Mrs Annabelle Mitchell

Preliminary Matters:

Proof of Service

1. The Panel accepted the advice of the Legal Assessor. The Panel had sight of an email dated 27 April 2023, sent to the Registrant at her registered email address, giving the requisite notice of today’s hearing. There was notification that the email had been delivered. The email notified the Registrant of the hearing time, the date and that it would be conducted by video conference. Information was included about how the Registrant could join the video conference, if she wished to do so, and the Panel’s power to proceed in her absence, in the event that she did not participate. The Registrant’s representatives at Thompsons Solicitors were copied into the email.

2. The Panel was thus satisfied that service had been complied with in accordance with the Health and Care Professions Council (Conduct and Competence Panel) (Procedure) Rules 2003 (as amended).

Proceeding in absence

3. Mr D’Alton made an application to proceed in the Registrant’s absence.

4. The Panel heard and accepted the legal advice from the Legal Assessor, who referred it to the case of the GMC v Adeogba [2016] EWCA Civ 162, and the principles to be considered when deciding whether or not to proceed in the absence of a registrant. The Panel had in mind the need to exercise its discretion to proceed with the utmost care and caution.

5. The Panel had sight of an email dated 18 May 2023 from Thompsons Solicitors, who stated that the Registrant would not be attending the hearing and nor would they. It was pointed out that no discourtesy was intended by the Registrant’s non-attendance and that the Solicitor would be available on the telephone, should the Panel require any further information.

6. The Panel noted that the Registrant faced a serious allegation and there was a clear public interest in the matter being dealt with expeditiously. There was cogent and compelling evidence before the Panel in the form of a certificate of conviction. The Panel recognised the potential prejudice to the Registrant in proceeding in her absence, however she had made it clear, through her solicitors, that she did not wish to attend. She had not requested an adjournment. She had provided written submissions that the Panel could take into account.

7. The Panel was satisfied that by her clear indication that she would not be attending, the Registrant had voluntary absented herself and thereby waived her right to be present. The Panel concluded that it was in the interests of justice that the matter should proceed notwithstanding the absence of the Registrant. The Panel would draw no adverse inference from the Registrant’s non-attendance and take into account the material provided on her behalf.

Application to hear part of the hearing in private

8. It was apparent that issues of health relating to the Registrant may be raised during the hearing or in the written determination. Accordingly, Mr D’Alton invited the Panel to consider going into private session if and when any such matters were raised.

9. The Panel accepted the Legal Assessor’s advice that, although the general rule is that hearings are to be in public, it is open to a panel to go into private session when dealing with matters relating to the health of a registrant. The Panel decided that when, and if, such matters were raised they would be heard in private, in order to protect the private life of the Registrant.

Application to amend

10. Mr D’Alton made an application to amend the Allegation in one minor respect, namely the date referred to, which was the date of sentence not the date of conviction. He thus applied to amend the date as reflected on the Certificate of Conviction.

11. The Panel accepted the advice of the Legal Assessor that it could amend the Allegation at any stage prior to the findings of fact provided any such amendment can be made without causing any injustice or unfairness. The Panel acknowledged that the Registrant had not been made aware of this application and therefore had not had an opportunity to respond to it. However, it was difficult to see how the amendment would cause her any undue prejudice since the date of the conviction was a matter of public record and one that she would be familiar with. The Panel was satisfied that this was clearly just a typographical error. The Panel therefore allowed the amendment requested.

Background:

12. The Registrant is, and was at all material times, registered as an Occupational Therapist with the HCPC.

13. At the time relevant to the allegations raised, the Registrant was employed as the Ward and Community Lead Occupational Therapist (Band 7), at the Riverside Acute Mental Health Service (part of the North West London NHS Foundation Trust ('the Trust’)).

14. On 28 August 2019 the HCPC received information from the Police that the Registrant had been arrested the previous day on suspicion of stabbing a male service user ('Person A') in the back.

15. In subsequent disclosure it was confirmed that the service user in question had been a previous patient of the Registrant prior to 2012 and had a history of stalking the Registrant.

16. In responding to the allegations raised, the Registrant set out to the Trust and HCPC that while she admitted stabbing Person A, she had been acting in self-defence, after he had followed her into her house and had acted threateningly towards her.

