Mrs Martina King

Preliminary Matters
Service
1. The certificate of the Registrant’s registration shows both a postal address and an email address for the Registrant. The Panel is satisfied that on 5 November 2021 notice of the hearing today was sent by the HCPC to the registered email address of the Registrant. This notice informed the Registrant that a review of the current Suspension Order would take place today by video conference and email confirmation that the notice of hearing had been delivered was received.

2. The Registrant’s representative Mr Oliver replied by emails dated 7 and 23 November 2021, stating that the Registrant will not be participating in the hearing today and has no representations to put before the Panel. The Panel finds there had been good service of the hearing notice, to an email address of the Registrant.

Proceeding in absence of the Registrant
3. The HCPC made an application for the Panel to exercise its discretion to proceed in the Registrant’s absence. There has been good service of the notice of hearing and the Registrant is aware of the hearing today. The Registrant has not made an application for an adjournment. Further, the Registrant’s representative states the Registrant will not be attending and has no representations to make to the Panel. There is no indication that she is likely to attend on another date.

4. The Registrant did not attend the final hearing on 1-2 June 2021. The HCPC submits that the Registrant has voluntarily absented herself and the hearing should proceed today in her absence.

5. The Panel took advice from the Legal Assessor who advised the Panel to consider the guidance in the HCPTS Practice Note on Proceeding in the Absence of the Registrant. The Panel finds that the Registrant has clearly stated via her representative that she has made an informed decision not to attend this hearing. Adjourning the case today would serve no useful purpose. It is in the public interest to proceed in the Registrant’s absence in accordance with Rule 11 of the Procedure Rules.

Conducting part of the hearing in private
6. In the absence of the Registrant the HCPC made an application on her behalf that, evidence in relation to matters relating to her personal life or health, be considered in private. All HCPTS hearings are usually heard in public. It is a matter for the Panel’s judgment as to whether in the interests of the Registrant matters relating to her private life are heard in private, in accordance with the HCPTS Practice Note on Proceeding in Private. The Panel noted that within the documentation there were several occasions where the issues raised related to personal information about the Registrant. It considered that these personal matters should not be within the public domain. This being the case the Panel decided that if any personal issues are raised today they would be heard in private.

Background
7. The Registrant worked as a Clinical/Counselling Psychologist from 16 November 2009 to 16 January 2019. On 29 April 2018, Service User A reported concerns regarding the Registrant’s conduct during a session on 10 April 2018. An initial fact-finding investigation into this matter was undertaken. In June 2018, SD commissioned a disciplinary investigation, which was then conducted by MR.

8. On 24 October 2018, Service User C made a fitness to practise referral to the HCPC in respect of the Registrant’s conduct during a private therapy session, which took place on 5 October 2018. On 16 January 2019, prior to the conclusion of the investigation, the Registrant resigned from her employment.

The original panel’s findings
9. The final hearing panel found that Service User A’s description of her feelings demonstrated that she was caused distress by the Registrant’s disclosures, and to make disclosures of a highly personal and sensitive nature to a Service User on an acute mental health unit constituted a breach of professional boundaries.

10. On 5 October 2018, the Registrant had inappropriately disclosed matters of a personal nature causing distress to Service User C a patient receiving treatment in an acute mental health unit. Service User C felt vulnerable and this experience made her quite distressed.

11. In relation to two different service users, the Registrant breached professional boundaries by disclosing highly personal, distressing and sensitive information about herself contrary to the applicable policy on personal and professional boundaries. The Registrant’s disclosures related to the same issue which Service User A was dealing with. This was obviously likely to cause her distress. In relation to Service User C, the Registrant talked in detail about her family and employment circumstances. Service User C received no therapy and felt upset, let down and burdened by the Registrant’s disclosures of personal information.

12. Service Users A and C were concerned about the Registrant, as she appeared distressed when talking about her circumstances, which they found upsetting. Both Service Users should have received treatment from the Registrant, this was compromised by the Registrant’s disclosures about her own circumstances.

