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As a registered Biomedical Scientist (BS40326) your fitness to practise is impaired by reason of misconduct and/or a health condition. In that:
1. In February 2019 you signed Colleague’s A signature on your own revalidation document.
2. Around April and May 2019, you discarded your revalidation document, on which you had signed Colleague A’s signature.
3. Your conduct in relation to allegation 1 and 2 was dishonest.
4. You have a health condition as set out in Schedule A.
5. The matters set out in allegation 1,2 and 3 constitute misconduct.
6. By reason of your misconduct and/or health your fitness to practise is impaired.
Application to transfer to the Health Committee or adjourn the hearing
1. At the outset of the hearing, Mr McCaffrey submitted that the Panel should not proceed with the hearing but should take one of the following courses:
- either the Panel should transfer the case to the Health Committee or
- adjourn proceedings so that those representing the Registrant could obtain relevant medical evidence.
Application to hear the application in private
2. Before making his submissions in support of those applications, Mr McCaffrey applied for the application to be heard in private because it would involve discussion of the Registrant’s heath.
3. On behalf of the HCPC, Mr Bridges agreed that the application be heard in private.
4. The Panel took into account the HCPTS Practice Note entitled “Conducting Hearings in Private” and accepted the advice of the Legal Assessor, which it incorporated into the decision set out below.
5. The Panel had regard to Rule 10(1)(a) of the Health and Care Professions Council (Health Committee) (Procedure) Rules 2003, which provides that “proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the registrant, the complainant, any person giving evidence or of any patient or client, the public should be excluded from all or part of the hearing.”
6. The Panel decided to hear the application in private because it was satisfied that the application and the evidence adduced in support of it will involve hearing evidence and otherwise dealing with questions of the Registrant’s health which are central to the private life of the Registrant.
7. The Panel heard and announced its decision in respect of Mr McCaffrey’s application in private.
8. In short, the Panel found there is no good reason to adjourn and the case must proceed.
Application to hear part of the proceedings in private
9. After announcing this decision, the Panel heard an application from Mr McCaffrey that those parts of the evidence and submissions that relate to the Registrant's health should be heard in private. Mr Bridges supported this application.
10. The Panel had regard to the same practice direction, referred to above and accepted the advice of the Legal Assessor which it has followed in this decision.
11. The Panel again had regard to Rule 10(1)(a) and decided that it would hold in private those parts of the hearing that dealt with the Registrant’s health because it was satisfied that the questions of health are central to the private life of the Registrant. The Panel directed counsel to alert the Panel and the Logger, whenever matters relating to health were likely to arise.
Application regarding the procedure the Panel should adopt
40. Before opening the case for the HCPC, Mr Bridges drew the Panel’s attention to a skeleton argument dated 27 April 2022 which he had served on the Panel and the Registrant in advance of the hearing.
41. He reminded the Panel that the Allegation contained references to health matters, which the Conduct and Competence Committee did not have jurisdiction to hear. He drew the Panel’s attention to the HCPC ‘Guidance Approach to Dual Allegations’ of June 2021 and submitted that the Allegation before the Panel was a dual allegation and the correct approach was for the Panel to have regard to evidence relating to the Registrant’s health, insofar as it was relevant to the conduct allegations, but not decide the health allegations.
42. Mr McCaffrey agreed that this was the correct approach for the Panel to follow.
43. The Panel heard and accepted the advice of the Legal Assessor, that this was the correct approach to the hearing of the Allegation and decided that it would hear all the evidence put before it relating to both misconduct and health but would decide only those parts of the Allegation relating to misconduct. At the end of the hearing, the Panel would consider further submissions about what it should do about the health allegations set out in the Allegation.
44. The Registrant is a registered Biomedical Scientist who worked at Nuffield Health Glasgow Hospital from December 2009 until November 2019. From 2016 she was the Clinical head of Department within the Pathology Laboratory. She also held a national role as the Blood Transfusion Lead within Nuffield Health Hospitals.
45. All Biomedical Scientists at Nuffield Health Hospital were required to go through a validation process to re-certify their competencies, in order to ensure that they held the required knowledge and skills for their role. The competency certification procedure either occurred on an annual or biannual basis, depending on the competency being verified. The procedure required each scientist to have their competency confirmed by a qualified colleague and for that confirmation to be signed or initialled on an appropriate competency form by the colleague confirming the competency.
46. In or around February 2019, during the Registrant’s competency re-certification process, concerns came to light regarding the signatures on the Registrant’s competency documents. The concerns were that the Registrant was believed to have signed her own competency documents. After these concerns came to light SC was asked to undertake an investigation into the matter. [redacted]
47. The Registrant was referred to the HCPC by her employer in 2019.
Summary of the evidence adduced by the HCPC
48. The Panel heard first from NB, who was in 2019 (and still is) the Head of Commercial and Operations Development Pathology for Nuffield Hospitals. He gave evidence that until the end of 2018 laboratory staff had reported to him. However, at the end of 2018 there was a reorganisation, as a result of which they reported to the matron at the hospitals where they worked. He confirmed that the Registrant reported to SC, the matron at the Glasgow hospital.