17. Following a jury trial, the Registrant was subsequently convicted at Reading Crown Court on 10 January 2022 of wounding/inflicting grievous bodily harm, contrary to Section 20 of the Offences Against the Person Act 1861. She was sentenced on 21 February 2022 to 14 months imprisonment, suspended for 24 months. Her sentence will therefore be completed on 20 February 2024. She was also required to carry out 150 hours of unpaid work and to pay £400 compensation to her victim.

18. As part of the investigation into these matters, the HCPC obtained a transcript of the sentencing remarks relating to the Registrant's conviction. These sentencing remarks set out that contrary to the Registrant's assertions:

• The Registrant had had a close relationship with Person A beyond her previous treatment of him as a patient;

• The Registrant had not acted in self-defence. She had deliberately left her house with a kitchen knife and attacked Person A outside stabbing him in the back, contrary to the advice of a 999 operator.

19. In sentencing the Registrant, the Judge provided more detail, saying the following:

“You first met [Person A] when you were employed as an occupational therapist at Lakeside Mental Health Unit. He was at that time an inpatient there where he was receiving treatment for paranoid schizophrenia. You became friendly. He liked and trusted you and those feelings continued after the end of your professional relationship.

Once discharged [Person A’s] mother passed away and left him an inheritance. A portion of that went on recreational drugs but he was also keen to do up the flat in which he was living. He looked to you for help with that which you willingly provided.

There was evidence directed at trial to whether the two of you were in a sexual relationship. Notwithstanding your conviction, I don't consider it is right to approach sentencing on the basis that it has been established on the evidence that the two of you did have a sexual relationship, or at least that if there was any intimacy in that sense, that it was part of any sustained sexual relationship. There were too many questions and doubts revealed to be confident about that and, in my judgment, such a conclusion forms no necessary part of the jury's verdict. The text messages were as consistent with a friendship which, though inappropriate, given your professional relationship originally, as I think you now recognise, was nevertheless consistent with that of a close friendship.

And it was a close and indeed at times loving friendship, perhaps not typical because there was always an imbalance in that relationship. [Person A] needed you more than you needed him and he trusted and relied on you, but there was, nevertheless, a closeness between the two of you forged by your love of cats and revealed by those text messages, and the time that you spent together, and the purchases made for you, at least certainly the ring. [Person A] no doubt had an infatuation with you which I accept was not reciprocated in like fashion.

In July 2019 you started to have unwanted contact from him. He remained infatuated with you and was travelling upwards of 45 minutes from his home address to be close to you. You responded, contacting the police to report incidents. [Person A] was attending your home and place of work and you were concerned he was stalking you.

At 4.57 on the 26th of August 2019, you called the police again to report his attendance. Your evidence is you were anxious and then drank an amount which was out of character, a bottle of wine and a quarter of a bottle of gin. I find it hard to believe that you drank the amount you say you did, at least if, as you said in evidence, that was out of the norm for you. However, you did drink when you were stressed. It is surprising you retained that relative coherence which you displayed in the 999 call and in the video clip but there is no doubt that alcohol played a substantial part in this offence and that you were disinhibited as a result of what you had drunk.

At about nine thirty the defendant returned. He had been there earlier that day. There may be no evidence that you contacted the police on that particular day. He was dishevelled and you helped him tidy himself up. The two of you sat on the patio and chatted without aggression of threat.

You considered [Person A] needed help and you persuaded him that you should ask the authorities for help for him. You called 999 for this reason. [Person A], however, became aggressive at the idea of being detained by the police. Initially, you were the model of restraint and calm, no doubt reflecting your generally collected personality and your professional training. The operator on the call was more concerned for your safety than at least initially you were, familiar as you were with [Person A’s] vulnerability and his personality and his dislike of the authorities.

However, as [Person A’s] aggression audibly built, the operator advised you to lock all doors and windows which you confirmed to him you had done. Shortly afterwards you snapped. You lost your composure and your professional reserve. You told the operator, "He's right outside the door, outside my door. I can't take any more of this. I've rung several times today. Sorry", and that was the trigger for you taking a sharp knife from the kitchen, going outside your house, contrary to the advice of the telephone operator, and stabbing [Person A] in the back, causing him to suffer a three centimetre stab wound to the right upper back. [Person A] evaded any further action of aggression on your part.

There was no question of this being self-defence of any nature, in my judgment. It was a deliberate decision on your part, albeit impulsive and in no way pre-planned, no doubt born of frustration and fuelled by impaired judgment through alcohol. [Person A], though aggressive, was outside and you were inside. In this attack you were the aggressor.

