Miss Ruramayi Runzirwayi

Profession: Operating department practitioner

Registration Number: ODP37945

Interim Order: Imposed on 18 Mar 2019

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 25/04/2022 End: 17:00 28/04/2022

Location: This hearing took place virtually

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

(As amended at the final hearing)

Whilst registered as an Operating Department Practitioner (ODP37945):

1. On 14 August 2018, whilst working for the Heart of England NHS Foundation Trust, you were:

a) On one or more occasions, seen holding the Bain breathing circuit near your face with the nitrous oxide and oxygen flowmeters turned on.

b) Seen holding the Bain breathing circuit with your mouth closed around the patient end of the circuit.

2. On 12 February 2019, whilst working for Oxford University Hospitals NHS Foundation Trust, you were seen holding the anaesthetic circuit attached to the anaesthetic machine to your face with the oxygen and nitrous oxide flowmeters turned on.

3. On 13 February 2019, whilst working for Oxford University Hospitals NHS Foundation Trust, you were seen holding the anaesthetic circuit in your hand/s with the end of the circuit just below your neck with high flow oxygen and nitrous oxide flowing.

4. You have a physical and/or mental health condition as set out in Schedule A.

5. The matters described at 1 – 3 above constitute misconduct.

6. By reason of your misconduct and/or health your fitness to practise is impaired.

Schedule A

[redacted]

Finding

Preliminary Matters

Notice of hearing

1. The Panel first sought to be satisfied that a valid notice of hearing had been served on the Registrant. The Panel was satisfied that the email sent to the Registrant on 3 March 2022 informing her of the date, time and manner in which it was intended this hearing would be conducted, constituted a valid notice of hearing.

Proceeding in the absence of the Registrant

2. After the Panel announced its decision that there had been good service of a notice of hearing, the Presenting Officer applied for a direction that the hearing should proceed in the absence of the Registrant. The Panel heeded the advice it received and considered the factors identified in the relevant Practice Note. Having carefully considered the matter, the Panel decided that the hearing should proceed notwithstanding the absence of the Registrant. The reasons for that decision were as follows:

• This is the second occasion on which this final hearing has been listed. It was previously listed for a hearing commencing on 2 November 2021. In the year before that hearing there had been minimal engagement in the process on the part of the Registrant. On five occasions between 5 May 2021 and 16 August 2021 the HCPC’s Solicitors sent emails to the Registrant variously asking for confirmation that they could send the hearing bundle electronically and chasing replies to earlier emails. On 8 September 2021 the HCPC’s Solicitors sent a further email, and that resulted in the Registrant replying on 10 September 2021 stating that she had been busy and had suffered ill health.

• Repeated efforts thereafter to secure a reply from the Registrant before the hearing listed on 2 November 2021 were unsuccessful until a reply was received in the afternoon of the day before the hearing, when she indicated an intention to participate in that hearing. On the morning of the hearing itself she sent a further email stating that changes to her work schedule made it impossible for her to participate until around 3:30pm on that first day. When, after the Hearings Officer sent an email and left a voicemail saying that the Panel would re-convene at 3:30pm, no appearance was made by the Registrant. Furthermore, when the Panel sat on the following day, 3 November 2021, the Registrant did not appear.

• The Registrant’s engagement in relation to the present hearing has been similarly lacking. The notice of hearing sent to the Registrant on 3 March 2022 asked the Registrant to reply saying whether she would attend the hearing. No reply was received. On 6 April 2022 the Hearings Officer assigned to this hearing sent an email to the Registrant introducing herself and explaining various aspects of the process. Included in her email was this passage, “I’d be grateful if you could please confirm receipt of this email and your attendance at the hearing.” No reply was received. On 7 April 2022 the HCPC Case Manager dealing with the case sent an email to the Registrant asking if she wished a statement previously submitted to be made available to the Panel. The Registrant was also asked if she intended to participate in the hearing. On 18 April 2022 the Registrant replied to the email sent on 7 April 2022 confirming that she wished the Panel to be provided with her statement, but she did not answer the question about participation in the hearing.