49. He adopted his written evidence regarding the circumstances in which concerns first came to his attention. His evidence was “In February 2019, Tracy Motley (Senior Biomedical Scientist) audited the competency documents of the Pathology Department. Whilst reviewing Rupinder Bhatti's file, she noticed that the signature of Colleague A was not consistent with the signature that she knew him to have. Further, the date that the signature was signed was after Colleague A had left Nuffield Health to go and work at another organisation. Although I do not recall the exact date that Colleague A left Nuffield Health in February 2019, I can confirm that he would not have been able to sign Rupinder Bhatti's competency documents as prior to leaving Nuffield Health - Colleague A had been off for an extended period of time due to [redacted].”
50. He also confirmed that he had told his colleague, TM, to raise matters with SC and he was aware that there were concerns that the relevant paperwork had “gone missing”.
51. He also confirmed that he was aware that the Registrant had a health condition but he had not observed this condition affecting her ability of work and no concerns had been raised with him.
52. In his oral evidence, NB confirmed that he had assisted SC in her investigation, because she was new in the job. He told the Panel that he had appointed the Registrant as Head of Blood Transfusion and he had never had any cause to question her integrity or competence. He confirmed that the Allegation was a “great shock” to him.
53. He confirmed that the business changes, at the end of 2018, had brought a degree of disruption at middle management level, which was the position occupied by the Registrant. Her reporting lines had moved from him to the matron, SC. He was aware that the Registrant had had difficulties around SC being available and he had offered her every support.
54. He told the Panel that he was aware that Registrant [redacted]. He had no recollection of it being suggested that the revalidation document had been signed in April.
55. The Panel noted that NB’s evidence was unchallenged and had no doubt that he was doing his best to assist the Panel. The Panel accepted his evidence of the background and the manner in which concerns had come to light.
56. The Panel heard next from SC, who was the matron at the Nuffield Glasgow hospital and became the Registrant’s line manager at the end of 2018.
57. She confirmed her written evidence, that she had been approached by three colleagues, including TM, who had raised a concern with her that the Registrant had signed her own competency documents, falsifying Colleague A’s signature. Their suspicion arose because “the date next to Colleague A signature was a date after Colleague A had left working at the Hospital.”
59. SC confirmed that she had conducted an initial investigation into the concerns and identified as the Registrant’s a document dated 10 September 2019 in which she set out the information she had considered and her findings.
60. Insofar as they are relevant to this Allegation, the Panel noted the following. SC reported in that document that concerns had been raised to her by one of the three colleagues referred to above, “in early June 2019”. She also recorded that she had requested to see the Registrant's revalidation document, but the Registrant had “advised this document was missing.” On this point she also recorded that “a copy of the document was subsequently found by (NB), National Commercial Manager, within which Colleague A’s signature can be seen from 2017 (appendix 8) and 2019 (appendix 9).”
61. SC also confirmed that, as part of her investigation she conducted a meeting with the Registrant on 17 July 2019, when the Registrant returned to work. She confirmed that she had asked the Registrant a number of times about the signing of her revalidation document and recorded the Registrant's answer as follows:
“Roopi initially advised that signatures can alter over time, however she subsequently admitted that she had signed the document off as Colleague A. She suggested she had originally given the document to Colleague A to sign off, and when he hadn’t she passed it to Linsey, who also did not sign it off. Roopi advised she did not flag this with Hospital or National Pathology leadership.
Roopi understood this action was inappropriate and unacceptable in any circumstances, and she advised she did this due to lab pressures before an inspection.”
62. SC confirmed that NB had appointed her to conduct the investigation and was satisfied that she was sufficiently impartial to conduct it. She said that her relationship with the Registrant was a professional one and that she was aware the Registrant had found her role difficult because she was managing a lot of things and was very experienced and wanted to do everything herself to a high standard.
63. She told the Panel that she was aware that the Registrant had health difficulties, but she did not accept that she knew that the Registrant had not been coping with her work. She told the Panel that the meeting of 17 July 2019 was arranged by HR and the Registrant. She did not know how the meeting was arranged but said that the Registrant would have been aware that it was an investigatory meeting and not just related to her return to work. She did not recall when Colleague A had left although it was before the date on the form. She confirmed there had never been any issue with the Registrant's competence. She was, she said, “a very competent scientist”.
64. The Panel noted that it was not suggested to SC that she had behaved in any way improperly at the meeting and it was not challenged that the Registrant had made the comments set out above.
65. The Panel noted that SC had little independent recollection of the events of 2019 and found that is no criticism of her. The Panel was reassured that she did not seek to guess at the matters she could not recall and relied upon the records she had made at the time. The Panel also noted that her evidence of what the Registrant had said on 17 July 2019 was unchallenged, and no suggestion was made to her that she had behaved improperly. For those reasons, the Panel was satisfied that SC was a reliable witness of the matters set out above and accepted her evidence.
66. Colleague A was a Senior Biomedical Scientist who was employed, between July 2008 and April 2019, in the laboratory of which the Registrant was manager, between 2016 and 2019. He confirmed that he had had a good working relationship with the Registrant until 6 or 8 months before he left in April 2019, when the Registrant had taken on a national role and she had started to interfere in everything done by the scientists in the laboratory.
