Paula J May

Preliminary Matters
Service
1. The Notice of Hearing was sent to the Registrant, by email, to her registered email address on 7 November 2023 informing her that there would be a Substantive Order Review hearing on 8 December 2023 via video hearing. A Certificate of Service has been provided confirming the Notice of Hearing was sent to the Registrant’s registered email address. An email dated 7 November 2023 confirmed delivery of the email to the Registrant’s registered address.

2. The Panel was satisfied that service had been effected in accordance with the Procedure Rules and the Practice Note on Service of Documents.

Proceeding in absence.

3. Ms Sampson on behalf of the HCPC applied for the hearing to proceed in the Registrant’s absence. She submitted that the Registrant had voluntarily absented herself and that no application had been made for an adjournment. She reminded the Panel that this was a mandatory review of a Substantive Order that was due to expire in January 2024. She submitted that there had been no engagement from the Registrant, and she did not attend the substantive hearing, although she did provide written submission. Ms Sampson submitted that there was no evidence that an adjournment would secure the Registrant’s attendance on any future occasion. She submitted that it would be fair and in the interests of justice to proceed in the Registrant’s absence.

4. The Panel had regard to the HCPTS Practice Note on “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor. The Panel was mindful that this was a review of a Substantive Order that was due to expire in January 2024. The Panel noted that the Registrant had not responded to the Notice of Hearing and neither had she responded to a further email sent by the Presenting Officer on 27 November 2023. No request for an adjournment has been made and no reason for the Registrant’s non-engagement has been provided.

5. The Panel considered that the Registrant had voluntarily absented herself, that an adjournment would be unlikely to secure the Registrant’s attendance at a future date and that no useful purpose would be served by an adjournment. The Panel was mindful of the need to proceed expeditiously to protect the public and to ensure that the order was reviewed before its expiry. In all the circumstances the Panel could identify no good reason to adjourn and decided that it was in the interests of justice to proceed with the hearing in the absence of the Registrant.

Background
6. The Registrant is a Podiatrist working in private practice. On 23 November 2020, the HCPC received a referral dated 22 October 2020 from the complainant, Service User 1. In the referral, Service User 1 alleged that the Registrant overcharged him for what he believed were ‘bespoke’ orthotics. Service User 1 stated that the insoles were marketed to him as custom made and bespoke by the Registrant.

7. Service User 1 alleges he was told by the Registrant that he would need two sets of insoles. The first pair would be a soft insole and then 18 months later he would progress to hard insoles. To create both insoles, Service User 1 alleged that the Registrant measured his feet using a ruler and protractor from the back of his heel. He stated that no Plaster of Paris mould or digital scan were taken of his feet. The soft insoles were provided in the spring of 2018.

8. Service User 1 received the hard insoles on or around 25 February 2020 and these were allegedly described by the Registrant as having been made using new NASA technology. Service User 1 stated that he wore the new, hard insoles for a few months, but that the insoles started to separate. Service User 1 informed the Registrant who advised that she would replace the insoles free of charge.

9. The replacement insoles provided did not fit Service User 1’s shoe and were nearly an inch smaller. On 9 July 2020, Service User 1’s wife contacted the Registrant to discuss her concerns with the insoles to which the Registrant responded that the manufacturer must have used the wrong mould. Service User 1’s wife advised that no mould had been taken of Service User 1’s foot and then proceeded to request a full refund. The Registrant provided a full refund on 16 July 2020.

10. On 24 July 2020, Service User 1 met another Podiatrist, PS and they discussed the insoles provided by the Registrant. PS expressed concerns around the cost of the insoles. The Registrant showed PS the old pair of soft insoles that the Registrant had previously given him for which he paid around £300. PS investigated the orthotics further and found the exact insoles online for £29.34. PS prepared a letter for the complainant to include in his subsequent referral to the HCPC.

Decision of the Substantive Panel.

11. The matter was heard by a panel of the Conduct and Competence Committee at a Final Hearing between 05 June – 08 June 2023. The panel found all the facts proved. That panel found that the Registrant had acted dishonestly and that, by reason of her misconduct, the Registrant’s fitness to practise was impaired in relation to both the personal and public components. In considering sanction, the panel noted that the Registrant had not engaged by attending the hearing and had not provided evidence of insight or remediation into her practice.

12. The panel considered that the aggravating factors were:

a) The lack of insight, remediation, remorse or apology;
b) The dishonesty was repeated;
c) The dishonesty took place within the workplace;
d) Breach of trust;
e) Financial harm caused to Service User 1.

And the mitigating feature was the refund that the Registrant offered Service User 1 for the hard insoles.

13. The panel did not think that making no order or a Caution Order were appropriate sanctions due to the serious nature of the concerns raised. Additionally, it concluded that a Conditions of Practice Order would not be workable because the Registrant had not engaged with the regulatory process and there was no evidence that she had insight into her failings or had taken any action to remediate them.

14. The panel considered a Striking Off Order but decided that this would be disproportionate.

15. The panel noted that the issues of misrepresentation and overcharging in professional practice are serious and concluded that a suspension order was the only sanction that could be imposed in the circumstances.

16. The panel decided that the proportionate term of the Suspension Order would be 6 months. This would allow the Registrant time to reflect on her behaviours and provide her with an opportunity to remediate and engage in the regulatory process to ensure that there is no risk of repetition.

17. The panel considered that a future panel reviewing this order may be assisted by:

a) The Registrant attending the review hearing;
b) The Registrant creating an up-to-date information sheet to be provided to service users which gives unambiguous information regarding assessment for, prescribing and provision of orthotics;
c) A practice position on charging for devices; and
d) A reflective piece on the Panel's findings and any measures taken to ensure that the misconduct will not be repeated.