• The Registrant has not sought an adjournment, nor has she stated that there is some reason why she cannot participate in it. In all the circumstances the Panel has concluded that the Registrant has voluntarily waived the right to participate in the hearing.

• There are no grounds on which the Panel can conclude that there is any likelihood that the Registrant would participate in a hearing on a future date if the present hearing did not proceed.

• Four witnesses have made themselves available to give evidence by video link at this hearing.

• Any disadvantage to the Registrant as a consequence of not appearing has been mitigated by the fact that she has submitted a statement which she has recently confirmed she wishes the Panel to consider.

• For these reasons the Panel has concluded that the clear public interest in the case proceeding, particularly in view of the facts that it has previously been adjourned and the incidents occurred over three years ago, outweigh the absence of the Registrant.

Amendment of the allegation

3. At the outset of the hearing the Presenting Officer applied for the HCPC to be permitted to amend the factual particulars of the allegation. The proposed amendments had been communicated to the Registrant by a letter dated 21 April 2022. There were three aspects of the application, namely:

• To open particular 1(a) with the words, “On one or more occasions”, in substitution for the words “on more than one occasion” at the end of that same particular.

• To add the words, “to your face” to particular 2.

• To add the words, “the end of the circuit just below your neck, with” to particular 3.

The Panel was satisfied that these proposed amendments were minor in nature, and that they appropriately clarified and focused the complaints made by the HCPC. They did not alter the thrust of the HCPC’s case. For these reasons, the Panel was also satisfied that, if permitted, they would not prejudice the Registrant. For these reasons the Panel acceded to the application. The allegation as it is set out at the head of this document is the allegation as amended, showing the changes made.

Part of the hearing in private

4. The Presenting Officer applied for a direction that any part of the hearing during which there would be mention of specific health concerns relating to the Registrant should be held in private. The Panel agreed to make this direction, finding that it was necessary for the protection of the Registrant’s private life. This consideration has also made it necessary to produce two versions of the Panel’s determination. This is the public version of the Panel’s determination and has been appropriately redacted to remove any detail relating to the Registrant’s health.

Application to introduce further evidence

5. Before opening the case, the Presenting Officer applied for the HCPC to be permitted to adduce in evidence a further document. The document is a letter dated 10 September 2018 written by an HCPC Case Manager to the Registrant informing her that the agency through which she had been working at the relevant time had made a referral to the HCPC concerning her alleged behaviour on 14 August 2018 (i.e. the events alleged by particular 1). The Presenting Officer made it clear that the HCPC would not contend that the letter could advance the HCPC’s case in relation to whether the Registrant had acted as alleged on 14 August 2018, but she submitted that it was relevant to the overall assessment of the HCPC’s case for the Panel to be aware that the Registrant had been informed that an allegation had been made against her in relation to 14 August 2018 before the events alleged by particulars 2 and 3 occurred some five months later. The Panel acceded to the application, finding that it was potentially relevant evidence, and that although the Registrant had not been put on notice of the application, there was no prospect of her suffering prejudice as the letter had been sent to her.

The “dual allegation”

6. When the Investigating Committee made its “case to answer” decision, it determined that there was a case to answer in relation to both an allegation that the misconduct arising from the incidents set out in particulars 1, 2 and 3 was impairing her fitness to practise, and also an allegation that her fitness to practise was impaired by reason of the health concerns included in Schedule A to the allegation. As the Investigating Committee referred the case to the Conduct and Competence Committee for a hearing, the allegation founded on misconduct is the primary allegation. The Panel has conducted the case in accordance with the HCPC’s revised guidance relating to the approach to dual allegations that was issued in June 2021. Accordingly, the misconduct allegation has been the focus of the Panel’s consideration, although before the conclusion of the case it will be necessary to return to the issue of the secondary allegation based on the Registrant’s health.

Background

7. The Registrant qualified as an Operating Department Practitioner (“ODP”) in September 2017, less than a year before the events alleged in particular 1.

