Shanthiratne Semage

The panel at the Substantive Hearing found the following:
Facts proved: 1(a) and 1(b)
Facts not proved: none
Grounds: Lack of competence

The panel found the Registrant’s fitness to practise to be impaired and a Conditions of Practice Order for a period of 18 months was imposed as a sanction. This decision was reviewed on 14 November 2022 and the panel imposed a further Conditions of Practice Order for a period of 12 months from the expiry of the original Order.

Preliminary Matters

Parts of the hearing in private
1. At the commencement of the hearing, Ms Khorassani, on behalf of the HCPC, applied for a direction that parts of the hearing be conducted in private. The basis of this application was that the Registrant had previously, and today may wish to refer to matters relating to his and his wife’s health. The Registrant, agreed with this application.
2. The Panel was aware, in view of the legal advice it received, that rule 10 of the Conduct and Competence Committee Rules gives it a discretion to depart from the usual practice of holding hearings in public, where matters of health are involved. The Panel determined that any references to the Registrant’s health, or that of his wife, would be heard in private.

Background

3. The Registrant is a Biomedical Scientist registered with the HCPC. He was employed by Cambridge University Hospital NHS Foundation Trust (‘the Trust’) from 22 February 2005 until 23 November 2018.

4. The Registrant was initially employed by the Trust as a Trainee Biomedical Scientist. On 22 April 2008 he was promoted to the role of a Band 6 Advanced Biomedical Scientist within the Cervical Cytology Department. In this role, one of the Registrant’s responsibilities was to review and assess cervical cytology samples received by the Trust as part of the National Health Service Cervical Screening Programme.

5. According to the National Guidelines for performance in Cervical Cytology, issued under the NHS Cervical Screening Programme (the National Guidelines), once a practitioner is qualified to undertake primary screening of cervical cytology samples, the accuracy of their assessments is monitored.

6. The National Guidelines set out that a practitioner should review a minimum of 3,000 slides per year. They state that primary screeners should, as a minimum, accurately detect 95% of samples that display high-grade abnormalities and 90% of all or low grade abnormalities. If a practitioner does not meet these criteria, they are considered to be ‘out of range.’

7. As part of the Quality Control system to monitor the accuracy of a primary screener’s assessments, all samples assessed are checked by a second Biomedical Scientist undertaking a rapid review. However, if a practitioner was deemed to be ‘out of range’, the Trust would then implement a ‘double screening ’process of the samples, meaning that a second Biomedical Scientist would assess the slide again from the perspective of a primary screener.
8. The Registrant’s line manager was IM, who was, at the relevant time, the Chief Biomedical Scientist at the Trust. He was the Registrant’s line manager from September 2011 until November 2018, save for a two- year period from 2012 to 2014 when IM was on secondment. In his role as the Registrant’s line manager, IM was responsible for conducting formal and informal one-to-one meetings with the Registrant.
9. In or around May 2017, as a result of the monitoring process to detect a practitioner’s accuracy levels, the Registrant was identified as being ‘out of range ’and concerns were raised in relation to his competence. Those concerns related to the accuracy of the cervical cytology primary screening conducted by the Registrant. It is alleged that the Registrant did not consistently meet the National Guidelines for accuracy in relation to high grade and low (all) grade sensitivity slides. It is further alleged that the Registrant did not review the required number of cervical cytology samples in accordance with national guidelines.

10. On 31st May 2017, the Registrant was advised that the informal stage of performance management would begin. As part of the informal stage, a Performance Improvement Plan (PIP) was drawn up. Objectives and support were set out in the PIP and included the stipulation that the Registrant’s review of slides was to be ‘double screened’. The PIP also set out an increased frequency of 1-1 meetings with the Registrant ’s line manager.
11. The Trust was not satisfied that the Registrant achieved a sustained improvement, whilst on the informal stage of performance management and so on 14 November 2017, the Registrant was moved to stage 1 of the Trust’s formal Managing Performance Process. On 11 July 2018, the Registrant was moved to stage 2 of the Trust’s formal process. The Trust did not consider that the Registrant had successfully managed to address the concerns during the informal and formal periods of the performance management process. Consequently, the matter was referred to the HCPC on 7th December 2018.