13. The Registrant’s actions breached the HCPC Standards of Conduct, Performance and Ethics, namely Standards:

1. Promote and protect the interests of Service Users and carers… Maintain appropriate boundaries.
1.7 You must keep relationships with service users and carers professional.
2 Communicate appropriately and effectively with service users and carers;
2.1 you must be polite and considerate,
2.2 you must listen to service users and carers and take account of their needs and wishes; and
2.3 you must give carers and service users information in a way that they need and understand.

14. The panel concluded that the Registrant’s actions fell far short of the standards expected of a registered Practitioner Psychologist. This behaviour, by the Registrant, is likely to be regarded as deplorable by fellow professionals, and the facts proved amount to misconduct. Furthermore, her misconduct occurred in a professional setting whilst the Registrant was responsible for providing therapy treatment to vulnerable Service Users, coping with their own acute mental health issues. The Registrant’s actions caused them further distress and worry, including about the Registrant herself.

15. The panel found the Registrant had not provided any evidence that she has insight into the impact of her actions, upon those Service Users. She did not appear to accept that her actions were inappropriate or breached the required professional boundaries. She sought to justify her actions and has not demonstrated any remorse or offered any apology. There was no evidence before the panel of any attempt by the Registrant to remedy her past actions and the Registrant has not engaged in the hearing process.

16. The Registrant’s misconduct in relation to Service User A; was repeated several months later with Service User C. After her being made aware of concerns about the disclosures to Service User A. There remained a risk of repetition of this potentially harmful misconduct in the future. The panel found the Registrant’s fitness to practise was impaired in respect of the personal component.

17. With regard to the public component of current impairment, the panel found the Registrant’s actions brought the profession into disrepute. Members of the public would expect a Practitioner Psychologist providing therapy to Service Users with acute mental health issues to maintain proper professional boundaries. The public would be concerned if the fitness to practise of a Registrant who had acted in this manner was nevertheless, not currently impaired. Confidence in the profession and this regulatory process is likely to be undermined if there is a finding of no impairment, under the public component.

18. The panel found a lack of insight on the part of the Registrant and a failure to appreciate the impact of her personal disclosures upon the Service Users. The Registrant did not engage with the final hearing, save that in a brief submission she stated she did not intend to renew her registration or engage further with the HCPC.

19. The Registrant had a long career as a Psychologist with no previous adverse fitness to practise history, and the Registrant has had difficult personal issues to deal with in her past. The Registrant referred herself to the HCPC in relation to the complaint by Service User C.

20. The panel found the Registrant had not appreciated the impact of her disclosures upon the Service Users or that she transgressed professional boundaries, and she had repeated her misconduct while similar concerns which had been brought to her attention, were being investigated. There had been no meaningful apology, expression of remorse or regret. There was an absence of any evidence of insight, and no evidence that her misconduct would be, or had been remediated. There was a risk of repetition should the Registrant return to practise given her lack of insight.

21. The panel found the HCPC Sanctions Policy (March 2019) factors indicating that no Order or a Caution Order may be appropriate were not present. The issues were not minor in nature or isolated. There was no evidence of insight or remediation and the risk of repetition was not low. A Caution would be insufficient to mark the seriousness of the findings and to maintain the confidence of the public and the profession.

22. The panel found Conditions of Practice were not appropriate, as it was not possible to address the concerns in the absence of the Registrant and without her cooperation.

23. The panel concluded that the Registrant might be able to resolve or remedy her misconduct if she engaged and concluded that a Suspension Order may be appropriate in the circumstances. A Striking-off Order would be disproportionate in the context of the Registrant’s long and previously unblemished record and the concerns found proved as at the date of the final hearing. A short period of suspension would appropriately mark the seriousness of the concerns. A Suspension Order would ensure public protection and safeguard the public interest. The Registrant was provided with an opportunity to demonstrate that she has remediated her past misconduct, at the review hearing.

Submissions by the HCPC today

24. Mr D’Alton summarised the background of the case as recorded in the decision of the previous panel. He sent an email to the Registrant on 19 November 2021 stating: …in the absence of any submissions or further evidence, the HCPC’s position will be to ask the reviewing Panel to impose a Striking Off Order.