8. In August 2018 the Registrant was working through an agency at the Good Hope Hospital in Sutton Coldfield, having started there on 25 July 2018. On 14 August 2018 she was working as an assistant to Dr JE, a Consultant Anaesthetist. What Dr JE saw and did as a result of what he saw, will be explained when the Panel describes his evidence. It is sufficient at this stage to record that the agency was informed that it was desired that the Registrant should not return to the hospital, and she did not do so.

9. The agency through which the Registrant had been working at the Good Hope Hospital made a referral to the HCPC on 7 September 2018. The fact that the referral had been made was communicated to the Registrant by the letter dated 10 September 2018 to which reference has already been made in paragraph 5 above.

10. In early January 2019, the Registrant commenced working through a different agency with Oxford University Hospitals NHS Trust, most frequently at the Nuffield Orthopaedic Centre. She was working there on 12 February 2019, when Dr AM, a Consultant Anaesthetist saw her in an Anaesthetic Room in the circumstances that will be described below.

11. The following day, 13 Febraury 2019, the Registrant was again working at the Nuffield Orthopaedic Centre. On this occasion she was observed in an Anaesthetic Room by Ms EW, a Deputy Theatre Manager, who had decided to keep an eye on the Registrant as a result of what she had been told about the events of the previous day. Again, Ms EW’s observations will be described below.

12. It is the HCPC’s case that on each of the occasions described, the Registrant was acting inappropriately in relation to the anaesthetic equipment, specifically, that she was using it to self-administer nitrous oxide and oxygen. The HCPC contends that this behaviour constitutes misconduct that is currently impairing the Registrant’s fitness to practise.

Decision on Facts

13. The HCPC called four witnesses to give oral evidence before the Panel. The relevance of the evidence of these witnesses will be explained when the Panel addresses the specific factual particulars. The HCPC also introduced the written report of, but did not call to give evidence before the Panel, a medical practitioner, who was instructed by the HCPC to offer an opinion on the Registrant’s health. The report was prepared on 24 August 2020 following a long consultation conducted by video on 31 July 2020. The HCPC also put before the Panel a bundle of exhibits, included in which were written accounts of events, including those made by the witnesses called at the hearing. The Panel was further provided with copies of the two referrals made by the agencies that had placed the Registrant at the two hospitals, as well as photographs showing anaesthetic machinery and equipment.

14. Included in the HCPC’s documentary exhibits was a written account provided by the Registrant. Further, the Panel was provided with the statement, dated 2 November 2021, prepared by the Registrant which she recently requested should be provided to the Panel.

15. In reaching its decisions the Panel has had regard to the totality of the evidence, has considered the particulars separately and has at all times kept in mind that the burden of proof rests on the HCPC to prove matters on the balance of probabilities. The Panel was also mindful of the need to exercise caution when considering whether hearsay evidence should be accepted.

Particular 1(a) & (b).

16. On 14 August 2018, the Registrant was assisting Dr JE, a Consultant Anaesthetist. Dr JE was a witness who gave evidence before the Panel. The Panel found him to be a careful, measured witness who gave clear evidence and did not hesitate to say if he could not recall something. The Panel was satisfied that it could rely on his evidence.

17. At some stage during the afternoon, after the second surgery, Dr JE saw the Registrant in Anaesthetic Room 1, holding the end of the Bain circuit close to her face. The Bain circuit is an arrangement of plastic tubing that carries anaesthetic gasses to the patient. Later, after the third surgery, he again saw the Registrant in the same room, holding the end of the Bain circuit to her face while standing in front of the anaesthetic machine. On this occasion Dr JE observed that the nitrous oxide flowmeter was turned up to near the top of its range, while the flowmeter for oxygen was turned to a lower flow rate. When he asked the Registrant what she was doing, she replied that there was a fault with the anti-hypoxic link of the machine. At this stage the Registrant returned to assist Dr JE with moving of the patient and taking the patient to recovery. Dr JE expressed his concerns to Ms LP, a Senior Sister. Having expressed his concerns, he returned to Anaesthetic Room 1 to collect his belongings in readiness to leave the hospital for the day. He again saw the Registrant standing in front of anaesthetic machine, on this occasion with the tube inside her mouth. He ran to inform Ms LP, who returned with him to Anaesthetic Room 1, and they were both able to see (looking through different, small porthole-type windows in the door to the room) that the Registrant was holding the end of the Bain circuit very close to her mouth and nose area, Dr JE again seeing it in her mouth. Ms LP, who saw the Registrant in right profile, was able to see the circuit tube very near the Registrant’s mouth, but did not remark on seeing it actually in her mouth. The Registrant was breathing in and out.