Decision by the Substantive Panel made on 10 May 2021
12. Having determined the facts as set out above, the Substantive Panel proceeded to consider whether the Registrant’s failings as found proved, amounted to a lack of competence on his part and if so whether his fitness to practise was impaired.

13. The Substantive Panel determined that the matters found proved did amount to a lack of competence on the part of the Registrant. Its reasons, as stated in its determination are set out below. For ease of reference, the paragraph numbers in the determination have been retained and are shown in brackets.

a. The Panel considered that cytology screening is a narrow field of a Biomedical Scientist’s work. Nevertheless, it took into account that the standards for a Biomedical Scientist appointed into that field are set by the national guidelines. The Panel considered that there were three elements to the question of whether or not the facts found proved amount to a lack of competence, namely:

i. Did the Panel have a fair sample of the Registrant’s work by which to assess his level of competence?

ii. What would be the standards expected of a reasonably competent Biomedical Scientist?

iii. Were the standards attained by the Registrant unacceptably low when measured against the standards of a reasonably competent Biomedical Scientist?

Question 1

b. In relation to whether the evidence represented a fair sample of the Registrant’s work, the Panel considered the timeframe over which the alleged lack of competence occurred. The Panel acknowledged that the Registrant had not been permitted to review slides in October 2018, and so did not included this period in its assessment. Nevertheless, in terms of the annual requirement to review a minimum of 3,000 slides per year, the Panel considered that the Registrant had consistently fallen significantly below the required rate for period from October 2017 to September 2018, a period of around 11 months.

c. In terms of the sensitivity rate of detecting high grade and all grade abnormalities, the Panel considered that the Registrant had consistently fallen significantly below the required percentages for the period from February 2018 to September 2018, a period of around eight months. The Panel considered that in respect of both time and quantity, the evidence represented a fair sample of the Registrant’s work.

Question 2

d. The Panel bore in mind IM’s evidence that in practical terms, reviewing 3,000 slides in a year represented around two to three hours of work during the working day. Whilst the Panel accepted that there were other work responsibilities on the Registrant, it nevertheless considered that this was an achievable target for the Registrant, who had previously comfortably exceeded the minimum number of slides to review, including between February 2017 and August 2017. The Panel was, therefore satisfied that the national guidelines requiring an annual rate of reviewing 3,000 slides represented the standard to be expected of a reasonably competent Biomedical Scientist.
e. The Panel acknowledged that there was an element of subjectivity involved in reviewing a slide and assessing whether an abnormality was present. Nevertheless, it considered that this was taken into account by the national guidelines when setting the sensitivity levels for high and all grade abnormalities. Given the potential for harm for a patient, particularly if a high grade abnormality was not detected, the Panel was satisfied that achieving the percentages as set out in the national guidelines represented the standard to be expected of a reasonably competent Biomedical Scientist.

Question 3

f. The Panel had regard to the number of slides being reviewed by the Registrant when compared to the requirements set under the national guidelines. In October 2017, the Registrant’s annual rolling number of slides reviewed missed the requirement by over 400 slides. Between March 2018 and September 2018, the Registrant’s annual rolling number of slides reviewed missed the requirement by over 1,500 slides. In the Panel’s judgement, this rate was unacceptably low when compared against the standards expected of a reasonably competent Biomedical Scientist.

g. The Panel had regard to the percentages of high grade and all grade abnormalities successfully detected by the Registrant. Between February and August 2017, the Registrant missed the 95% detection of high grade abnormalities by less that 1%, which the Panel accepted may represent a small number of the total slides reviewed. However, between March and September 2018, the Registrant consistently missed the 95% detection of high grade abnormalities by around 8% – 9%. In the Panel’s judgement, this rate was unacceptably low when compared against the standards expected of a reasonably competent Biomedical Scientist.