67. He told the Panel that the Registrant had shared with her colleagues that she had [redacted] health difficulties and he was aware of these.
68. He told the Panel that, although he had signed off the Registrant’s competences in the past, he had not signed her competency form in 2019. He looked at a document which was agreed to be the Registrant's competency form in 2019 and confirmed that the four initials on the last page were not written by him. He told the Panel that the examples of his initials on the second page of the document were copies of his initials on a form for a completely different scientist.
69. He told the Panel that if a scientist’s competency were not properly verified with the time required, so that it “ran out”, everything done from that time onwards would have to be reviewed. He confirmed that he had never had any reason to doubt the Registrant's competency in blood transfusion.
70. The Panel noted that Colleague A's evidence was not challenged and accepted his evidence.
71. The Panel also had regard to the following documentary evidence arising from the investigations conducted at the Nuffield Glasgow Hospital.
72. A disciplinary hearing was held on 11 November 2019, at which a note was taken of the Registrant’s evidence. Her evidence regarding the allegation that she had signed her own form is recorded as follows: “Due inspection, everyone updating competences. Don't recall signing/dating. No effort to mimic signature. Not something I'd have done…..” The note shows that she was then asked, “if you didn't sign it, would anyone else”. Her reply is recorded as follows: “don't know. Maybe I did it myself. No attempt to copy (colleague A’s) signature. Something I've done irrationally without knowing”. She added that, at the time, “I was doing things without realising”. when further asked if she remembered signing somebody else’s revalidation documents she replied, “I don't remember what I was doing day today.”
73. The Panel also saw the following documents prepared by the Registrant for an appeal procedure held on 8 January 2020.
74. Dealing with the admission she is recorded as having made on 17 July 2019, the Registrant wrote: “I recall I said to SC and AT that I did not sign it and on the 4th time they asked me I just said ‘I did it’ as I just wanted to have them stop asking me so I could get out the room as I had been in the room 2 hours. They were both quite demanding and AT said at one point ‘this shows a total shambles in management’. This was so distressing as she does not know me and neither does SC”.
75. In answer to a written question, “can you confirm your recollection of events?" The Registrant wrote: “I am unable to explain the signing off of my revalidation document as I have no recollection of the events from March onwards as I was under [redacted] from significant workloads balancing three key areas of my role and [redacted]. I was acting irrationally and this event would have been an irrational occurrence”.
Submission of no case to answer in respect of paragraph 2 of the Allegation
76. At the close of the HCPC’s case, Mr McCaffrey submitted that there was “no case to answer” in respect of paragraph 2 of the Allegation. He submitted that there was no evidence that the Registrant had disposed of the revalidation document. He reminded the Panel that the evidence showed that the document had been handled by three colleagues of the Registrant, who had not been called to give evidence, before the witness NB was found to have a copy. Mr McCaffrey submitted that there was no evidence that any of those who had handled the document had replaced it in the Registrant's file and reminded the Panel that throughout the disciplinary investigation and hearing at the Nuffield Glasgow Hospital nobody involved in the case had thought there was sufficient evidence that the Registrant had disposed of the document to even ask her about it.
77. Mr Bridges submitted that there was an irresistible inference that the Registrant had thrown away the document and referred the Panel to all the evidence set out above.
78. The Panel heard the advice of the Legal Assessor which it followed in its decision.
79. The Panel considered all the evidence set out above and concluded that, in the absence of any evidence that those colleagues of the Registrant who had handled her revalidation document and taken a picture of it had returned that document to the Registrant’s file, there was no evidence from which the Panel could properly conclude that it was more likely than not that the Registrant had herself disposed of that document. Taken at its highest, the evidence adduced by the HCPC gave rise to no more than suspicion.
80. Accordingly, the Panel found that the Registrant had no case to answer in respect of paragraph 2 of the Allegation and marked that paragraph as not proved.
81. The Registrant then gave evidence to the Panel. She adopted her written statement. She set out her career as a Biomedical Scientist since she had qualified in 1994. Her CV showed a career in which she had risen to Biomedical Scientist Band 7 before joining Nuffield Health Hospital Glasgow in 2009 and been promoted to a management position in 2016. It was apparent from the document that she had been highly regarded by her employers and described as a “top performer” in 2018.
82. The Registrant confirmed that she had been made manager of the pathology department in 2016. She confirmed that she had been appointed the national blood transfusion lead for all 33 Nuffield sites from January 2018 and in August 2018 taken on a temporary role managing the X-ray department.
84. She set out in detail how the additional responsibilities and work had adversely affected her health and her functioning at work and at home.
85. Dealing with the allegation that she had written Colleague A's signature on her own revalidation document she said in her statement, “[redacted] I am not able to say for sure whether I signed colleague A’s signature on my revalidation document or not.”
86. She added, “I left the document in the main lab for checking and signature which must have been between February – March 2019. The checker checks the entries via the audit trail on the analyser, BT book, EQA and the checker then speaks and quizzes the individual.”