18. Ms LP also gave evidence before the Panel. The Panel found her to be a reliable witness upon whose evidence it could safely rely.

19. The medical practitioner who prepared the report of which mention has already been made records that during his conversation with the Registrant on 31 July 2020, she accepted that she had inhaled nitrous oxide and also that she had lied when she gave the explanation to Dr JE that there was fault with the anti-hypoxic link. The Panel accepts this hearsay evidence as true because it corroborates the evidence of Dr JE, and is consistent with the explanation of a fault with the anti-hypoxic link not being a credible explanation for the Registrant’s actions.

20. The Panel found that the evidence of Dr JE relating to his observations before he was joined by Ms LP proved that on more than one occasion the Registrant was seen holding the Bain breathing circuit near her face with the nitrous oxide and oxygen flow meters turned on. Accordingly, particular 1(a) is proven. The Panel considered that the evidence of Dr JE was generally supported by the evidence of Ms LP who attended after he stated he first saw the tube in the Registrant’s mouth. This bolstered the evidence that Dr JE saw the Registrant holding the Bain breathing circuit with her mouth closed around the patient end of it. For that reason particular 1(b) is also proven.

Particular 2.

21. The witness in relation to this particular was Dr AM, a Consultant Anaesthetist working at the Nuffield Orthopaedic Centre. Dr AM was at pains to draw the attention of the Panel to the considerable passage of time since the events of 12 February 2019, as well as to the fact that what he saw was over in a very short period of time, and he felt that these factors reduced the confidence he currently felt about the relevant matters. The Panel found that the expression of those reservations was to Dr AM’s credit, and reinforced the impression the Panel had that he was a careful witness who was not motivated by any hostility towards the Registrant, someone of whom he had no knowledge. Despite the reservations expressed to the Panel by Dr AM, he did say that he did not consider than anything in his statement was incorrect, and he did not think that he would change anything contained in it. In that regard, it was noteworthy that Dr AM had made not only the witness statement prepared for the present proceedings on 10 May 2020, but also an earlier record of events on 30 September 2019. In both of these written accounts Dr AM stated that he saw the Registrant sitting on a chair, holding the anaesthetic circuit. In his fuller, HCPC, statement Dr AM stated that she was holding the circuit to her face in the area of her mouth and nose. Furthermore, in both statements he said that he saw that the nitrous oxide and oxygen flowmeters were turned on. He also stated that the Registrant said to him that she had hurt her leg, a remark most likely expressed because of a look of surprise by Dr AM at what he was seeing.

22. The Panel concluded that Dr AM, as a Consultant Anaesthetist, would be used to seeing nurses and ODPs in Anaesthetic rooms, and would be unlikely to think anything was amiss unless there was something that did not seem to be appropriate. That Dr AM did consider that something was amiss that day is demonstrated not only by his own evidence, but by his actions, because he immediately went to speak to a Consultant Anaesthetist colleague, Dr DC. In a written account dated 15 March 2019 (approximately five weeks after the incident) Dr DC confirmed that Dr AM had spoken to her about what he had seen and expressed his concerns. As a result of the conversation they attempted to speak to Ms EW, the Deputy Theatre Manager, but found that Ms EW was not on site that afternoon. Dr DC agreed to speak to Ms EW at a later stage to pass on Dr AM’s concerns. The Panel accepted the hearsay evidence of Dr DC. As Dr DC had not seen the incident alleged, her evidence cannot directly prove what did or did not occur in the anaesthetic room. But the Panel is satisfied that it does corroborate that what Dr AM saw struck him at the time as inappropriate, and that bolsters the evidence he recorded in writing.