h. The Panel was of the view that the Registrant had been provided with extensive support from IM in the form of regular supervision sessions. It acknowledged that the Registrant was working in a challenging and busy department and there were many additional demands on his time. However, for a significant period of time the Panel identified that the Registrant was not able to review the slides to the appropriate and safe standard to be expected of a reasonably competent Biomedical Scientist. In the Panel’s judgement, the evidence demonstrated that the Registrant did not have the ability to manage his own workload and resources effectively or manage his fitness to practise accordingly. Consequently, the Panel was of the view that the Registrant had breached standards 1.3, 3 and 3.3 of the Standards.

i. In all the circumstances, the Panel concluded that the Registrant had persistently fallen below the standards expected of a reasonably competent Biomedical Scientist, over a considerable period of time, and as judged against a fair sample of his work. As such, in the Panel’s judgement, the facts found proved amount to a lack of competence on the Registrant’s part. The Panel concluded that the Registrant’s lack of competence is sufficiently serious to lead the Panel to a consideration of whether or not his fitness to practise is currently impaired by reason of that lack of competence.

14. The Substantive Panel further determined that the Registrant’s fitness to practise was, at the time, impaired. Its reasons, as stated in its determination, are set out below. For ease of reference, the paragraph numbers that appear in the determination of the Substantive Panel have been retained but are shown in brackets.

(66) In relation to insight, the Panel was of the view that the Registrant had some insight in that he recognised that he was not consistently achieving the required standards. However, the Panel considered that he did not understand the potential risk to patients and increased workload on colleagues, as he maintained that there was no actual risk of harm because the samples which he reviewed were double checked by another Biomedical Scientist who would pick up any oversight by the Registrant. The Panel concluded that the Registrant’s insight into the risks of his failings was not sufficiently developed.

(67) In relation to remediation, the Panel firstly considered whether the Registrant’s lack of competence was capable of remediation. It was satisfied that there was no character flaw which may impede remediation. The position was that his skill level had fallen significantly below the required standards in the area of cytology, but the Panel was of the view that through training, refresher courses and regaining experience in the laboratory, the Registrant’s lack of competence was capable of remediation.

(68) The Panel next considered whether the Registrant had taken remedial action to address his lack of competence. He told the Panel that he had been reading monthly professional journals, including SCAN and IBMS. However, the Panel bore in mind that the Registrant had not worked in cytology since he had left the Trust in October 2018. It also noted that when the Registrant had undertaken the exercise of reviewing 400 training slides he had achieved the required standards, but had not been able to replicate this when reviewing actual slides. The Panel was not satisfied that in the absence of practical experience, for example shadowing a Biomedical Scientist in the laboratory, the academic reading which the Registrant had undertaken was sufficient to redress his lack of competence. Consequently, the Panel was not satisfied that the Registrant had remediated his lack of competence.

(69) In the absence of fully developed insight and remediation, the Panel concluded that there remained a risk of repetition that the Registrant would not review the required annual number of slides or achieve the required level of sensitivities for high grade and all grade abnormalities both as set by the national guidelines. Although the Registrant had achieved the required standards in respect of the 400 training slides, the Panel was not confident that the Registrant could consistently achieve the
required standards in respect of actual slides. In the Panel’s judgement, it was this unpredictability which led to a significant risk of harm to patients. His failure to consistently identify at least 95% of high grade and 90% of all grade abnormalities placed increased pressure on the second checker, which in turn meant a potential risk of harm to patients.

(70) In all the circumstances, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the public [sic] component.

(71) In relation to the public component, the Panel was of the view that members of the public need to have confidence that Biomedical Scientists screening cytology slides are competent to review them and appropriately detect high grade and low grade abnormalities. The Panel noted that the national screening programme has been implemented to deal with public health and it considered that public confidence would be damaged if practitioners assigned to screen slides were not competent to consistently detect abnormalities. The Panel concluded that public confidence in the profession would be undermined if no finding of current impairment were made in the particular circumstances of this case.

(72) Accordingly, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the public component.

15. The Substantive Panel imposed a Conditions of Practice Order for a period of 18 months. Its reasons as stated in its determination are set out below. For ease of reference the paragraph numbers used in the determination have been retained, but are shown in brackets.