The video evidence of the aftermath shows you again relatively composed, seemingly indifferent to what you had done, throwing household objects casually in the direction of [Person A]. When he came close to you, you again threatened him with the knife. You didn’t call an ambulance. He then left your property and you went about tidying, putting the knife in the dishwasher, changing clothes.

I reject the prosecution's case this was an attempt to cover your tracks. I doubt at the time you really thought about the consequences of what you were doing. Even at the point [Person A] was found by the police bleeding in a nearby street, he wasn't keen to get you in trouble. It is clear that feelings for you remained notwithstanding what you had done to him.”

20. In deciding on the appropriate sentence, the Judge said:

“It is in the context of those facts that I've got to impose an appropriate sentence. I must have regard to the relevant guidelines on which I have had assistance from counsel.

There's no dispute between counsel, and I agree, that the harm in this case against the severity of this offence was category 3 harm. The question which I have to consider is whether I should approach this offence on the basis that it was A, high culpability or B, medium culpability. That's not an easy question and the way I look at it is this, that in terms of culpability there are particular factors which I must bear in mind; first of all, the question of whether the victim was obviously vulnerable due to age, personal characteristics or circumstances; secondly, whether there was the use of a highly dangerous weapon and those are two matters that are potentially relevant in the application of A. On the other side of the fence, at C, lesser culpability, there is the question of whether or not this was an impulsive, spontaneous and short-lived assault.

The Crown say this is A because of the use of the knife. They say this is clearly a higher culpability offence. Your counsel says this is B because this is factors that fall both sides of the line which balance themselves out.

The view I take – and I will come on to explain that this is more nuanced than some cases – is that on balance this is, nevertheless, a category A culpability here.

Notwithstanding submissions forcefully made on your behalf as to the context in which the knife was used, it remains the case that this was the use of a highly dangerous weapon and it seems to me that the circumstances of its use go to the balancing factor of whether this was impulsive or spontaneous and short-lived which I accept that in principle it does.

But I also reject your counsel's submission that [Person A] wasn't vulnerable. I accept that here he was a strong man and I accept that this was a physical assault but at the same time he was, as you knew, vulnerable. He was shouting and aggressive because of his vulnerabilities and, indeed, you had displayed a full understanding of that in the course of the telephone call and, in those circumstances, it does seem to me that that factor is relevant in these circumstances where you deliberately went outside and this wasn't a case of excessive self-defence.

That said, it's a close run thing, in my judgment, as to whether there was a balancing out of factors and while it is the case that the starting point under this category guideline is a custodial sentence of two years with a category range of one to three, I consider that in these unusual circumstances that is not the appropriate way in which I should look to the starting point of a sentence even before applying mitigation and aggravating features and I regard the proper starting point here, reflecting this as being rather the lower end of the category A range, as being about 18 months and I look to the fact that this is also a sentence point that appears in culpability level B as a cross-check.

From there I look to what mitigating and aggravating factors there are in this case and I must be careful not to double count those factors that have already been brought into play in the way that I have looked at questions about culpability and in these circumstances there are aggravating features.

You were certainly in drink at the time and on your case had drunk a substantial amount but it is also right to point out, as your counsel notes, that the circumstances in which that came about are unusual. This was an unwanted attendance on you by the victim. You in no way sought him out and he came to you late at night when you had been drinking, for coincidental reasons, you thought in the safety of your own home and, therefore, while that is an aggravating feature, it seems to me that it doesn't count to a particularly high regard.

Likewise, the fact that there was still a relationship of trust by him of you on the facts of this case doesn't seem to me to count for very much in circumstances where this was a physical assault born of an attendance which was not part of a regular pattern, at least on your part, even if it was unwanted conduct on the part of [Person A] and, therefore, I don't take much account of that either.

I do take account, by way of looking at factors the other side of the line, to matters that you are able to point to by way of mitigation and those are substantial. There has been – in this case you are somebody with no previous convictions. You are somebody of previous good character and exemplary conduct. You have had a long career working in very worthwhile and laudable public service in the caring profession for those ironically vulnerable and in need and, indeed, have displayed yourself very able in that direction and those matters must be reflected.

Further, there is personal mitigation beyond that as reflected by references that have been given on your behalf, by your partner, by your employer, by a former colleague, all of whom speak to your good character, to your abilities, to your organisation and to your care which, I confess, having observed you in the witness box – and this may chime with comments you have made to probation – perhaps some of that care wasn't automatically clear but it's quite clear you are a very caring person and have been over many years and that has come across to those who have been close to you.