23. In all the circumstances the Panel found it proved that on 12 February 2019 the Registrant was seen holding an anaesthetic circuit attached to the anaesthetic machine to her face with the oxygen and nitrous oxide flowmeters turned on. Particular 2 is proven.
Particular 3.

24. The Deputy Theatre Manager, Ms EW, whom Dr AM had not been able to speak to, received his concerns via Dr DC later that same day. She was also at work the following day.

25. Having on 13 February 2019 received a report from two anaesthetists (who have not been called as witnesses at this hearing) that they had seen the Registrant hunched over the anaesthetic machine, Ms EW went to Anaesthetic Room 4 where she found the Registrant sitting next to the anaesthetic machine with her elbows on her knees. The machine was on with nitrous oxide and oxygen flowing. The circuit from the anaesthetic machine was in her hands going up between her breasts. The end of the circuit was just below her neck at the approximate height of her clavicle. The Registrant’s head was facing downwards and she was in a slumped position. At the time Ms EW observed these things there was a patient in the operating theatre and Anaesthetic Room 4 in which the Registrant was seated was set up for the next patient.

26. The Panel accepted the evidence of Ms EW, finding her to be an accurate and fair witness who was positive about her earlier interactions with the Registrant. Having accepted her account of what she saw on 13 February 2019, the Panel found it established that the Registrant was seen holding the anaesthetic circuit in her hands with the end of the circuit just below her neck with the high flow oxygen and nitrous oxide flowing. Particular 3 is proven.

27. The inescapable inference to be drawn from each of the instances in which the Registrant was found holding the end of a circuit tube close to her face was that she was inhaling nitrous oxide on each such occasion.

Decision on Misconduct

28. The Panel began its decision on whether the proven facts constituted misconduct by considering whether the Registrant’s behaviour breached any of the HCPC’s Standards of conduct, performance and ethics. In the judgement of the Panel the following standards were breached:

• Standard 6.2, “You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.”

• Standard 9.1, “You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.”

29. The Panel heeded the advice it received that a finding of breach of the standards required by the HCPC should not automatically translate to a finding of misconduct, and it therefore assessed the seriousness of the Registrant’s behaviour. The Panel identified the following facts that were relevant to this consideration:

• By her actions the Registrant put patients at risk of harm. This applied not only on 13 February 2019 when the patient for whom she had responsibility was still in the operating theatre. Even if the list in the theatre to which she had been assigned had been completed, she would nevertheless be expected to be available to cover for colleagues working in other operating theatres.

• The Registrant relied upon her professional status to have access to the machinery she misused. She thereby abused the trust placed in her by the people with whom she was working and the organisations engaging her.

• The behaviour not only occurred on a number of occasions extending over a period of approximately six months, but was repeated after the Registrant was informed that a referral to the HCPC had been made in relation to what had occurred on 14 August 2018.

• Had the Registrant become adversely physically affected as a result of her actions, she might well have diverted professional resources from patients while colleagues attended to her.

30. The Panel is satisfied that fellow professionals would consider the Registrant’s behaviour to have been deplorable. The Panel is satisfied that it crossed the threshold so as to be properly categorised as misconduct.

Decision on Impairment

31. When the Panel considered the issue of current impairment of fitness to practise, it heeded the guidance contained in the relevant Practice Note and, in particular, considered the matter from the point of view of both the personal and public components.

32. To answer the question whether the Registrant’s fitness to practise is impaired, the Panel first considered whether the Registrant:

• has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm;

• has in the past brought and/or is liable in the future to bring her profession into disrepute;

• has in the past breached and/or is liable in the future to breach one of the fundamental tenets of her profession;

33. When the Panel answered these questions it concluded:

• For the reasons already explained, the Registrant did put patients at unwarranted risk of harm. That was the inevitable result of an ODP inhaling nitrous oxide during her shift. The Panel also finds that there is an appreciable risk of recurrence. In addition to the fact that the incidents in February 2019 occurred after the Registrant was informed that the HCPC had received a referral in relation to 14 August 2018, the Registrant’s insight is limited. An apology has been tendered, but there is scant evidence that the Registrant accepts the seriousness of her actions and the potential consequences of it. Furthermore, there is no independent evidence that problems that might have been impacting on her at the relevant time have been addressed, still less resolved.

