Ann-Marie Golden

Preliminary Matters

Service

1. The Panel was satisfied that the email dated 4 August 2021 informing the Registrant of the date, time and manner in which it was proposed that this hearing would take place constituted a valid notice of hearing.

Proceeding in the absence of the Registrant

2. Being satisfied that a valid notice of hearing had been served, the Panel had jurisdiction to consider the HCPC’s application that the hearing should proceed in the absence of the Registrant. In deciding on this application the Panel heeded the advice it received from the Legal Assessor and it also had regard to the terms of the relevant Practice Note. Having carefully considered the matter, the Panel concluded that the hearing should proceed in the absence of the Registrant for the following reasons:

• The last occasion on which the Registrant communicated with the HCPC was on 2 November 2020 when she sent written representations for the purposes of the Investigating Committee’s “case to answer” decision. Since the Investigating Committee decided on 23 November 2020 that there was a case to answer in relation to the allegation now being considered by the Panel (the Registrant being notified of that fact on 2 December 2020), there has been no contact made by the Registrant. This absence of engagement has occurred despite a number of communications made by and on behalf of the HCPC. As already stated, the notice of the present hearing was sent on 4 August 2021. Before that date, on 22 June 2021, the HCPC’s Solicitors sought to send the electronic hearing bundle to the Registrant. On 21 September 2021 the HCPC’s Solicitors sent an email asking the Registrant if she wished the present Panel to be provided with a copy of the representations sent to the Investigating Committee on 2 November 2020. Finally, the Hearings Officer sent an email on 29 September 2021 with regard to administrative arrangements for the present hearing.

• The absence of communication on the part of the Registrant has resulted in the Panel concluding that she has decided to disengage from these proceedings, and that she has voluntarily absented herself from the present hearing.

• There has been no application for an adjournment, and there are no grounds on which the Panel could conclude that the Registrant would be likely to engage in a hearing were it to take place on a future occasion.

• The allegations cover a period of time that commenced over eight years ago, and there is a clear public interest in there being no further delay unless absolutely required.

• Furthermore, the sole witness to give evidence before the Panel, Service User A, had made herself available to give evidence by video link.

• For all these reasons, the clear public interest in the hearing proceeding outweighed any disadvantages arising from the absence of the Registrant.

Proceeding partly in private

3. At the commencement of the hearing the Presenting Officer raised with the Panel the fact that it might become necessary to direct that certain elements of the evidence should be received in private so as to ensure that confidential information concerning Service User A and the Registrant should not be publicised. The Panel agreed this application so that evidence could be recorded in Private as and when required.

Background

4. The Registrant is registered in the Practitioner Psychologist part of the HCPC Register. However, an unusual aspect of this case is that the events considered by the Panel commenced not in the United Kingdom, but rather in Canada. From 28 October 2011 until 28 October 2013 the Registrant was registered with the College of Psychologists of Ontario (hereafter “CPO”) for supervised practice. The Registrant was granted a certificate by the CPO authorising supervised practice while she completed the CPO’s requirements for qualifying for autonomous practice. Two of the established Psychologists registered with the CPO who were designated as the Registrant’s supervisors have been referred to during this hearing as “Employer A” and “Employer B”. The Registrant ceased to be registered with the CPO in any capacity after 28 October 2013.

5. Service User A is a Canadian citizen who resides in Canada. She has experienced profoundly disturbing events in her life and had suffered ill mental health for some years before she became involved with the Registrant. In October 2012 a therapist whom Service User A was seeing recommended a form of therapy called dialectical behaviour therapy (“DBT”). When Service User A sought a therapist offering that form of therapy, she found the Registrant who was offering DBT through the practice of Employer A.

6. The first session Service User A had with the Registrant was in the first week of November 2012. Sessions then continued in Canada in the circumstances that will be more fully described when the Panel explains its findings of fact. However, in about June 2014, the Registrant left Canada and returned to the United Kingdom. Thereafter therapy sessions continued by Skype, although Service User A visited the Registrant in Croatia and Italy, and the Registrant visited Service User A in her home as alleged in the factual particulars of the allegation. Contact continued until approximately May 2017.