87. She said that the allegation first came to her notice, “Sometime after March 2019, (L and T) approached me as I walked into the department asking me who signed my Transfusion competency and they showed me the signature which I glanced at. I said colleague A signed it and [anonymised] replied colleague A was not here in April 2019 and I said he was. Both (T and L) left it like that, and I walked away thinking nothing of it and that colleague A must have signed and left it in my folder.”
88. Turning to the meeting of 17 July 2019, the Registrant said that she was expecting a meeting only about her phased return to work and was “harassed, bullied and ambushed in the meeting non-stop for two hours.” She was, she confirmed, told that “this shows shambles in your management”.
89. She described the effect of the meeting on her as follows: “half-way through the meeting their voices became muffled to me. I had never been in such a situation and spoken to in such a way, and all that I saw were two bodies towering over me and a sense of feeling trapped, and claustrophobic. I switched off from answering any questions and said anything that came to the top of my head. I asked if I could leave as my mind was all over the place and the answers made no sense to me as neither did the questions.”
90. After confirming that the contents of her statement were true, the Registrant said that “I don't recall signing the document. I was feeling under a lot of stress. I was not myself. It is not something I would have done.” She then told the Panel that she did remember specifically leaving the form in the main laboratory. She said that there was a hatch where she left the document and there were two colleagues sitting there at the time, Colleague A and another colleague.
91. In cross examination, the Registrant was asked about the documents prepared for the workplace appeal procedure in January 2020 which just set out above. She confirmed that those documents were written with the assistance of her union representative, and she was aware that she had to give truthful answers. She confirmed that she had written that she had no recollection of the events from March onwards.
92. The Registrant confirmed that she accepted Colleague A’s evidence that the initials on the third page of the revalidation document were not his and did not deny that this was her revalidation document. However, she could not confirm it was hers when she gave her evidence.
93. The Registrant then added “I said at the meeting that I left (the form) with two people and the next time I saw it was in my folder and signed." Turning to the circumstances of her apparent admission she said this: “I was interrogated by colleagues for two hours… I had two people leaning over me and shouting at me with no breaks.” When asked why she did not simply leave the meeting if it was oppressive, she explained that her state of mind was such that she could not bring herself to do that and then added “SC was right in front of the door”.
94. She denied that she had “come clean” in that meeting.
95. In answer to questions from the Panel [redacted]. She also confirmed that the revalidation document that she had being shown by her colleagues before the meeting was also shown to her electronically in the meeting and was indeed her revalidation document.
96. The Panel found that the Registrant’s evidence was at times difficult to accept because it was not consistent and differed from other evidence recorded at the time of the events in question.
97. The Panel also heard the evidence of MM, a registered Specialist Community Public Health Nurse Practitioner specialising in Occupational Health. She told the Panel that she had worked with the Registrant since 2016 and formed a high opinion of her as a colleague and an honest person.
98. She told the Panel that the [redacted]. She told the Panel that the Registrant “was a completely different person” between January and August 2019. She described her as distraught and not sleeping or eating as a result of stress at work.
100. The Panel also read a number of testimonials by colleagues who had known the Registrant over a number of years from 2015 to 2020. They all paid tribute to her qualities as a scientist and regard her as a person of integrity.
101. The Panel noted that this evidence accords with the view of the witnesses called by the HCPC and accepted that the Registrant is a very competent scientist who has impressed colleagues over a number of years that she is a person of integrity. The Panel also accepted that the Registrant was showing signs of distress [redacted] from the end of 2018 until late in 2019.
Decision on Facts
102. Mr Bridges drew the Panel’s attention to the evidence, and in particular the evidence that the Registrant had admitted signing the revalidation form in July 2019. He drew the Panel’s attention to the definition of dishonesty and submitted that if the Registrant signed her own revalidation form in circumstances where she must have known that it should be signed by a colleague and it effectively forged Colleague A’s signature, the Panel must find that the Registrant’s conduct was dishonest.
103. Mr McCaffrey reminded the Panel that the Registrant was a person of good character and no one questioned either her competence or her integrity. He also reminded the Panel of the [redacted] background in this case and that the Registrant had been unable to remember who had signed her competency form [redacted].
104. He submitted that the Panel should approach the apparent admission made on 15 July 2019 with real caution because there was no contemporaneous record of that meeting or the purpose for which it was convened. He submitted that this was of particular importance because the evidence that the Registrant had signed her revalidation form with Colleague A’s signature came entirely from her. No one had identified the initials on the Registrant’s revalidation form as Colleague A’s signature. Colleague A had said in terms the initials were not his signature.
105. He [redacted] submitted that even if the Panel found that the Registrant had signed the revalidation form, she was not dishonest.
106. The Panel accepted the advice of the Legal Assessor, which it followed in its decision.
107. The Panel bore in mind that, at this stage, the burden of proving each paragraph of the Allegation rests upon the HCPC. The Registrant does not have to prove anything. It reminded itself that the standard of proof is the civil standard, that is to say the balance of probabilities.