As regards provocation, I find that a difficult concept. I am persuaded here that it’s just not apt to look at this case in any way under the domestic abuse guidelines. First, I find that there had been no sexual relationship. Secondly, I am persuaded by your counsel that the particular circumstances of this case don't automatically engage those provisions and, thirdly, in any event, when one looks at the aggravating features that are there under those guidelines, I consider that, to the extent relevant, I have already taken them into account in my approach towards culpability, so I take no further account of those. I am prepared to accept that the context of this offence to some degree may be regarded as a provoking factor but I don’t regard provocation of itself as a particular issue here. It's more the context of the offence more generally in which I have already reflected matters by way of my approach to culpability.

So, taking all those factors into account, both the slightly aggravating factors and the substantially mitigating factors, I arrive at an indicative sentence of some 14 months. But I then have to ask myself whether it is appropriate, in the light of that indicative conclusion, to impose an immediate custodial sentence. I don't regard this as being a case where the dangerousness provisions are engaged. I do not consider that there is any significant risk to the public in this case.

The real question for me is whether or not this is a sentence I should suspend and I have concluded that I can suspend the sentence and I am going to do so on terms. I have had regard to the guidelines in terms of suspension. Do you present a risk or danger to the public? In my view, very low in all the circumstances. This was a very unusual offence.

Your counsel has persuaded me of that. I do not consider there is a significant risk to the public. I don't consider that appropriate punishment can only be achieved by immediate custody. There are particular reasons in your case with your mitigation [redacted], which point to me – along with the fact that there are no factors that indicate it would not be appropriate to suspend the custodial sentence and there are real factors that indicate that it may be appropriate to do so in this case.

I have had regard to what has been said very helpfully by the Probation Service and that you have, if not expressed remorse for the offence – you have almost challenged yourself to wonder how this could have taken place [redacted]. You have had considerable stress and difficulties as a result of these events over a number of years now since they took place, partly because of the retrial, partly because of COVID and partly because of the investigation, all of which seem to me to point to the fact that allied to the prospect of continued employment, the success you are having with your employment, your ability to have rebuilt your life in a new part of the world and the positive benefits that that will have on you and I think the community, that this would be an appropriate case in which the sentence should be suspended.”

21. On 8 March 2020, the Registrant provided a statement to the HCPC setting out the circumstances of the incident. She spoke of how she became aware of a former patient acting strangely towards her and stalking her. The patient was, she said, known to the police for serious assault and had served a long custodial sentence for violence. He was 6 feet 3 inches tall and 49 years old, of no fixed abode. She said that in 2019 he embarked on a harassment stalking campaign targeted against her, whereby he left objects on her car windscreen, including macabre items. She said he would also peer through windows at her place of work and enter reception looking for her, resulting in the police being called.

22. The Registrant said that she had provided a timeline of Person A’s activity to the National Stalking Line, highlighting more than a dozen separate incidents either at her place of work or at her home. She said she lived in a ground floor flat with communal gardens, accessible by the public and not secure. The Registrant spoke of Person A twice sleeping in a neighbour’s tent they had left out overnight for their child to play in. He was asked to leave by the neighbours. She said the police were called. This was around 16 August 2019. He was also staring in through her patio door windows and again the police were called.

23. The Registrant said the police were called twice on 17 August 2019 because Person A was at her place of work all day and again on 21 and 23 August 2019 the police were called on over five occasions because Person A was at her place of work. On Monday 26 August 2019, the Registrant said Person A was at her home address ringing the external buzzer. This was around 3pm. She ignored him, shut all her curtains and called the police. However, they did not attend. She said Person A had left some clothes folded in a pile at the side of her flat.

24. The Registrant said she retired to bed around 10pm on 26 August 2019. She was nervous and anxious regarding the events of the day. She said she got up to let her cat out through the patio doors and Person A appeared from around the side of her building. She said he was clearly unwell and he agreed that she could call an ambulance for him. He was given some food and a hot drink while the Registrant persuaded him to go to hospital.

25. The Registrant said that whilst she was making the call for the ambulance Person A changed and became aggressive verbally and physically. She said there was a scuffle and altercation where threats were made by Person A, he tried to sexually assault the Registrant and manhandled her saying he wanted to sleep with her. She said he had entered her flat and was shouting whilst holding her. She then said “At this point I picked up a vegetable knife from my draining board and in order to defend myself used the knife once to make him leave me alone up injuring him in the back of his upper shoulder.” (sic)

26. The Registrant said the police attended and she was arrested and Person A was taken to hospital.

27. In the email from Thompsons Solicitors dated 18 May 2023, it was said that the Registrant accepts the Regulatory body’s concerns following the guilty verdict and asked that the documentation attached be put before the Panel. Those documents consisted of a statement from the Registrant and a letter from the National Stalking Helpline.

