, both in and outside the workplace, can have a significant impact on the trust placed in those who have been dishonest… It is likely to lead to more serious sanctions”

58 …..However, panels should bear in mind that there are different forms, and different degrees, of dishonesty, that need to be considered in an appropriately nuanced way. Factors that panels should take into account in this regard include:

• whether the relevant behaviour took the form of a single act, or occurred on multiple occasions;
• the duration of the dishonesty;
• whether the registrant took a passive or active role in it;
• any early admission of dishonesty on the registrant’s behalf; and
• and other relevant mitigating factors”.

60. The Panel has concluded that the Registrant took an active role in the dishonest conduct which took place during one shift on 21 December 2018 and was, in effect, a single act of dishonesty. The Panel has also concluded that the Registrant admitted his misconduct to CP on the 2 January 2019 when she first asked him about it, and as regards recording Colleague A’s signature in the CD book, did not seek to justify his actions. The Registrant followed this up by making admission in his self-referral letter to the HCPC of the same date.

61. The Panel has considered the available sanctions in ascending order of seriousness. It has decided that to take no action or to impose a caution order in this case would not be appropriate or proportionate given the seriousness of the misconduct concerned which involved dishonesty and false entries in a legal record relating to controlled drugs. The misconduct could not be described as relatively minor. The Panel has found that there is a risk of repetition. In these circumstances, the Panel considers that to protect the public and ensure that public confidence in the profession is not undermined, it must consider a more severe sanction.

62. The Panel has considered a conditions of practice order. The Panel notes that the Registrant has not engaged with the regulatory process since an email he sent to the HCPC in January 2019. It has no information about the Registrant’s current employment status and whether he has been maintaining his skills and knowledge. The Panel has no information to suggest that were it to impose a conditions of practice order the Registrant would agree to comply with it. The Panel has already concluded that there is a risk of repetition of the serious misconduct it has found in this case, in part due to lack of insight and lack of remediation. In these circumstances, the Panel has decided that it cannot formulate any conditions of practice which would be appropriate, workable and measurable and would address the issue of dishonesty.

63. The Panel next considered whether to impose a suspension order. It has had in mind the following guidance from the HCPC’s Sanctions Policy:

“121 A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:

• the concerns represent a serious breach of the Standards of conduct, performance and ethics;
• the registrant has insight;
• the issues are unlikely to be repeated;
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”

64. The Panel has found the misconduct in this case to be serious. While it also considers it to be capable of being remedied, the Registrant’s lack of insight into his misconduct and his lack of engagement means that the Panel has seen no evidence to suggest that the Registrant is likely to take steps to resolve or remedy his misconduct. The Panel has found that there is a risk of repetition. The Panel has therefore decided that a Suspension Order is a disproportionate sanction as it would not adequately protect the public interest in this case.

65. The Panel then considered whether the appropriate and proportionate sanction in this case is a striking off order. It has borne in mind that such an order is “a sanction of last resort for serious, persistent, deliberate or reckless acts involving” … “dishonesty” [paragraph 130 of the Sanctions Policy]. The Panel has found the misconduct to be serious and deliberate.

66. The Panel has had in mind paragraph 131 of the Sanctions Policy:

“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession and public confidence in the regulatory process. In particular where the registrant:

• Lacks insight;
• Continues to repeat the misconduct …
• Is unwilling to resolve matters.

67. The Panel has already noted the Registrant’s lack of insight and considers that this, together with his lack of engagement with these proceedings, indicates an unwillingness to resolve matters. Certainly, there is no evidence which suggests that he wishes to address his misconduct and move forward. The Panel considers that a striking off order is required in these circumstances. The Panel considers that a striking off order is also required in order to declare and uphold proper standards of conduct and behaviour in the profession and to maintain public confidence. The Panel has therefore decided that the appropriate and proportionate sanction in this case is a striking off order.

Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

European Alert Mechanism:
In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been restricted/prohibited.
You may appeal to the County Court against the HCPC’s decision to do so. Any appeal must be made within 28 days of the date when this notice is served on you. This right of appeal is separate from your right to appeal against the decision and order of the Panel.

Interim Order Application:

1. Mr Lloyd for the HCPC applied for an Interim Order in this case and for the Panel to proceed in the absence of the Registrant as he had been put on notice of the possibility of this application in the Notice of hearing emailed to him on 16 July 2020.

2. The Panel has decided to hear this application in the absence of the Registrant as it is satisfied that he has been notified that it may be made, and he has voluntarily absented himself from the whole of this hearing and has not engaged with the regulatory process since January 2019.

3. The Panel has made a finding of impairment in this case on both personal and public components and decided that the appropriate sanction is a Striking-off Order which will not take effect until 28 days from the date when the Registrant is served with notice of this decision or the outcome of any appeal that he may make against that Order.

4. For the reasons set out in the substantive decision above, the Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001 for a period of 18 months.

Interim Suspension Order:

The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Mr Adam Stenning