7. In September 2018, Service User A contacted Ms MM, a Case Manager in the Investigations and Resolution Team of the CPO, to raise concerns she had about the Registrant. Of course, by that time the Registrant had long since ceased to be registered with the CPO, but the CPO investigated Service User A’s complaints insofar as they related to the period when the Registrant had been registered by it, albeit that the focus of the investigation was the adequacy of the supervision of the Registrant by Employer A and Employer B.

8. On 26 September 2019, Ms MM referred the Registrant to the HCPC regarding the complaints made by Service User A.

Decision on Facts

9. The HCPC called a single witness to give evidence before the Panel, namely Service User A. In addition to her oral evidence the Panel was provided with a witness statement made for the purposes of the present proceedings as well as her letters and emails of complaint dating back to 2018. The documentary exhibits produced by the HCPC extended to approximately 284 pages, and many of these were documents produced by Service User A, including details of payments made and photographs taken by her when she was with the Registrant.

10. In addition to the oral and written evidence of Service User A, the Panel was provided with a witness statement made by Ms MM. Ms MM had no direct personal knowledge of any of the relevant events, but her evidence was helpful to the Panel because it provided information that was gathered by the CPO for the purposes of the investigation that body carried out.

11. The Panel did not receive any evidence from the Registrant. The Panel was informed that in early October 2020 the Registrant had made written representations to the Investigating Committee at the “case to answer” stage of the proceedings. However, it is the HCPC’s practice not to disclose to the final hearing Panel any such representations in the absence of a request from the Registrant that they should be disclosed. The Registrant was informed of this fact in the letter dated 2 December 2020 in which she was told that an allegation had been referred to the Conduct and Competence Committee. She did not request that her representations be disclosed having received that letter, nor did she reply to an email sent to her on 21 September 2021 when she was asked if she wished for them to be disclosed.

12. In reaching its decisions on the facts the Panel drew no adverse inferences against the Registrant from the fact that there had been no engagement at the present stage of the proceedings. The Panel proceeded on the basis that it was for the HCPC to discharge the burden of proof to the civil standard of the balance of probabilities. The Panel also accepted the advice of the Legal Assessor.

Particular 1(a) to (c)

13. It has already been stated that the therapy sessions between the Registrant and Service User A commenced in early November 2012. The accounting records of Employer A’s practice confirm the evidence of Service User A that a fee of CA$200 was paid by Service User A per session, the payment being made by debit card to the receptionist. Copies of some of the receipts were included in the bundle. However, by the first date alleged in particular 1 (namely 17 June 2013) that practice had changed. Service User A very candidly informed the Panel that the suggestion that she should pay cash directly to the Registrant was made by her, Service User A. She recorded that the Registrant’s initial reaction was to state that it would be wrong for her to receive payment in that way, but then agreed and accepted the cash payments. The Panel found the evidence of Service User A to be credible on this important point, but it also found that there was other evidence that supported Service User A’s account. This evidence included:

• An email exchange in September 2013 between Service User A and the Registrant when the former apologised for forgetting to hand over cash which she realised was in her pocket after she left a therapy session.

• The records of Employer A’s practice which demonstrated that between 17 July 2013 and 17 June 2014, the Registrant recorded on 26 occasions that her sessions with Service User A were “no charge”, something that could happen if a Psychologist was treating a patient on a pro bono basis.

• An email from the Registrant to Service User A giving details of other individual therapy sessions, including the time, 7.30pm, and where to go for the session. Service User A explained the time and the manner of the access to the building via a side entrance (in fact, the premises of Employer B) were designed to avoid others becoming aware that the session would be taking place.

14. The Panel accepted the evidence of Service User A that the Registrant did not issue her with receipts for the cash payments.

15. In the response Employer A made to the CPO it was made clear that practitioners could treat people on a pro bono basis. However, the circumstances in the present case were that the service user was indeed paying, but the funds were being withheld from the employer and diverted to the Registrant. The Panel therefore finds that in accepting the cash payments from Service User A, the Registrant was indeed seeking to defraud Employer A.

16. The Panel finds each element of particular 1(a) to (c) inclusive to be proven.

Particular 2 (a) to (g)

17. The Panel has approached this particular on the basis that it should first consider whether the sub-particulars (a) to (g) are proven, and then address the allegation of failing to maintain appropriate professional boundaries advanced by the stem of particular 2.