HCPC submissions.

18. Ms Sampson on behalf of the HCPC submitted that the Registrant’s fitness to practise remains impaired on the basis that there was no evidence before this Panel that she had taken any steps to remedy the concerns that led to the previous finding of misconduct. Ms Sampson drew the Panel’s attention to the fact that the Registrant had not engaged with the HCPC since the substantive hearing and her written submissions for the substantive hearing did not provide any evidence of insight or remediation. Ms Sampson also submitted that the Registrant had not taken any of the steps referred to by the previous panel that would be likely to assist a reviewing panel. In the circumstances Ms Sampson submitted that the Registrant had not discharged the persuasive burden that she had remedied her previous failings and was no longer impaired. Ms Samson submitted that there was no evidence before the Panel to enable it to conclude that the Registrant was no longer impaired.

19. With regard to sanction, Ms Sampson, referred the Panel to the HCPC sanctions policy and in particular, paragraphs 121 and 131. Ms Sampson submitted that there was no evidence before the Panel today to suggest that the registrant has insight, that the issues that led to the original suspension order are unlikely to be repeated or that the Registrant is willing to resolve or remedy her failings. Therefore, she submitted that the criteria for a further Suspension Order were not met and that in circumstances where a Registrant is not engaging with the regulatory proceedings a further Suspension Order would serve no useful purpose. She submitted that a Striking Off Order may be the most appropriate Order. In the alternative, if the Panel were minded to offer the Registrant a further opportunity to remedy her misconduct, she submitted a further short suspension order may be appropriate.

Decision on Impairment
20. The Panel's remit on this Review is to determine whether the Registrant's fitness to practise remains impaired, and, if so, how to approach any sanction, with reference to its powers under Article 30(1)(a), (b) and (c) of the Consolidated Health Professions Order 2001, as amended (the Order).

21. The Panel considered whether the Registrant's fitness to practise is impaired by reason of her misconduct. It took into account the evidence before it and to the submissions of Ms Sampson. It accepted the advice of the Legal Assessor and had particular regard to the HCPTS Practice Note on Finding that Fitness to Practise is Impaired. It recognised that the decision on impairment was a matter for its own independent judgment. The Panel also noted that it was entitled to take into account and give respect to the previous panel's reasons and conclusions, but that this Panel should approach its remit independently, based on the evidence before it today. The Panel determined that the Registrant’s fitness remains impaired by reason of her misconduct. It concluded that both the personal and the public component is engaged. Its reasons were as follows;

• There has been no material change in the underlying facts of this case since the substantive hearing.
• The Registrant has not complied with any of the suggestions made by the substantive panel as to what might assist the Panel. In particular the Registrant has not attended or provided any reason for non-engagement and there is no evidence of recent relevant training or reflection.
• There was no evidence of insight or remediation before the previous panel and there has been nothing provided to this Panel.
• The Panel has concluded that in the absence of any evidence that the Registrant has taken steps to address the concerns there is a significant risk of repetition of the Registrant’s misconduct and thus a continuing risk to service users.
• The Panel further concluded that public confidence in the profession and in the HCPC as its regulator would be undermined if a finding of present impairment was not made. The Panel also concluded that such a finding was necessary to maintain proper standards of conduct within the profession.

22. Having concluded that the Registrant’s fitness to practise remains impaired, the Panel next considered the available sanctions. In reaching its decision on Sanction, the Panel noted its powers under Article 30(1) (a), (b) and (c) of the Order. It accepted the Legal Assessor's advice and took into account the HCPTS' Sanctions Policy. It considered each outcome and sanction available to it, in ascending order of restriction.
23. It considered that to take no action or to impose a caution order would be wholly inappropriate and would provide no protection to the public or in any way address the public interest.

24. The Panel then considered a Conditions of Practice Order. However, the Panel had no confidence that the Registrant would comply with a Conditions of Practice Order. In coming to this conclusion, the Panel adopted the reasons identified by the substantive panel. The Panel considered that it could not devise workable or appropriate conditions that would address the Registrant’s lack of insight or her apparent unwillingness to engage.

25. The Panel then considered making a further Suspension Order. It considered this aspect very carefully and had regard to the Sanctions Policy. In particular the Panel had regard to paragraph 121, of the Sanctions Policy which states:

“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;
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings."

26. The Panel noted that the previous panel had imposed a suspension order for six months to provide the Registrant with “…time to reflect on her behaviours and provide her with an opportunity to remediate and engage in the regulatory process to ensure that there is no risk of repetition.” There was no evidence before this Panel that the Registrant was willing to engage in the process and there was no evidence to suggest that she had developed insight and the issues were unlikely to be repeated. The Panel considered that a further suspension order in the hope that the Registrant would develop insight would not be in the public interest and would not uphold public confidence in the regulatory process. The Panel considered that a further Suspension Order would serve no useful purpose in these circumstances.

27. In coming to this conclusion, the Panel had in mind the principle of proportionality; not to impose a more restrictive order than is necessary to protect the public and sustain the public interest. However, the Panel was mindful of paragraph 131 of the Sanctions Policy which states that a Striking Off Order is likely to be appropriate in circumstances where the Registrant lacks insight and is unwilling to resolve matters.

28. The Panel concluded that on the basis of the lack of evidence of remediation and insight and the absence of any explanation from the Registrant regarding the failure to engage, she was unwilling to resolve matters and that this was incompatible with continuing to be a registered professional. In these circumstances the Panel concluded that the only appropriate order was a Striking Off Order.

ORDER: The Registrar is directed to strike the name of Ms Paula May from the Register on the date this Order comes into effect.

The Order imposed today will apply from 6 January 2024.

History of Hearings for Paula J May