(75) The Registrant apologised to the Panel for his previous lack of insight into the situation, and said he now understood how his
lack of competence had impacted upon colleagues. He said that he was planning to improve his practice and do a three day update course, without which he would be unable to return to practice. The Registrant explained that he had identified such a course that was available in Edinburgh or Manchester. He submitted that if he could improve his practice then that would improve safety for service users. The Registrant said that his understanding was that once he gained employment, he, like any newly appointed employee, would be put through a competency assessment process by his employer to prove that he could work safely at that level.

(76) The Panel accepted the advice of the Legal Assessor and exercised its independent judgement. The Panel had regard to the Policy and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public. In this regard it bore in mind paragraph 10 of the Policy which states: The primary function of any sanction is to protect the public. The considerations in this regard include:

a. any risks the registrant might pose to those who use or need their services;

b. the deterrent effect on other registrants;

c. public confidence in the profession concerned; and

d. public confidence in the regulatory process.

(77) The Panel first identified what it considered to be the principal mitigating and aggravating factors in this case.

Mitigating factors:

a. The Registrant has engaged with these proceedings and has shown some insight in accepting that he did not meet the required standards and needs to improve his practice with training and refresher courses;

b. There is no previous fitness to practise history.
Aggravating factors:
c. The failings were serious in that there was a repetition and pattern of underperformance which persisted over a considerable period of time;
d. There was a potential risk of harm to patients due to the inconsistency of the Registrant’s ability to detect abnormalities, and the second checker was relied upon to pick up what the Registrant may not have detected.

(78) The Panel considered the sanctions available beginning with the least serious. It did not consider the options of taking no further action, mediation or a Caution Order to be appropriate or proportionate in the circumstances of this case. The Panel was of the view that none of these options would be sufficient to protect the public or meet the wider public interest, given that it had identified a risk of repetition in both not meeting the national minimum guidelines for reviewing slides and not consistently detecting abnormalities. The Panel considered that this risk of repetition led to a consequent significant risk of harm to patients .
(79) The Panel next considered the imposition of a Conditions of Practice Order. The Panel, in its findings on impairment, had considered that the practice concerns were capable of remediation, but that the Registrant had not yet remedied his practice at this time, having not worked in the field of cytology since 2018. Whilst he had attempted to keep up to date with informal CPD in reading professional journals, the Panel did not consider that this was sufficient. It appeared to the Panel that the Registrant had struggled to remediate pending the fitness to practise proceedings, and his remediation was dependent upon him successfully completing the three day cytology refresher course first.

(80) Having heard from the Registrant during the course of the proceedings, the Panel considered that he was genuinely committed to resolving the failings in his practice and had indicated a willingness to undertake refresher courses and training in order to do so. The Panel considered that it would be possible to formulate workable and measurable conditions to enable the Registrant to return to practice and take the necessary remediation steps in order to regain his fitness to practise.

(81) In all the circumstances, the Panel concluded that a Conditions of Practice Order would be sufficient to protect the public and satisfy the public interest, while at the same time supporting the Registrant in remedying his fitness to practise.

(82) The Panel considered that the length of the order should be for a period of 18 months. Given that the Registrant had been out of the field for a considerable amount of time, the Panel was of the view that 18 months would provide him with the time to successfully complete the three day refresher course to allow him to re-enter the field; to secure a relevant post; and to work meaningfully under the conditions.

(83) In order to satisfy itself that a Conditions of Practice Order was the appropriate and proportionate response, the Panel looked at the next level of sanction possible namely a Suspension Order. It had regard to the Registrant’s good level of engagement with these proceedings, his lack of previous fitness to practise history, and his willingness to remedy his failings. The Panel decided that suspension would be wholly disproportionate and unduly punitive, in that it would significantly impede the Registrant from remediating his practice.

(84) Accordingly, the Panel imposed a Conditions of Practice Order for a period of 18 months.