18. The Panel is satisfied on the basis of the evidence of Service User A that issues relating to the Registrant’s private life, including those set out in (a)(i) to (iii) were discussed. In reaching its decision, the Panel took account of both the written and oral account of Service User A. Service User A explained that the therapy sessions with the Registrant “[…] became more personal and we started to have discussions that were not related to my therapy” and included discussing the Registrant’s personal life. Sub-particular (a) is proven.

19. It is not suggested that the hugging or expressions of love had any sexual overtones, but the Panel is satisfied that hugs were instigated by the Registrant. Some took place in the context of group therapy sessions, but others on non-therapeutic occasions, such as when Service User A either collected or dropped off the Registrant when she was travelling or sometimes at the end of their individual therapy sessions. The expressions of “love” were those that might more usually be expected to be expressed by close family members or extremely good friends. Sub-particular (b) is proven.

20. That the Registrant introduced Service User A to men with whom she was in relationships was proved by the photographs produced by Service User A. The Panel noted two photographs showing two different boyfriends of the Registrant. Sub-particular (c) is proven.

21. Again, the photographs taken by Service User A’s husband and taken at the request of the Registrant for her to use for her private clinic marketing purposes were included in the documentary exhibits. There is also evidence of the Registrant discussing her website layout with Service User A via email. Sub-particular (d) is proven.

22. The trip to Trieste is evidenced by photographs that include shots of the Registrant’s family taken by Service User A. Sub-particular (e) is proven.

23. Return air tickets from Manchester to Toronto were purchased by Service User A at the request of the Registrant. The Registrant stated that the cost of the tickets would be cheaper if bought in Canada than bought by her in the United Kingdom. Copies of the tickets purchased by Service User A for the Registrant and Person B and a declaration to the Canadian Airport Immigration service made by Service User A to support the Registrant’s entry to Canada are exhibited in the documentary evidence. The Panel accepted Service User A’s account that the cost of the tickets was not reimbursed. Sub-particular (f) is proven.

24. Although it was originally intended that Person B would accompany the Registrant on a visit to Service User A’s home, in the event Person B did not travel to Canada. However, that the Registrant and a friend did stay at Service User A’s home is supported by photographs of them relaxing inside the house. Sub-particular (g) is proven.

25. Applying the findings just explained to the stem of particular 2, the Panel found that there was a comprehensive blurring of proper professional boundaries. As Service User A said in evidence before the Panel, she considered that she and the Registrant “developed a personal relationship over the years” and thought she was the Registrant’s friend.

Particular 3

26. In order to decide if the proven elements of particular 1 amounted to dishonesty, it is necessary for the Panel to decide if the Registrant’s actions, taken in conjunction with her intentions in performing them, would be viewed as dishonest by an ordinary, decent person.

27. The Panel has come to the clear conclusion that an ordinary decent person would consider the acceptance of cash payments from a service user when recording “no charge” on the employer’s financial system to be dishonest.

28. Particular 3 is proven.

Decision on Grounds

29. The Panel accepted the advice of the Legal Assessor that it was not inhibited from considering whether the proven facts constituted misconduct by reason of the fact that they occurred overseas. Article 22(3) of the Health and Care Professions Order 2001 makes clear that an allegation of misconduct is not prevented from applying because the allegation is based on matters that are alleged to have occurred outside the United Kingdom or at a time when the Registrant was not registered with the HCPC.

30. In order to decide if the proven facts should be categorised as misconduct, the Panel decided first to consider whether relevant standards of behaviour required by the HCPC were breached. Then the Panel considered the effect of the Registrant’s behaviour on Service User A.

31. The HCPC’s Standards of conduct, performance and ethics were reviewed from January 2016, and so the Panel considered that it was appropriate to consider the version of those standards in force before date. The Panel found the following version of standards in force between 2008 and 2016 to have been breached:

Standard 1, “You must act in the best interests of service users.” It is when the proven matters are viewed in the round that the Registrant’s motivation was largely motivated to advance her own interests.

Standard 3, “You must keep high standards of personal conduct.” This standard is not only breached by the explicit of dishonesty, but also by behaviour not alleged to have been dishonest, such as the failure to reimburse the purchase of air tickets.

Standard 13, “You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in your or your profession.” The dishonesty demonstrated by particulars 1 and 3 clearly breached this standard.

The Panel has not overlooked that some of the matters found proved (for example, particulars 2(f) and 2(g)) occurred after this version of the standards was revised, but it does not consider that it is necessary to identify standards from the more recent document.