108. With regard to the allegation of dishonesty, the Panel had regard to the test laid down by the Supreme Court in Ivey v Genting Casinos (UK) Ltd 2017 UKSC 67:
a. When dishonesty is in question the fact-finding tribunal must first ascertain-(subjectively) the actual state of the individual’s knowledge or belief as to the facts.
b. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held.
c. Once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the (objective) standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.
109. The Panel also bore in mind the direction given to panels by the High Court that a finding of dishonesty must be based on “solid ground” or “cogent evidence”.
110. The Panel also reminded itself that the Registrant is a person of good character, against whom there have been no adverse findings in the past and who is regarded by a number of colleagues, who have known her many years and who are aware of the allegations she faces, as a competent scientist and a person of undoubted integrity.
111. In light of the above evidence, the Panel considered first whether it was the Registrant who signed her revalidation form with the initials shown on the form put before the Panel. It approached the evidence that she had admitted this on 17 July 2019 with appropriate caution. Nevertheless, it rejected the evidence that the Registrant gave to the Panel in oral evidence that the admission was the result of improper pressure or bullying. The Panel found that the Registrant's evidence to the Panel that she had been shouted and bullied by two people actually standing over her was a significant embellishment of what she had said before and in particular her own written statement, as set out above.
112. The Panel also had regard to the explanations the Registrant gave subsequently for how the revalidation document came to be signed. It compared the evidence given by the Registrant in November 2019 and the written answers given in the appeal hearing in January 2020, that she had no recollection of the events of February and March 2020 with the more detailed account she gave the Panel of leaving the revalidation document in the office where her colleagues (including Colleague A) were present and next seeing it signed in her folder. The Panel concluded that the Registrant was embellishing her account and rejected this account. It drew the inference that she was doing so to try to distance herself from what she had done by suggesting that it was less likely than she had previously stated.
113. Taking those two matters together, the Panel was satisfied that the Registrant had signed the form, as she admitted in July 2019.
114. In deference to Mr McCaffrey’s submission, the Panel considered whether the initials on the revalidation form were properly described as Colleague A’s signature. It compared what was written on the form with the initial set out above which it was agreed Colleague A had written. Without attempting in anyway to analyse the handwriting, it could see for itself that the initials were the same, “DM”. It also bore in mind that the Registrant’s Colleagues, conducting an audit of the re validation forms saw what was written as Colleague A's signature. The Panel also had regard to the admission made by the Registrant, set out above. Taking all those matters together the Panel was satisfied that it was right to describe what the Registrant had written on the revalidation form as Colleague A's signature.
115. The Panel then went on to consider whether the Registrant's action in signing the revalidation form was dishonest. The Panel was satisfied that the Registrant knew the revalidation process and had, she told the Panel, conducted revalidations on many occasions and signed other colleagues’ forms. The Panel found that the Registrant had admitted in her evidence that she knew that she should not sign her own form.
116. The Panel then asked whether, in those circumstances, ordinary decent people would regard the Registrant's conduct as dishonest. The Panel found that they would because they would see that by signing Colleague A’s initials, she had given the false impression that Colleague A had signed her form in circumstances where she knew that this was not true and she needed a colleague’s signature on that form to complete her revalidation.
Paragraph 5 proved in relation to paragraphs 1 and 3
117. Having found paragraph 1 proved and paragraph 3 proved in relation to paragraph 1, the Panel next considered whether the facts proved amounted to misconduct that is serious.
118. The Panel had regard to the submissions of counsel and in particular bore in mind Mr McCaffrey’s submissions about the importance of having regard to the context in which the Registrant's actions occurred. It also accepted the advice of the Legal Assessor which it has followed in its decision.
119. The Panel had regard to the guidance given to panels by the High Court in Roylance v General Medical Council (No.2)  1 AC 311, “that misconduct is an act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances.”
120. The Panel also reminded itself that in order to give rise to a finding of impairment the misconduct must be serious.
121. The Panel had regard to paragraphs 9 and 10 of the HCPC Standards of Conduct, Performance and Ethics:
- Paragraph 9 provides that a registrant must:
9 Be honest and trustworthy
Personal and professional behaviour
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
- Paragraph 10 provides that a registrant must
10.1. Keep records of your work
Keep accurate records
10.2 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.
123. The Panel found that both paragraphs 9 and 10 set out above were breached by the Registrant. The Panel found that the breach was serious because it related to a process in place to ensure that proper standards of competence were observed in order to protect the public. The Panel found that fellow professionals and informed members of the public would regard it as serious that a Registrant, in a relatively senior position, had falsified the signature of a colleague on a document in those circumstances.
124. The Panel had regard to the likely effect of stress [redacted] upon the Registrant, in circumstances where it is satisfied that she acted in a way that was completely out of character. Nevertheless, the Panel found that, taken together, the seriousness of the Registrant’s conduct and her culpability in acting in a way that was dishonest in the circumstances set out above, meant that her actions amounted to misconduct that was serious.
Decision on Impairment
125. Having found that the facts proved amount to misconduct that is serious, the Panel went on to consider whether the Registrant's fitness to practise is currently impaired.