• The nature of the serious breaches of the HCPC’s Standards of conduct, performance and ethics mean that the Registrant both breached fundamental tenets of her profession and brought it into disrepute. The risk of repetition has the consequence that she is liable to breach fundamental tenets in the future and again bring her profession into disrepute.

34. These findings have the inevitable consequence that from the perspective of the personal component, the Registrant’s current fitness to practise is impaired.

35. The Panel was also satisfied that a finding of current impairment of fitness to practise is required to satisfy the public component. Such a finding is necessary to declare and uphold proper professional standards, and a failure to do so would be to risk diminishing public confidence in a profession which by its very nature requires its members to have contact with people when they are acutely vulnerable.

36. The consequence of the finding that the misconduct based on the proven facts is currently impairing the Registrant’s fitness to practise is that the allegation is well founded. The Panel must now go on to consider the issue of sanction.

Decision on Sanction

37. After the Panel handed down its decision explaining the decisions it had arrived at on the facts, misconduct and current impairment of fitness to practise, it allowed the Presenting Officer time to consider the written determination before making submissions on sanction.

38. The Presenting Officer made submissions as to the proper purpose of a sanction and urged the Panel to have close regard to the HCPC’s Sanctions Policy when making its decision. She also outlined some mitigating factors and identified a number of aggravating features. These will not be repeated here as they accord with the Panel’s view as to those matters and will be itemised below. The HCPC did not submit that any particular sanction should be imposed.

39. The absence of the Registrant meant that there were no oral submissions on sanction given by her or on her behalf. However, the Panel reminded itself of the content of her statement dated 2 November 2021, and in particular what she said about the personal difficulties she was experiencing at the time the misconduct occurred, what she has done since that time, as well as what she said about her wishes for future work as an ODP.

40. The Panel accepted the advice it received that a sanction should not be imposed with the intention of punishing the Registrant. Rather, any sanction imposed should be no more restrictive than is necessary to protect the public, maintain a proper degree of public confidence in the ODP profession and the regulation of it, and to declare and uphold proper professional standards. As the finding that the misconduct allegation is well founded does not of itself require the imposition of a sanction, logically the first question to be addressed is whether the particular findings in this case require a sanction. If they do, the available sanctions should be considered in an order of ascending seriousness. As the finding is one of misconduct, the entire sanction range up to, and including, striking off is available. Furthermore, the Panel accepted that it was necessary to consider the HCPC’s Sanctions Guidance in reaching its decision.

41. The Panel first identified those factors that could be said to be in favour of the Registrant. The Panel thought it proper to have regard to the following:

• The incidents occurred when the Registrant was experiencing challenging personal circumstances.

• Although there were no formal admissions of the facts, nevertheless the Registrant accepted in interview with the medical practitioner and in the statement she submitted for the consideration of the Panel that she had acted inappropriately.

• There were no other regulatory findings against the Registrant, a factor of limited value in view of the fact that she had qualified only approximately a year before the events that occurred on 14 August 2018.

42. The Panel also identified aggravating factors. The Panel identified the following:

• The misconduct found included a breach of trust and abuse of the Registrant’s professional position.

• The unacceptable behaviour was repeated and after the Registrant was made aware by the HCPC of a referral relating to the incident on 14 August 2018.

• Service users were put at risk of harm.

• The Registrant’s insight is limited in that her statement of 2 November 2021 focusses on her circumstances rather than the potential impact on service users or the profession.

• The Registrant’s engagement with the HCPC has only been partial and she has persistently been slow to respond to emails or has only responded in part to clarification sought by the HCPC.

43. With these factors in mind, the Panel first considered whether its findings required the imposition of any sanction. The conclusion of the Panel was that a sanction is required not only because of the risk of repetition with the attendant risk of future harm to patients, but also because not to impose a sanction would diminish public confidence in the ODP profession and regulation of it.