32. A further factor that is relevant to the decision on misconduct is the length of time over which breaches of different categories occurred. The financial irregularities continued for very nearly a year, the crossing of proper professional boundaries for some four years.

33. It is when the effect of the Registrant’s behaviour on Service User A is recorded that the true gravity of what occurred becomes clear. Service User A was and is an acutely vulnerable individual who has experienced significant episodes of poor mental health, both before and after her involvement with the Registrant. The Panel found her to be an intelligent and articulate person who appeared not to be motivated by spite or malice. At the time of her involvement with the Registrant she said that she viewed her as a good friend. But she felt that she was dropped by the Registrant after she went to a specialist unit for a significant period of time after which there is no evidence of further contact from the Registrant. Service User A explained that she felt hurt and experienced feelings of guilt and shame. Following the cessation of her contact with the Registrant, Service User A found it difficult to be able to place her trust in professionals. Although she is now seeing a Psychiatrist, her experiences with the Registrant resulted in her having some difficulty in being able to trust a Psychiatrist and even now she cannot trust a therapist. The Panel does not find this reaction at all surprising given the numerous aspects in which the Registrant involved herself in Service User A’s life. It is precisely to prevent abuse of this sort that has occurred in this case, which includes serious breaches of trust over a significant period of time, that health professionals are required to maintain proper professional boundaries.

34. Having regard to all the circumstances, the Panel finds that so serious are the separate issues of the dishonest receipt of cash payments and the crossing of professional boundaries, that a finding of misconduct is required.

Decision on Impairment

35. As required, the Panel considered the issue of current impairment of fitness to practise both from the standpoint of the personal component and the public component.

36. So far as the personal component is concerned, the Panel’s findings are of the utmost gravity and demonstrate widespread and deliberate disregard for the standards any health professional would know they should observe. Despite the passage of time since the events occurred, very significant evidence of remediation would be required were a Panel not to find that there is a risk of repetition. In fact, there is no evidence of remediation at all. The Panel is therefore unable to come to any other conclusion than that if the Registrant returned to practise without restriction, there would be a very real risk of repetition. Her fitness to practise is currently impaired on the personal component.

37. The Panel is satisfied that fully informed and fair-minded members of the public would be dismayed were a finding of impairment of fitness to practise not made. To fail to do so would risk diminishing public confidence in the profession of Practitioner Psychologists and it would send entirely the wrong message to fellow professionals. The factors require a finding of current impairment of fitness to practise to satisfy the public component.

38. The finding of current impairment of fitness to practise necessitates consideration of the issue of sanction.

Decision on Sanction

39. After the Panel handed down its decision explaining why the allegation is well founded, it allowed time for the Presenting Officer to consider the written determination before making submissions on sanction.

40. When he made his submissions on sanction, the Presenting Officer stated that the HCPC did not urge the Panel to apply any particular sanction, although he did submit that the circumstances of the present case would be unlikely to result in no sanction being imposed. He reminded the Panel of the proper approach to the making of a decision on sanction and referred the Panel to the HCPC’s Sanctions Policy. He also submitted that the Panel could consider aggravating factors to be that the Registrant’s dishonesty continued for a period of nearly a year and the crossing of proper professional boundaries for approximately four years.

41. The Panel accepted the advice of the Legal Assessor as to the proper approach to the issue of sanction. A sanction is not to be imposed to punish a registrant against whom a finding has been made; rather, any sanction imposed should be the least restrictive outcome consistent with the need to protect members of the public, to maintain a proper degree of confidence in the registered profession and to declare and uphold proper professional standards. This approach requires the Panel to consider the available sanctions in an ascending order of gravity. In undertaking this exercise the Panel has carefully considered and applied the HCPC’s Sanctions Policy.

42. The Panel began its deliberations by considering the aggravating factors demonstrated by the case. They were:

• Dishonesty amounting to a breach of trust with regard to the Registrant’s employer which could be fairly said to amount to a pattern of behaviour as it continued for nearly a year and involved 26 payments of CA$200 each.

• Breach of trust with regard to Service User A arising from the failure to maintain appropriate professional boundaries, and that also represented a pattern of unacceptable behaviour extending over a period of approximately four years.

• Actual harm suffered by Service User A.

• An apparent lack of apology or expression of remorse and an absence of insight.