126. The Panel had regard to Mr McCaffrey’s submissions that the Registrant's misconduct was remediable, that she had taken steps to remediate and that her misconduct was unlikely to be repeated.
127. He reminded the Panel of the Registrant's written reflection and the context in which the misconduct occurred. He submitted that the Registrant’s fitness to practise was not currently impaired, having regard to either the personal or public components of impairment.
128. With regard to the latter, he submitted that a fully informed member of the public, who knew not only of the misconduct but the context in which it had occurred, would not require a finding of impairment in order to maintain their confidence in the profession.
129. The Panel accepted the advice of the Legal Assessor which it followed in its decision.
130. The Panel is aware that impairment is a matter for its own professional judgement. In reaching its decision, the Panel had regard to the conduct of the Registrant, the nature, circumstances and gravity of the misconduct found proved and the critically important public policy issues, in particular the need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour for the profession.
131. The Panel also bore in mind that it was concerned with whether the Registrant’s fitness to practise is currently impaired and focused on the need to protect the public and the wider public interest in the future.
132. The Panel bore in mind that a finding of impairment is separate from the finding of misconduct and that a finding of misconduct does not automatically mean that the practitioner’s fitness to practice is impaired.
133. The Panel had at the forefront of it mind that over three years have elapsed since the Registrant’s misconduct and there is no evidence that the Registrant has committed similar misconduct either before or since the matters proved.
134. On this issue, the Panel noted in particular the observations of Silber J in Cohen v GMC  EWHC 581 (Admin):
“There must always be situations in which a Panel can properly conclude that the act of misconduct was an isolated error on the part of a medical practitioner and that the chance of it being repeated in the future is so remote that his or her fitness to practice has not been impaired. Indeed the Rules have been drafted on the basis that once the Panel has found misconduct, it has to consider as a separate and discreet exercise whether the practitioner’s fitness to practice has been impaired.”
135. The Panel also bore in mind that in deciding whether the Registrant’s fitness to practise is still impaired it should follow the approach of Dame Janet Smith endorsed by the High Court in CHRE v NMC and P Grant  EWHC 927 (Admin): "Do our ﬁndings of fact in respect of the (registrant’s) misconduct, deﬁcient professional performance, adverse health, conviction, caution or determination show that his/her ﬁtness to practise is impaired in the sense that s/he:
i. 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; and/or
ii. has in the past brought and/or is liable in the future to bring the …..profession into disrepute; and/or
iii. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or
iv. has in the past acted dishonestly and/or is liable to act dishonestly in the future."
136. The Panel also had regard to the passage from the Cohen case above and cited by Cox J which reminds panels that there may need to be a finding of impairment in the public interest, even if the misconduct can be characterised as an isolated incident:
“Any approach to the issue of whether a doctor's ﬁtness to practise should be regarded as 'impaired' must take account of 'the need to protect the individual patient, and the collective need to maintain conﬁdence [in the] profession as well as declaring and upholding proper standards of conduct and behaviour of the public in their doctors and that public interest includes amongst other things the protection of patients, maintenance of public conﬁdence in the (profession)”.
137. The Panel also had regard to the direction given to panels by the High Court that they must have regard to all three aspects of the overarching objective, to protect the public, when reaching a decision.
138. It also reminded itself that the overarching objective involves acting
- to protect, promote and maintain the health, safety and wellbeing of the public
- to maintain public confidence in the profession
- to promote and maintain proper professional standards and conduct for members of that profession.
139. The Panel considered whether there was evidence that the Registrant had developed insight into her misconduct and taken sufficient steps to remediate so that the Panel could have confidence that she would not repeat her misconduct.
140. The Panel found that although dishonesty is difficult to remediate, the Registrant's misconduct was capable of remediation because it was an isolated incident committed in circumstances where it is likely that the stress of work and her failing health contributed to her behaving in a way that was, on all the evidence, out of character.
141. Having regard to the Registrant's written reflection and her evidence to the Panel, the Panel found that the Registrant has started to develop insight to the extent that she now recognises the gravity of her misconduct and the need to ensure that she avoids the risk situations that cloud her judgment in the future.
142. Nevertheless, the Panel found that her insight was still only partial because she has not understood her personal responsibility to ensure that her [redacted] difficulties do not put her in this position again and has not recognised that, [redacted] she has a responsibility to behave honestly.
143. The Panel is partly reassured that the Registrant has recognised the situations she must avoid but found that she has not yet recognised what she has done and understood that she remains responsible for her conduct.
144. Turning to the questions, set out in the case of Grant (above), the Panel does not find that the Registrant acted in a way liable to put service users at risk because it accepts that she was at all times a competent practitioner. Nevertheless, it finds that by reason of falsifying a record intended to protect the public, in the circumstances set out above, she has brought the profession into disrepute, breached the fundamental tenet of the profession, that professionals must be honest and trustworthy, and acted dishonestly.
145. Turning to the question of whether she is liable to repeat the misconduct with the same effects in the future, the Panel found that she was. It acknowledges that the Registrant has started to develop insight but found that the insight is not yet complete, and the Registrant has not sufficiently demonstrated that she can behave honestly if a similar situation arose in the future. The Panel found that the Registrant’s fitness to practise was currently impaired under the personal component.