28. In that statement the Registrant provided much more detail about her relationship with Person A. She spoke of her role as Person A’s Occupational Therapist from August 2009 to March 2011 at Lakeside Mental Health Hospital. She then worked with Patient A when he left hospital, attending his home twice a week to support him in settling back into a routine at home. She said when working with Person A she was aware of the risks when he is unwell and she knew he had served a prison sentence for attacking a friend with a hammer. He was also part of a group involved in cutting up a homeless man with a Stanley knife and had set his cell mate on fire when in prison. However, she said that when well he was pleasant and polite and keen to remain abstinent from substance and alcohol abuse. She said he engaged well with therapy.

29. The Registrant said that in 2013 she changed her job and thereafter only saw Person A occasionally in the area. However, there was an occasion where Person A was looking through the windows of the flat where she lived and the police were called. She said Person A did not look himself, he was very thin, unshaven and dirty and apparently had been sleeping rough. She said she called 999 for an ambulance, but none attended. She provided Person A with dry clothes and gave him food and a hot drink. She sat with him in her garden (he did not enter her flat) and he came and went for around six hours and then did not return.

30. The Registrant said she did not then see Person A for several months, by which time she had taken up a new post at the Riverside Centre. Person A, she said, would often turn up at her place of work and was seen drinking with patients from the adjoining rehabilitation unit. He looked well and they would exchange pleasantries.

31. In 2017/2018 Person A informed the Registrant that he had some money left to him by his mother who had died and he wanted to sort out his flat. The Registrant began to meet up with him more often, around once a week, and helped him with his flat. They exchanged phone numbers and began messaging each other. The Registrant said she was separated from her husband at this time and began looking forward to seeing Person A. They would go for coffee and lunch and to visit a cats’ home. She said, however, that Person A began to slip into his old pattern of substance misuse and became irritable. The Registrant said she told Person A he needed to return to the drug and alcohol service and get help and she told him she could not meet up with him or help him anymore.

32. The Registrant said that Person A began to hang around her place of work more often from around May/June 2019 and also returned to her flat ringing the buzzer. She took steps to avoid him. Then in July 2019, Person A turned up at her place of work. He appeared to be intoxicated and he gave her a red ball and a half-eaten kebab. Over the following days Person A was seen at her place of work, staring in through the windows, shouting at the sky and hitting passing cars with his belt. He was found by neighbours sleeping in their tent in the communal gardens. He was also seen in the Registrant’s rear garden one evening talking to her cat and siting on her garden bench. She asked him to leave and he did. He continued to hang around her place of work.

33. The Registrant said that the week prior to the incident of 26 August 2019 matters escalated further with Person A looking through windows at work continuously. He left a book of psychiatric conditions on her car windscreen with “red gunge” smeared across it. All of this was reported to the police.

34. The Registrant said that on Friday 24 August 2019, she was informed by security at her place of work that Person A had gone to reception and said he was going to kill someone, it was not clear who. This was reported to the police. She did not see Person A that weekend but did see him on the Monday, 26 August 2019. He turned up at her flat and was pressing the buzzer. The Registrant said she did not respond and drew the curtains. She called the police but was put on hold and the call dropped out. Around 7.30pm she put her rubbish out and saw that Person A had left his clothes folded in a pile at the side of her flat. She said she was very shaken by this and the friend she was with suggested a glass of wine to calm her down. She had two glasses of wine and then her friend left at around 8.30pm. She said she then continued drinking, consuming a further bottle of wine and about half a bottle of gin. She then went to bed.

35. The Registrant said that further information on the rest of the night was in her police statement and the video and phone recordings from the night. None of that material was available for the Panel.

36. The second document provided by the Registrant was a letter dated 2 November 2020 from a Senior Helpline Adviser at the National Stalking Helpline. The letter confirmed that the Registrant had first got in contact with them in November 2019, reporting that she had been stalked by a former patient, Person A and providing details of Person A’s behaviour.

Decision on Facts:

37. In reaching its decisions on the facts the Panel took into account all the relevant documents relied on by both parties, together with the submissions made by Mr D’Alton on behalf of the HCPC. The Panel also heard and accepted the advice of the Legal Assessor.