The Conditions of Practice imposed by the Substantive Panel

16. The Conditions of Practice Order was in the following terms;

The Registrar is directed to annotate the HCPC Register to show that for 18 months from the date that this Order takes effect (the Operative Date), Mr Shanthiratne Semage must comply with the following conditions of practice:

1) Before undertaking any work as a Biomedical Scientist in the field of cytology you must:

A. satisfactorily complete the three day cytology refresher course; and

B. within 14 days of satisfactorily completing the course, forward confirmation of your results to the HCPC.

2) Before undertaking any work as a Biomedical Scientist in the field of cytology, you must:

A. satisfactorily complete the training and competency programme of the organisation for whom you are working for; and

B. within 14 days of satisfactorily completing the programme, forward confirmation of your results to the HCPC.
3) Upon commencement of employment in the field of cytology, you must place yourself and remain under the supervision of an HCPC registered workplace supervisor of a minimum of Band 7 and supply details of your workplace supervisor to the HCPC within three months of commencing employment. You must attend upon that supervisor as required and follow their advice and recommendations.

4) Prior to any review, you must obtain and send to the HCPC a report from your workplace supervisor commenting on your practice as a Biomedical Scientist in the field of cytology. The report should include information regarding your ability to meet the national guidelines for high grade and all grade sensitivities and minimum annual numbers of cytology slides reviewed.
5) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

6) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
7) You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and

C. any prospective employer (at the time of your application).

8) You will be responsible for meeting any and all costs associated with complying with these conditions.

First review hearing – 14 November 2022

17. By the date of the first review hearing on 14 November 2022 the Registrant had not returned to practice. REDACTED. He gave evidence to the panel that he wanted to resume a career as a Biomedical Scientist and that he was prepared to work at band 5. He acknowledged that he had not worked in his profession for 3.5 years and as such he had not maintained his professional skills, nor remediated his failings. 

18. The reviewing panel determined that the Registrant’s fitness to practise remained impaired on both the personal and public components. He had not complied with any of the conditions imposed by the original panel. As such, there had been no change or progress which would justify a conclusion that there was no longer current impairment.
19. That panel considered that a varied Conditions of Practice Order would give the Registrant an opportunity to develop the skills necessary to enable him to return to safe and effective practice. The panel imposed the following Conditions of Practice for a period of 12 months:

1) As a Biomedical Scientist you must work for only one substantive employer, that must not be an Agency.

2) Upon commencement of employment as a Biomedical Scientist, you must:
A. satisfactorily complete the training and competency programme of the organisation for whom you are working for, and in the discipline for which you are employed and appropriate to a Band 5 Biomedical Scientist;

B. within 14 days of satisfactorily completing the programme, forward confirmation of your results to the HCPC.

3) Upon commencement of any employment as a Biomedical Scientist, you must place yourself and remain under the supervision of an HCPC registered workplace supervisor of a minimum of Band 7 and supply details of your workplace supervisor to the HCPC within three months of commencing employment. You must attend upon that supervisor as required and follow their advice and recommendations.
4) Prior to any review, you must obtain and send to the HCPC a report from your workplace supervisor commenting on your practice as a Biomedical Scientist.

5) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment as a Biomedical Scientist.

6) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

7) You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;

B. any prospective employer (at the time of your application).

8) You will be responsible for meeting any and all costs associated with complying with these conditions.

Second Review Hearing, 22 November 2023
HCPC Submissions

20. Submissions were received from Ms Khorassani on behalf of the HCPC. She submitted that the HCPC remains neutral in this mandatory review of the Conditions of Practice Order which is due to expire on 7 December 2023. Having outlined the background, Ms Khorassani set out the Panel’s powers at this review. She submitted that the current Order could be extended for a further period to allow the Registrant to obtain a role as a Biomedical Scientist. A future panel would then potentially have the benefit of seeing what the Registrant could achieve in employment. She submitted that without employment, the Registrant’s fitness to practise remains impaired.