146. The Panel then considered whether a finding of impairment was necessary under the “public component” or, in other words, in the wider public interest in order to promote and maintain public confidence in the profession and promote and maintain standards of conduct in the profession.
147. The Panel had careful regard to the background [redacted] which it found was likely to have had an impact on the Registrant's conduct, having regard to her previous good character and the fact that there has been no repetition of dishonesty in the three years that have elapsed.
148. Nevertheless, the Panel found that there was not sufficient evidence for the Panel to find that these factors had diminished her responsibility to the point where a finding of impairment was not required to maintain the confidence of a fully informed member of the profession or the public and in order to promote and maintain proper standards of conduct for the profession.
149. Accordingly, the Panel found the Registrant’s fitness to practise impaired under both the personal and public components.
Decision on Sanction
150. Having found the Registrant’s fitness to practise impaired, for the reasons set out above, the Panel considered, what, if any sanction it should impose on the Registrant.
151. The Panel heard submissions from Mr Bridges who reminded the Panel of the relevant paragraphs of the Sanctions Policy (SP) and in particular paragraph 58 of SP which reminds Panels that dishonesty is a serious matter “likely to result in more serious sanctions. However the panel should bear in mind there are different forms and different degrees of dishonesty, that need to be considered in an appropriately nuanced way”
152. The Panel heard submissions from Mr McCaffrey who reminded the Panel that the purpose of sanction is not punish but to protect the public and submitted that the sanction in this case need be no more restrictive than a short period of suspension of between 3 and 6 months.
153. In support of that submission, Mr McCaffrey drew the Panel’s attention to the following factors:
- The length of time which has elapsed since the misconduct, without repetition;
- The ill health and stress, which the Panel has accepted had an impact upon the Registrant;
- The misconduct in this case is an isolated, “one off” and according to a number of witnesses, entirely out of character;
- The impressive testimonial submitted on behalf of the Registrant;
- The absence of risk to service users;
- That the misconduct was capable of remediation – in part because of the interaction with the Registrant’s health;
- The Registrant has started to develop insight;
VIII. The Registrant has understood the situations she should avoid in future;
He submitted that Paragraphs 120, 121 and 122 of SP apply in this case.
154. The Panel also accepted the advice of the Legal Assessor and had regard to the HCPC’s Sanctions Policy (SP), which it has followed in this decision.
The Panel’s approach
155. The Panel is aware that the purpose of a sanction is not to be punitive but to protect the public and the wider public interest, which includes the deterrent effect on other registrants, the reputation of the profession and public confidence in the profession and the regulatory process.
156. The Panel also bore in mind the principle of proportionality and balanced the Panel’s duty to protect the public against the rights of the Registrant.
157. The Panel took into account the following mitigating factors:
- The misconduct was an isolated incident in a career spanning nearly 30 years;
- The Registrant’s misconduct occurred when the Registrant was experiencing exceptional pressure at work [redacted];
- The Registrant has started to develop insight in the way set out at the impairment stage;
- The Registrant was held in high esteem by colleagues both as a Biomedical scientist and an honest person;
158. The Panel also took into account the following aggravating factors:
- There is a finding of dishonesty, which is identified in the Sanctions Guidance as a serious matter likely to undermine public confidence in the profession;
- A risk of repetition remains because the Registrant has not demonstrated remediation.
159. The Panel also noted there is no evidence before it regarding the Registrant’s employment and how she has progressed since 2020.
160. The Panel then considered the sanctions available to it in ascending order of severity.
161. The Panel considered that to take no action or to impose mediation would not be appropriate given the serious nature of the misconduct found. Such a course would not be sufficiently restrictive to protect the public, including the wider public interest.
162. The Panel next considered whether it should impose a caution order. The Panel had regard to paragraph 101 of the SP, which provides:
101. A caution order is likely to be an appropriate sanction for cases in which:
- the issue is isolated, limited, or relatively minor in nature;
- there is a low risk of repetition;
- the registrant has shown good insight; and
- the registrant has undertaken appropriate remediation.
163. The Panel found that the Registrant’s misconduct was isolated but not sufficiently minor to impose a caution order, in particular having regard to her seniority and position of responsibility. The Panel also found that the Registrant’s insight was still limited for the reasons set out at the impairment stage.
164. The Panel considered whether a conditions of practice order would be sufficient to protect the public. The Panel had already found that the Registrant’s misconduct is capable of being remediated. Nevertheless, the Panel had regard to paragraph 108 of SP which provides that conditions are unlikely to be appropriate in cases involving dishonesty and concluded that it was not possible to draft conditions that would address the concerns raised by the Registrants misconduct or be sufficiently restrictive to protect the public and the wider public interest.
165. The Panel then went on to consider whether a Suspension Order would be sufficient to protect the public and the wider public interest and had regard to paragraph 121 of SP, which provides:
121. A Suspension Order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:
• the concerns represent a serious breach of the Standards of conduct, performance and ethics;
• the registrant has insight;
• the issues are unlikely to be repeated; and
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.