25. The HCPC submits that the Registrant has not remediated and there remains a risk of repetition because she does not accept that the Service Users were uncomfortable with her behaviour or that she breached professional boundaries. There is no evidence of insight and the Registrant’s misconduct was serious. The previous panel gave guidance on steps the Registrant could take to assist this Panel, including a need for future engagement. There is an obligation upon the Registrant to address the concerns raised but she has failed to do so, suggesting her fitness to practise is still impaired. As is noted in the Article 30 Review Practice Note the reviewing Panel’s task: is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed. The decision in Abrahaem v GMC [2008] EWHC 183 (Admin) states there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he or she has fully acknowledged the deficiencies, which led to the original finding and has addressed that impairment sufficiently.

26. The HCPC submits that the Registrant’s fitness to practise is impaired under the personal component due to her serious misconduct. The Registrant has not remediated or apologised and there is a risk of repetition. There has been a complete lack of engagement and her behaviour was potentially harmful to Service Users. Her misconduct could be extremely harmful if repeated and there is no evidence of remorse or regret. The Registrant also remains impaired under the public component because public confidence in the profession and the regulator would be undermined if such a finding was not made.

27. If the Panel finds that the Registrant is still impaired, the HCPC submits that a Striking-off Order is the only appropriate disposal today.

Legal Assessor’s advice

28. The Legal Assessor advised that the Panel is dealing with a Review under Article 30(1) of the Health Professions Order 2001 and should take into account the HCPTS Practice Note: Review of Article 30 Sanction Orders.

29. Article 30(1) provides that a Conditions of Practice Order or Suspension Order must be reviewed before it expires and the reviewing Panel may extend, or further extend the period for which the order has effect, make an order which could have been made when the order being reviewed was made, or replace a Suspension Order with a Conditions of Practice Order.

30. Any order made following an Article 30(1) review only takes effect from the date on which the order under review expires, so the Registrant must continue to comply with the expiring order until then. The review process is not a mechanism for appealing against or ‘going behind’ the original finding that the Registrant’s fitness to practise is impaired. The purpose of review is to consider if 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.

31. The key issue to be addressed by the Panel is what, if anything, has changed since the current order was made. There is an obligation upon the Registrant to address the concerns raised. The Article 30 Review Practice Note states the Panel’s task: is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed. The decision in Abrahaem v GMC [2008] EWHC 183 (Admin) states there is a “persuasive burden” on the Registrant to demonstrate at a review hearing, that he or she has fully acknowledged her deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...

32. The factors to be taken into account include any steps which the Registrant has taken, to address any specific failings, or other issues identified in the previous decision. The degree of insight shown, and whether this has changed, the steps which the Registrant has taken to maintain or improve his or her professional knowledge and skills, whether any other fitness to practise issues have arisen and whether the Registrant has complied with the existing Order.

33. The decision reached today must be proportionate, striking a fair balance between interfering with the Registrant’s ability to practise and the objective of public protection. Given that part of the Panel’s task is to assess whether the fitness to practise of the Registrant remains impaired, the Panel should also take into account the HCPTS Practice Note on Finding Impairment, the HCPC Sanctions Policy and relevant Professional Standards Authority (PSA) guidance. For example, the PSA has stated that it is important to provide equally detailed reasons with regard to public impairment and personal impairment. The Panel should include specific considerations of public impairment and not simply repeat the reasons with regard to personal impairment because personal mitigation is less relevant when considering the need to uphold professional standards and maintain public confidence.

Decision

34. The Panel accepted the advice of the Legal Assessor that there is a persuasive burden on the Registrant to demonstrate to this reviewing Panel that she has taken sufficient steps to develop her insight and to remedy her misconduct. The Panel has concluded that the Registrant’s fitness to practise is still impaired under the personal and the public components. The Panel finds that has been no significant change since the previous hearing when the panel imposed a Suspension Order. There has been no engagement by the Registrant with this review and there has been no suggestion of any future engagement. The Registrant is adamant that she will not engage with the HCPC in the future and she has failed to acknowledge her misconduct. She is unwilling to remediate and does not accept she crossed boundaries in her behaviour towards Service Users A and C.