44. When the Panel considered whether a caution order should be imposed, it also rejected that as an appropriate disposal. The Panel considered paragraph 101 of the Sanctions Guidance and concluded that the findings against the Registrant were not isolated, limited or relatively minor in nature. It could not be said that there is a low risk of repetition, and the Registrant has not shown good insight.

45. The Panel next considered a conditions of practice order, which it also rejected as inappropriate. The Panel had regard to paragraph 106 of the Sanctions Guidance. The Panel could not formulate appropriate and workable conditions that would enable the Registrant to practise as an ODP autonomously, but more particularly because the history of the Registrant’s engagement in this fitness to practise process did not give the Panel the necessary degree of confidence that, even if conditions of practice could be formulated, they would be complied with.

46. The Panel next considered a suspension order, and in that context reviewed paragraph 121 of the Sanctions Guidance. The Panel carefully considered whether a suspension order should be made, acknowledging that it would provide public protection for the duration of the period of suspension. The Panel was of the view that a suspension order might well be thought appropriate for a case such as the present were there to be substantial grounds for believing that the Registrant would engage in the process. However, this would require taking meaningful steps to address the shortcomings identified and also to demonstrate to a future reviewing panel that such steps were being, or had been, taken. In this particular case, the history of the Registrant’s engagement is such that there can be no such confidence. The Registrant did not attend the Preliminary Hearing held in early 2021, she did not attend the hearing on 2 November 2021, even at 3:30pm having earlier that day saying that she would be able to at that time. She did not respond to either voicemail messages from the Hearings Officer assigned to that hearing, and she did not appear on the second day of the hearing. The written determination explaining of the adjournment of the November 2021 hearing contained this sentence in the final paragraph, “The Panel would, however, urge [the Registrant] to take the view that if she wishes to engage and participate, she should do so fully and at an early stage, and also communicate with others, particularly when she is asked to respond.” In relation to the present hearing, she has not answered repeated questions as to whether she intended to appear, as earlier set out by the Panel in explaining why this present hearing proceeded in the Registrant’s absence. There being no confidence that the Registrant would engage in a future review, the Panel has concluded that there is not the required degree of confidence that a suspension order would achieve its clear purpose of enabling a practitioner to be permitted a future return to practise.

47. The rejection of a suspension order had the consequence that the Panel arrived at the conclusion that a striking off order should be imposed. The Panel was satisfied that in the particular circumstances of the present case this was a proportionate response; the shortcomings identified were serious, were liable to be repeated with a risk of patient harm, and there was insufficient confidence that those risks would be diminished in the future.

Order

The Registrant is directed to strike the name of Miss Ruramayi Runzirwayi from the Register on the date this order comes into effect.

Notes

Application for an Interim Suspension Order

1. After the Panel announced its decision that the sanction is one of striking off, the Presenting Officer applied for an interim order to cover the period during which the Registrant’s appeal rights would be extant.

2. The Panel was satisfied that it had jurisdiction to consider the making of an interim order because the Registrant was informed that an application for an interim order might be made in the notice of hearing email sent on 3 March 2022. Accordingly, the Registrant had been afforded an opportunity of making representations on the issue of whether such an order should be made.

3. The Panel considered that it is appropriate to consider this application in the absence of the Registrant. In addition to the facts that required the substantive hearing to proceed in the Registrant’s absence, there is now the additional factor that the Panel has made a finding of misconduct against the Registrant and that there is a risk of repetition which could result in patient harm. That being the case, the HCPC should be able to make an application for an interim order without further delay. The Panel was satisfied that the application should be considered in the absence of the Registrant.

4. The Panel approached its decision on whether an interim order should be made by accepting that the default position is that when a substantive sanction is imposed a Registrant’s ability to practise should remain unrestricted while their appeal rights remain outstanding.

5. However, in the present case the Panel has concluded that the fact that the risk of repetition presented in this case carries with it a risk to the safety of the public. This has resulted in the Panel concluding that a restriction on the Registrant’s ability to practise during the appeal period is necessary for the protection of members of the public and is also required in the wider public interest. It follows that an interim order is required.