21. Alternatively, Ms Khorassani submitted that it is open to the Panel to decide on the appropriate sanction, if it was of the view the Registrant remains currently impaired. She noted that all registrants must abide by the HCPC’s standards, and the relevant standard here was 9.1 – you must make sure that your conduct justifies the public’s trust and confidence in you and your profession. She also cited the test formulated by Dame Janet Smith in the Fifth Shipman Inquiry, which has been adopted in health regulation through the case of Healthcare Regulatory Excellence v Grant and the Nursing and Midwifery Council [2011] EWHC 927 (Admin).

22. Ms Khorassani submitted that since the review in 2022 the Registrant has not engaged with the HCPC in a manner that would assist the Panel today. The Panel should therefore consider the sanctions open to it in ascending order of severity.

Registrant’s evidence

23. The Registrant gave evidence under affirmation. He said that he has applied for three jobs with the NHS but has not been shortlisted. He has also contacted a locum agency to discuss employment options, but had not submitted an application to them.

24. In terms of CPD, the Registrant informed the Panel that he had studied an ICT course at level 3, which is relevant to his practice as it had included preparing presentations. He has also read journals and textbooks. However, because he has not been employed as a Biomedical Scientist, he has not been able to undertake training with Sysmex Academy (a company that provides training on haematology instruments).

25. When asked about the impact of his performance on people who have submitted samples for screening, the Registrant acknowledged that his performance may have had an impact on patients, and also on colleagues as someone else was required to review his work. He alluded to the Trust’s performance plan having not been entirely fair, and said that if the meeting in April 2018 had been delayed by a week, then he ‘would not be facing this problem’. When asked by Ms Khorassani what he had learnt about himself since the allegations, the Registrant responded that he had learnt how important it is to do work correctly, but he had been unable to achieve the 3000 slides required as he was the only Biomedical Scientist and had been given too much other work to do.

26. As to his work since the last review, the Registrant informed the Panel that he has been working two days a week for a food production company. He had undertaken voluntary work at his Temple.

27. The Registrant asked the Panel to take into account (REDACTED). The Registrant accepted that he is currently impaired as he has not been in employment. 

28. The Panel, noting the first condition of practice is that the Registrant is not to be employed by an Agency, asked him to clarify his statement that he had contacted locum agencies. The Registrant explained that he had contacted an agency to discuss possible vacancies, but had not submitted an application to them. The agency could see from the Register that he was subject to conditions of practice. When asked specifically about the first condition of practice, the Registrant said that he had misunderstood it.

Legal Advice

29. The Panel accepted the advice of the Legal Assessor, who outlined its role and the options open to it at this review of the current Conditions of Practice Order, which must be reviewed before its expiry. Whilst strike of had not been an option for the original panel, or the last reviewing panel, as the Registrant has now been subject to a Conditions Of Practice Order for more than two years, in accordance with Article 29(6) of the Health Professions Order, a strike-off order may be made. Guidance as to the appropriateness of such an order is given in the Sanctions Policy, which refers to there having been a failure to address the lack of competence.

30. The Legal Assessor reminded the Panel that today there is a persuasive burden on the Registrant, who needs to persuade the Panel that he has insight and understanding and is no longer currently impaired - Abrahaem v General Medical Council [2008] EWHC 183 (Admin). Findings of fact are not to be re-opened. Insight can be demonstrated without acceptance of the findings of the original panel, and the role of the Panel is to consider whether the Registrant has fully appreciated the gravity of the matter and be satisfied that patients will not be put at risk if he resumes practice - Yusuff v GMC [2018] EWHC 13 (Admin).

Decision

31. The Panel considered the information before it. It noted that the Registrant has not worked as a Biomedical Scientist for over 5 years, and that since the last review a year ago, he has undertaken very little meaningful CPD. Indeed, he had referred to the ICT course at the last review. Notwithstanding the letter from Ms Khorassani to the Registrant sent on 24 October 2023, setting out the matters that would assist the Panel today, including a reflective statement, evidence of CPD and testimonials, the Registrant had not provided anything in writing to the Panel.