38. The Legal Assessor referred the Panel to Rule 10(1)(d) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003, which states:

“Where the registrant has been convicted of a criminal offence, a certified copy of the certificate of conviction (or, in Scotland, an extract conviction) shall be admissible as proof of that conviction and of the findings of fact upon which it was based.”

39. The Panel was satisfied, therefore, that the Allegation was proved by virtue of the Certificate of Conviction issued by the Crown Court at Reading on 10 January 2022 and the sentence imposed by the Court on 21 February 2022.

40. Accordingly, the Panel found the facts as set out in Allegation 1 proved.

Decision on Statutory Ground:

41. The Panel next considered the statutory ground. Because this is a conviction case, and the Panel had been provided with the Certificate of Conviction, the Panel found the statutory ground to be made out.

Impairment:

42. Having found the statutory ground of conviction to be well founded, the Panel went on to consider whether the Registrant’s current fitness to practise was impaired as a result of that conviction. In doing so it took into account the submissions made by Mr D’Alton and all the relevant documents provided by the parties. The Panel accepted the advice of the Legal Assessor. Nowhere in the documents provided by the Registrant did she deal with the question of current impairment. Indeed her statement only dealt with the history of events leading up to 26 August 2019, and two further events of stalking in December 2019 and February 2020, with nothing thereafter.

43. The Panel had been advised by the Legal Assessor that an important factor when considering current impairment is whether the conduct which led to the allegation is remediable, that it has been remedied and that it is highly unlikely to be repeated. The level of insight shown by the Registrant is also an important factor when considering current impairment. The Registrant had not attended nor had she provided any evidence of remediation or an understanding of the impact of her behaviour on the victim, the profession and the HCPC as its Regulator. Furthermore, the Registrant had not explained in her written submissions what had actually happened that evening. In her statement for this Panel when she got to that part in her narrative she said that further information on the rest of the night was in her police statement and the video and phone recordings from the night. However, none of that material was provided to this Panel. Given the Registrant contested the criminal charge and her account of self-defence was rejected by the jury the Panel considered it a reasonable inference to draw that her account was similar to that given in the March 2020 statement. In her statement for this hearing there was no reflection on her conviction or indication that she accepted the jury’s verdict.

44. This meant the only account the Panel had from the Registrant about the actual stabbing was her account given on 8 March 2020, where she described a scuffle and acting in self-defence. That account was clearly rejected by the jury and then the Judge, as it was not corroborated by the 999 call. This is clear from the sentencing remarks of the Judge, set out above. Accordingly, the Registrant had not provided the Panel with any evidence of insight into her offending behaviour. Furthermore, she had not provided any evidence of remorse, remediation or reflection on both the stabbing and her blurring of professional boundaries. She had allowed herself to develop a close personal relationship with a vulnerable former patient with an enduring mental illness, of which the Registrant was well aware. That relationship created a power imbalance between them, with her, the professional and Person A, the former patient. The Panel did not know whether the Registrant was now critical of her relationship with Person A nor did it have any evidence to ascertain whether she might act differently in the future.

45. The offence of wounding is very serious. The Panel took into account the Judge’s sentencing remarks where he concluded “I do not consider there is a significant risk to the public.” However, the Panel considered that where a woman is prepared to stab a man in the back with a knife, whatever the circumstances, she represents a risk to public and more particularly the people in her care, even if not a significant one as opined by the Judge. In this case the Registrant stabbed a vulnerable, former patient in the back, not in self defence but rather when she appears to have lost control. The Judge described it thus, “Shortly afterwards you snapped. You lost your composure and your professional reserve. You told the operator, "He's right outside the door, outside my door. I can't take any more of this. I've rung several times today. Sorry", and that was the trigger for you taking a sharp knife from the kitchen, going outside your house, contrary to the advice of the telephone operator, and stabbing [Person A] in the back, causing him to suffer a three centimetre stab wound to the right upper back.”

46. Applying the criteria from the case of the Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin), which referred to the approach in determining the issue of impairment, the Panel was satisfied that the Registrant had caused a former patient unwarranted harm, she had brought the profession into disrepute by her actions and by blurring professional boundaries, in pursuing a close friendship with a vulnerable former patient over a considerable period of time, she had breached a fundamental tenet of the profession. With her complete lack of insight, remediation or any assurance that she would not behave in such a way again, the Panel could not be satisfied that she would not repeat such behaviour. In addition, she had clearly lied about what had happened in her statement in 2020, putting her own interests ahead of her victim and the profession.