• An absence of remediation.

43. The only factor that the Panel was able to identify as something that could be put in the balance in favour of the Registrant is the fact that it has not been suggested that she has been the subject of previous regulatory findings.

44. When the Panel considered whether this is a case in which a sanction is required, the emphatic answer was that it is.

45. A caution order would not be appropriate. Not one of the factors suggested in paragraph 101 of the Sanctions Guidance is present. The issues were not isolated, limited or relatively minor in nature. There is a risk of repetition, and the Registrant has neither shown good insight nor has she undertaken appropriate remediation.

46. When the Panel considered the appropriateness of conditions of practice, again the circumstances did not meet the factors suggested in paragraph 106 of the Sanctions Guidance because the Registrant does not have insight, the failings were persistent and general, and she would pose a risk of harm even in restricted practice.

47. The Panel next considered whether a suspension order would be appropriate, and in that regard considered paragraph 121 of the Sanctions Guidance. Apart from the fact that the concerns identified represent serious breaches of the Standards of conduct, performance and ethics, in other respects the circumstances of the case did not meet the suggested factors because the Registrant does not have insight, the issues are likely to be repeated and there is no evidence to suggest that the Registrant is likely to be able to resolve or remedy her failings. The Panel rejected the making of a suspension order as appropriate disposal.

48. It followed from the rejection of other lesser sanctions that the Panel considered whether a striking off order should be made. The Registrant’s failings were serious and persistent with regard to two of the categories identified in paragraph 130 of the Sanctions Guidance, namely dishonesty and abuse of professional position. The Registrant took advantage of the vulnerability of Service User A on multiple occasions, both in the therapeutic settings and in Service User A’s private life. Furthermore, no lesser sanction would be sufficient to protect the public, nor would a lesser sanction sufficiently address public confidence or the need to declare and uphold proper professional standards. Taking all these factors into account, the Panel decided that the appropriate sanction in this case is striking off.

The Registrar is directed to strike the name of Dr Ann-Marie Golden from the register on the day this order comes into effect.

Application for an interim order

1. After the Panel announced that the sanction is one of striking off, the Presenting Officer applied for an interim order to cover the period before that sanction comes into effect.

2. The Panel first considered whether it had jurisdiction to consider making an interim order. The Panel was satisfied that the Registrant had been put on notice by the Notice of Hearing date 4 August 2021 that in the event of a striking off order being made an interim order might be applied for. That constituted a Notice of Hearing for interim order purposes. Furthermore, the Panel considered it appropriate to make a decision on the application in the absence of the Registrant. It is in the nature of an application of this sort that there is a degree of urgency, and the application should not be frustrated by disengagement on the part of the Registrant.

3. The Panel accepted the advice it received that the default position provided for by the legislation is that when a substantive sanction is imposed, the right to practise of the registrant against whom that order has been made will not be affected while their appeal rights remain extant.

4. It follows that a positive reason must exist to depart from the default position identified. Any such reasons must be measured against the grounds that can justify the imposition of an interim order, namely, (i) that it is necessary for protection of members of the public, (ii) otherwise in the public interest, and (iii) in the interests of the registrant him or herself.

5. For the reasons advanced in the substantive decision, the Panel has found that there is significant risk that the Registrant would repeat behaviour of the sort that has been found against her. Furthermore, were there to be such a repetition, there would be a significant risk of harm to service users. These findings mean that an interim order is required for protection of members of the public and is otherwise in the public interest.

6. The Panel considered whether the risks presented by the Registrant while her appeal rights remain outstanding could be satisfactorily addressed by the imposition of interim conditions of practice. The Panel concluded that they could not for two reasons. One is that the failings demonstrated by the Registrant are far too wide-ranging to be addressed by conditions of practice. Furthermore, there is no evidence available to the Panel concerning the Registrant’s present activities.

7. The consequence of these findings is that there must be an interim suspension order, and this is the order the Panel makes.

8. As to the duration of the interim order, the Panel has decided that the appropriate length of the order is 18 months. If the Registrant does not appeal the Panel’s decision or order, then the interim order will simply fall away when the time during which she could commence an appeal expires. If, however, she does appeal the Panel’s decisions, then the final resolution of that appeal could well take 18 months, and the protection provided by the order would be required in the meantime.

Interim 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 Ann-Marie Golden