35. The Panel therefore concludes that the Registrant’s fitness to practise remains impaired on the personal component and on the public component because members of the public would not have confidence in the profession, or in the regulator, if the Registrant is permitted to return to unrestricted practice.

36. The Panel has considered the HCPC Sanctions Policy which states: 54. In cases where a service user has been harmed, or there was potential for harm to be caused, panels should be particularly mindful of any ongoing risk to service user safety, and any impact on public confidence in the profession. 55. Service user harm, or the potential for this, will be of particular importance in cases involving vulnerable service users. In these cases, the public expect that more serious action is taken to address concerns around conduct or behaviour.

37. The Panel has identified the following aggravating factors:

• There were serious breaches of the HCPC Standards of Conduct.
• There was repeated misconduct.
• The misconduct caused harm to Service Users A and C.
• The Registrant is currently impaired under the public and the personal components and she has not positively engaged with the HCPC process.
• She has not remediated her misconduct or engaged with this process.

38. The Panel identified the following mitigating factors:

• The Registrant was of previous good character with no previous disciplinary findings.
• She had personal problems during the relevant period.
• Her representative has contacted the HCPC to confirm her non-attendance.

39. The Panel’s finding of current impairment of fitness to practise means that the Panel has concerns about the Registrant’s current ability to practise safely and effectively. It is unlikely a panel would take no action, following such a finding of impairment. Therefore taking no action would not be appropriate to mark the serious nature of the misconduct and to protect the public in this case.

40. A Caution Order is likely to be an appropriate sanction for cases in which: the issue is isolated, limited, or relatively minor in nature; there is a low risk of repetition; the Registrant has shown good insight; and the Registrant has undertaken appropriate remediation. A Caution Order is not appropriate in this case because the issues are not isolated, limited, or relatively minor in nature. There is a high risk of repetition, the Registrant has not shown insight; and she has not undertaken any remediation.

41. A Conditions of Practice Order is likely to be appropriate in cases where: the Registrant has insight, the failure or deficiency is capable of being remedied, there are no persistent or general failures, which would prevent the Registrant from remediating, and appropriate, proportionate, realistic and verifiable conditions can be formulated. The Panel must be confident the Registrant will comply with the conditions, and a reviewing panel will be able to determine if those conditions are being met, and the Registrant does not pose a risk of harm by being in restricted practice. Conditions are less likely to be appropriate in the more serious cases.

42. The Panel has decided that a Conditions of Practice Order is not an appropriate sanction in this case, because there is a risk of harm, there has been no remediation and there is a lack of engagement. Therefore workable conditions cannot be formulated which would address the misconduct.

43. 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 HCPC Standards but the Registrant has insight. The issues raised are not likely to be repeated and there is evidence to suggest the Registrant is likely to be able to resolve, or remedy her failings. Any Suspension Order must be for a fixed period of up to 1 year, and it must be reviewed, by another HCPTS panel before it expires.

44. The Panel has decided that a further Suspension Order is not appropriate and proportionate in this case, having regard to the Registrant’s misconduct and the impairment of her fitness to practise. A Suspension Order would serve no useful purpose in a case where the Registrant does not intend to practise again.

45. The Sanctions Policy states a Striking-off Order is a sanction of last resort for serious, persistent, deliberate or reckless acts. 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, maintain public confidence in the profession, and the regulatory process. In particular, where the Registrant: lacks insight, or is unwilling to resolve matters.

46. The Panel concludes that the relevant criteria are fulfilled and the appropriate and proportionate sanction consistent with the Sanctions Policy is a Striking-off Order. There has been no engagement with this review process. The appropriate sanction is now a Striking-off Order. A further Suspension Order would serve no useful purpose and any lesser sanction would not be sufficient to protect the public or safeguard the public interest.

That the Registrar is directed to strike the name of Mrs Martina King from the Register from the date this order comes into effect.

The Strike Off order will take effect on 30 December 2021

History of Hearings for Mrs Martina King