32. The Panel considered whether the Registrant remains currently impaired. In reaching the view that he is, it took into account that he has not maintained his skills as he has been out of practice for over 5 years. Whilst the Registrant had told the Panel that he had applied for three roles unsuccessfully, and the Panel had no reason to disbelieve him, there was really nothing for the Panel to work with to enable it to see that any progress towards regaining the ability to practise safely and effectively had been made. Indeed, if anything, the Registrant had deskilled further in the time which had elapsed, and the only logical conclusion that could be reached was that he is currently a risk to patients. No evidence had been provided of the content or learning that had been taken from reading of journals and text books, and no courses in the field of biomedical science had been undertaken. The Panel considered that if the Registrant had been serious about intending to return to practice, he would have taken active steps in the last year to resolve the issues that led to the original finding of impairment. Accordingly, the Panel concluded that the Registrant is currently impaired on the personal component.

33. Moving to the public component, the Panel considered that an informed member of the public would be very concerned if no finding of current impairment were made and the Registrant permitted to return to unrestricted practice. They would lose trust in the Regulator and the regulatory process if a Registrant who had taken no steps to remedy his unsafe practice, and who had demonstrated only very limited insight, was not subject to ongoing or further restrictions on his practice. The Registrant, when asked, had shown no real insight into the implications for patients of his failures to interpret cytology slides competently, such as the risks this posed to them, and to public confidence in the profession more broadly. Accordingly, the Panel determined that the Registrant remains impaired on the public component.

34. In light of its finding of ongoing current impairment, the Panel first considered whether to extend the current Conditions of Practice Order. As very little had been done by the Registrant in the last year to seek to return to practice and bring his knowledge and skills up to the required standards, the Panel was of the view that the Registrant would be unlikely to engage with the conditions if the Order were extended. It was concerned at the Registrant’s lack of understanding of the first condition; that he must not work for an agency. In the Panel’s view the conditions were clear and unambiguous. Extending the Order would, in the Panel's view, achieve nothing. The next reviewing panel would in all likelihood have no further information or evidence upon which to assess impairment and risk. The Panel determined that extending the current Order would not be a proportionate outcome.

35. The Panel then considered varying the conditions. It noted that the first review panel had made some changes to the original Order, with a view to making the conditions more workable. This Panel could not formulate any changes which would assist the Registrant to obtain employment whilst at the same time providing the necessary public protection. The Panel concluded that it will not vary the conditions, and as such, conditions of practice are no longer appropriate.

36. The Panel then moved to consider a suspension order. It considered that this would achieve nothing, noting that its purpose is not to seek to punish the Registrant. If the Registrant were suspended he could not address the concerns as to his lack of competence. Such an order would simply prolong the period for which the Registrant is subject to the fitness to practise process.

37. The Panel therefore considered a strike-off order. It noted that that this is indicated where a registrant has not addressed concerns of lack of competence having been subject to conditions of practice for two years or more. The Panel considered that this was the situation before it. The Registrant had been subject to conditions of practice for 2.5 years and had provided both reviewing panels with no real evidence of a commitment to remedy his past failures and demonstrate that he will, at any time in the foreseeable future, be capable of returning to safe and effective practice.

38. Whilst not a decision to be taken lightly, the Panel determined that this is the only Order that is appropriate. The Registrant lacks insight, has failed to address his lack of competence and in the Panel’s view, is unwilling to resolve matters. Had he been serious about regaining competence, he would have taken active steps to make himself employable, such as undertaking training and development related to his profession, and would have presented evidence to the Panel as outlined in Ms Khorassani’s letter. Given that this is the second review, and in light of the previous panel’s decision, the Panel found that the Registrant should have had an understanding of what was required of him over the last year, and today.

39. The Panel had heard the Registrant’s comment that he would prefer to voluntarily remove himself. However, that is a separate process, which needs to be raised with the HCPC, who will then follow a process to determine whether it is appropriate to permit voluntary removal in all the circumstances of the case. The matter would come before a panel such as this, who would make the final decision. The matter having been brought to this Panel as an Article 30 Review of the Registrant’s current Conditions of Practice Order, the Panel had no option but to make a determination in line with its powers under that Article.

ORDER:

The Registrar is directed strike the Registrant’s name off the Register

The Order imposed today will apply with immediate effect.

History of Hearings for Shanthiratne Semage