6. The Panel considered whether conditions of practice imposed on an interim basis would provide an adequate degree of protection and sufficiently maintain public confidence while the Registrant’s appeal rights remain outstanding. However, having carefully considered the matter, the Panel concluded that interim conditions of practice are not appropriate for the same reasons already expressed by the Panel for rejecting substantive conditions of practice as a substantive sanction outcome.

7. The result of these findings is that the Panel concluded that an interim suspension order is the necessary and proportionate order to make.

8. It is appropriate that the interim order should be made for a period of 18 months. Such a period is appropriate because the interim order will automatically fall away if the initial 28 day period during which an appeal can be made passes and the Registrant does not appeal, yet if she does appeal it could be 18 months or more before that appeal is finally determined.

Interim Order

The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001 for a period of 18 months, 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 have been 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.

 

THE PANEL SITTING AS A HEALTH PANEL

The secondary allegation

The Panel’s view in relation to the secondary allegation

1. As has already been explained, the Investigating Committee found that there was a case to answer in relation to a dual allegation. The Panel (sitting as a Conduct and Competence Panel) has concluded its investigation in relation to the primary allegation, finding it to be well founded. The Panel has decided that the appropriate sanction in relation to the primary allegation is a striking off order. At the time of handing down its decision on that sanction the Panel expressed the view included in the next paragraph as to the secondary allegation that the Registrant’s fitness to practise is impaired by reason of her health. The Panel re-constituted itself as a Health Panel in order to consider the secondary allegation.

2. As a striking off order has been imposed in relation to the primary allegation, the Panel is of the view that no useful purpose would be served by the secondary allegation proceeding to a substantive hearing. No greater public protection could be provided were that allegation to be determined to be well founded (indeed, the sanction of striking off could not be imposed in respect of it) and there are no other factors that could justify a decision being made on it. Accordingly, the Panel is of the view that the secondary allegation should be discontinued, and if the HCPC agrees with that view, the present Panel will reconstitute itself as a Health Committee in order to effect that discontinuance.

The HCPC’s submission in relation to the secondary allegation

3. Having received the Panel’s view as to the secondary allegation contained in the immediately preceding paragraph, and after the Panel also announced its decision that an interim suspension order should be imposed for a period of 18 months to cover the appeal period, the Presenting Officer made submissions as to the disposal of the secondary allegation. The submissions were:

• That the secondary allegation should be discontinued on the basis that no purpose would be served by preserving it as no greater public protection could be provided by it continuing.

• This submission was made notwithstanding the statement in the final paragraph of the HCPC’s guidance document revised in June 2021 which stated that discontinuance of the secondary allegation is not required in circumstances where a striking off order is made in relation to the primary allegation.

The Panel’s decision in relation to the secondary allegation

4. The Panel accepted the advice it received that it should consider the issue of discontinuance, as the striking off order does not have immediate effect and therefore the Registrant will remain on the HCPC Register while her appeal rights remain outstanding.

5. Having considered the merits of the discontinuance allegation, the Panel agreed that its provisional view should stand. Public protection would not be advanced were it to continue to a hearing, and it is not an allegation of a type where there are any other public interest considerations requiring it to be pursued.

6. Accordingly, the Panel Chair will sign the appropriate Notice of Discontinuance.

Hearing History

History of Hearings for Miss Ruramayi Runzirwayi

Date Panel Hearing type Outcomes / Status
25/04/2022 Conduct and Competence Committee Final Hearing Struck off
18/02/2022 Conduct and Competence Committee Interim Order Review Interim Suspension
02/11/2021 Conduct and Competence Committee Final Hearing Adjourned
02/09/2021 Conduct and Competence Committee Interim Order Review Interim Suspension
09/06/2021 Conduct and Competence Committee Interim Order Review Interim Suspension
08/03/2021 Conduct and Competence Committee Interim Order Review Interim Suspension
14/12/2020 Investigating Committee Interim Order Review Interim Suspension
03/06/2020 Investigating Committee Interim Order Review Interim Suspension
14/01/2020 Investigating Committee Interim Order Review Interim Suspension
13/09/2019 Investigating Committee Interim Order Review Interim Suspension