47. For all these reasons the Panel concluded that the Registrant continues to represent a risk to the public and her fitness to practise as an Occupational Therapist was at the time, and remains, impaired on public protection grounds.

48. The Panel went on to consider whether this was the type of case that required a finding of impairment on public interest grounds in order to maintain public confidence in the profession and the Regulator and to uphold professional standards. The Panel was satisfied that a fully informed member of the public, who was aware of all the background to this case, would have their confidence in the profession and the Regulator undermined if a finding of impairment were not made. The Panel considered that a member of the public would be extremely concerned if the Regulator took no action in a case where an experienced Occupational Therapist and Team Leader had used a kitchen knife to stab a vulnerable former patient in the back, given the history of the case. The Panel noted the Registrant’s account of stalking by Person A and recognised that this caused her distress. However, the Panel found that those circumstances would not justify the violent actions the Registrant took on that day.

49. The Panel also noted that the Registrant had yet to complete her suspended prison sentence from the Court and that, in accordance with the case of The Council for the Regulation of Healthcare Professionals v (1) General Dental Council (2) Alexander Fleischmann [2005] EWHC 87 (Admin), she should not be permitted to resume her practice until she had satisfactorily completed her sentence.

50. The Panel therefore determined that the Registrant’s fitness to practise is currently impaired on public protection and public interest grounds and that the allegation of impairment is well founded.

Decision on Sanction:

51. In reaching its decision on sanction, the Panel took into account the submissions made by Mr D’Alton, together with all the relevant written evidence and all matters of personal mitigation available. The Panel also referred to the guidance issued by the Council in its Indicative Sanctions Policy (“ISP”). The Panel had in mind that the purpose of sanctions was not to punish the Registrant, but to protect the public, maintain public confidence in the profession and maintain proper standards of conduct and performance. The Panel was also cognisant of the need to ensure that any sanction is proportionate. The Panel accepted the advice of the Legal Assessor.

52. The Panel considered it was unfortunate that the Registrant had, for whatever reason, chosen not to attend this hearing. By not doing so, and by not providing written representations on the subject, the Panel had no evidence of any reflection, insight, remorse, remediation or plans for the future. Given her long and unblemished career in the profession such evidence could have been helpful to the Panel in determining the appropriate sanction in this case. The Panel noted, however, that the Registrant did have the benefit of legal representation and so is likely to have made an informed choice about her level of engagement and the material she wished to provide. The Panel noted that the Judge made reference to the Registrant’s health history however, the Panel had no information before it at the hearing regarding the Registrant’s health.

53. Beyond the account of stalking, the Registrant did not provide any specific mitigation in either of her statements, but taken from the Judge’s sentencing remarks, the Panel noted the following mitigating factors:

• prior to this matter the Registrant had no previous criminal convictions and no disciplinary history with the HCPC;

• the Registrant had been of previous good character and exemplary conduct;

• she had had a long career working in a very worthwhile and laudable public service in the caring profession for those vulnerable and in need;

• the Crown Court was provided with character references (not seen by this Panel) who spoke of the Registrant’s good character, her abilities and care and the Judge, having seen and heard from the Registrant concluded “it is quite clear you are a very caring person and have been over many years and that has come across to those who are close to you.”

54. The Panel could not ignore the Registrant’s account of Person A stalking her over a prolonged period and the distress that it caused, which was clearly a mitigating factor. However, it was equally apparent that their relationship was a complex one and that for a significant period she provided support and assistance to Person A, including exchanging phone numbers, messaging each other and going for coffee and lunch. Furthermore, she accepted gifts from him. The Judge described it as a “close and at times loving friendship”. By blurring professional boundaries in this way the Registrant created a power imbalance and it is perhaps unsurprising that Person A, who had paranoid schizophrenia, went on to behave unpredictably when she brought their relationship to an end.

55. The Panel also noted the Judge’s comments when considering aggravating factors such as being under the influence of alcohol at the time and in a relationship of trust. The Judge concluded that neither counted as particularly aggravating features in light of the particular circumstances of this case, as detailed above. The Panel agreed with reference to the alcohol. However, for this Panel, concerned with professional regulation, the relationship of trust between a registrant and a service user and her breach of that position was an aggravating factor. Of significance also was the Judge’s conclusion that:

“There was no question of this being self-defence of any nature, in my judgment. It was a deliberate decision on your part, albeit impulsive and in no way pre-planned, no doubt born of frustration and fuelled by impaired judgment through alcohol. [Person A], though aggressive, was outside and you were inside. In this attack you were the aggressor.”