166. The Panel found that not all these factors are well demonstrated in this case. Nevertheless, the Panel found that, because:
- the Registrant’s misconduct was an isolated incident; and
- the Registrant has started to develop insight into the seriousness of what she has done; and
- there is no evidence of any misconduct in the 3 years since the misconduct in this case;
- the Registrant has the benefit of impressive testimonials from colleagues; there was sufficient material to satisfy the Panel that a period of suspension would be sufficient to protect the public, including the wider public interest, and that there was a realistic prospect that the Registrant would use the time to develop sufficient insight and remediate her misconduct so that there was no longer a risk of repetition.
167. Therefore, the Panel decided to impose the Suspension Order for a period of 6 months. It decided that 6 months was sufficient to mark the seriousness of the misconduct at this time and also to give the Registrant sufficient time to undertake the work she must do to remediate.
168. The Panel did consider whether it was necessary to impose a striking off order in this case. It took into account paragraph 131 of SP which provides:
a. 131. A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:
• lacks insight;
• continues to repeat the misconduct or, ….
• is unwilling to resolve matters.
169. The Panel found that, in light of the material referred to above, a striking off order was not necessary at this stage because a Suspension Order would protect the public and there was a realistic prospect that the Registrant would use the time to remediate. The Panel also found that the single act of misconduct in this case was not so serious that only a striking off order could be justified to protect the public.
170. Accordingly, the Panel imposes a Suspension Order for a period of 6 months.
171. The Suspension Order will be reviewed before its expiry. At the review hearing the reviewing panel is likely to be assisted by
- The Registrant’s attendance at the review hearing;
- Evidence of the Registrant’s employment, paid or unpaid;
- A reflective piece demonstrating that the Registrant has understood her own responsibility to ensure that she can cope with the demands of work without resorting to misconduct;
- Any references or testimonials the Registrant can obtain demonstrating her ability to work in stressful situations;
- Evidence that the Registrant has maintained her CPD and skills;
- Any other material the Registrant can present to demonstrate that the risk of repetition has been further reduced.
172. Following the announcement of its decision, the Panel acceded to an application by Mr Bridges, supported by Mr McCaffrey, to transfer the outstanding health allegation (allegation 4) to a Health Committee to decide if that allegation should be heard or discontinued.
Order: That the Registrar is directed to suspend the registration of Mrs Rupinder Bhatti for a period of 6 months from the date this order comes into effect.
- After the Panel announced its decision on sanction, Mr Bridges applied for an interim order to cover the period before the Suspension Order will come into effect (that is to say, initially 28 days or the final determination of the appeal if the Registrant appeals the Panel’s decision within the initial period of 28 days).
- Mr Bridges submitted that, in light of the Panel’s finding that there was still a risk of repetition of the Registrant’s misconduct, an interim Suspension Order was necessary to protect members of the public and was otherwise in the public interest, because public confidence in the profession would be undermined if the Registrant could continue in unrestricted practice following the Panel’s findings.
- Mr McCaffrey made no submissions regarding the application.
- The Panel accepted the advice of the Legal Assessor which it has followed in this decision.
- The Panel reminded itself that Article 31 of the Health Professions Order 2001 as amended provides that the Panel may make and interim order if it is satisfied that it is necessary for the protection of members of the public or is otherwise in the public interest, or is in the interests of the person concerned, for the registration of that person to be suspended or to be made subject to conditions.
- SP gives guidance in the following terms:
135. An interim order is likely to be required in cases where:
• there is a serious and ongoing risk to service users or the public from the registrant’s lack of professional knowledge or skills, conduct, or unmanaged health problems; or
• the allegation is so serious that public confidence in the profession would be seriously harmed if the registrant was allowed to remain in unrestricted practice.
- For the reasons already explained in the determination relating to the substantive issues, the Panel has concluded that there remains a risk that the Registrant will repeat her misconduct until she develops further insight and demonstrates that she has remediated. Accordingly, the Panel found that an order was necessary to protect members of the public. The Panel is also satisfied that public confidence in bio medical scientists would be undermined if the Registrant were allowed to practice without restriction pending the substantive order coming into force. Accordingly, the Panel was satisfied that an interim order is also in the wider public interest.
- Having decided that an interim order is required, the Panel next considered whether an interim conditions of practice order would offer sufficient protection during the period while the Registrant’s appeal rights remain extant. The Panel concluded that it would not for the same reasons that it rejected substantive conditions of practice as an appropriate sanction.
- It followed from this decision that an interim Suspension Order is required, and the Panel makes that order.
- As to the length of this interim order, the Panel determined that it should be for the maximum period of 18 months. If the Registrant does not appeal the Panel’s substantive decision the interim order will simply fall away after 28 days, and therefore the maximum length of the order will not prejudice her. If, however, she does appeal the final determination of the appeal could well take 18 months from the present time, and it is appropriate that there should be the full degree of public protection until that final determination.
- 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 Rupinder Bhatti
|Date||Panel||Hearing type||Outcomes / Status|
|03/05/2022||Conduct and Competence Committee||Final Hearing||Suspended|