56. The Panel did consider the false account given by the Registrant in March 2020 to be an aggravating factor, because whilst she was entitled to deny the allegation and to defend herself, it was clear from the 999 call that she was not telling the truth about how the stabbing occurred.

57. The Registrant’s complete absence of insight and the blurring of professional boundaries, given her close relationship with Person A, a vulnerable, former patient, were also aggravating features of this case, as was the complete lack of remediation.

58. The Panel took particular note of the following paragraphs of the ISP:

"69: A registrant may abuse their professional position in a number of ways such as:
Inappropriate relationships: Our standards require registrants to ‘maintain appropriate relationships’. Where a registrant uses their professional status to pursue inappropriate relationships with service users or carers this may undermine the care or treatment provided and the public’s trust in the profession. Registrants should take care to set clear boundaries, and avoid conduct which strays beyond that typically expected of a therapeutic / professional relationship.

When considering whether a relationship is inappropriate, the panel should have particular regard for:

• evidence that the registrant’s professional status was a coercive factor in the relationship’s instigation;

• evidence that the service user or carer is particularly vulnerable;

• evidence that the relationship is of a sexual or otherwise inappropriate emotional nature.

Former service users

70. If a registrant forms a personal relationship with a former service user or carer, this may still be inappropriate. In determining whether or not the registrant has abused their professional position, the panel should consider:

• the nature of the previous professional relationship;

• the length of time since the professional relationship ended;

• if there is evidence that the registrant used their professional relationship to facilitate a personal relationship (actual or prospective) with a service user or carer and, having done so, ended the professional relationship with that person;

• the vulnerability of the service user.

Vulnerability

73. Registrants must not abuse a service user or carer’s trust. This is especially so where they might already be particularly vulnerable to such abuse.

74. Given the unequal balance of power between registrants and service users or carers, any service user or carer accessing treatment is vulnerable to some extent. However, a service user or carer is considered particularly vulnerable if they are unable to take care of themselves, or are unable to protect themselves from significant harm or exploitation. This might include factors such as:

• mental illness;

• history of abuse or neglect.

75. Where a registrant has pursued a sexual or otherwise inappropriate emotional relationship with a particularly vulnerable service user or carer, panels should consider this an aggravating factor which is likely to lead to a more serious sanction.

93. “Registrants have a duty to ensure that their conduct justifies the public’s trust and confidence in them and their profession (see standard 9.1 of the Standards of conduct, performance and ethics). Where a registrant has exhibited violent behaviour, this is highly likely to affect the public’s confidence in their profession and pose a risk to the public. In these cases, a more serious sanction may be warranted.”

59. In light of the serious nature of the conviction, the Panel did not consider this was an appropriate case in which to take no further action.

60. The Panel next considered whether a Caution Order would adequately reflect the seriousness of the conviction. The Panel’s role, as indicated by the ISP, was not to punish the Registrant twice for the same offence, but to protect the public, maintain high standards amongst registrants and maintain public confidence in the profession. The Panel did not consider that such an Order would adequately mark the seriousness of the behaviour or protect the public in this case.

61. This was not a case where conditions of practice would be appropriate because of the serious nature of the Registrant’s conduct. The Panel considered that conditions would not protect the public or the public interest and in any event the Panel considered a Conditions of Practice Order would not adequately reflect the seriousness of the Registrant’s offending behaviour.

62. The Panel next considered whether to make a Suspension Order. The ISP states that, “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.”

63. The Panel reminded itself of the serious nature of the conviction, namely the Registrant losing control, leaving her locked home contrary to the advice of the 999 call handler, going into her garden and stabbing a vulnerable, former patient in the back with a kitchen knife. Although a Suspension Order would provide protection to the public for its duration, in the absence of any information from the Registrant about remediation and insight, the Panel doubted whether suspension would be appropriate, since it could not rule out the possibility that the Registrant might repeat such behaviour. Accordingly, she continues to represent a risk of significant harm to those in her care. She has not provided any evidence of insight and there is no evidence to suggest the Registrant is likely to be able to resolve her failings. Therefore, the Panel cannot say that the issues are unlikely to be repeated.

64. In addition, the Panel was not satisfied that a period of suspension would be sufficient to maintain public confidence in the profession or the regulatory process, or to send a clear message to the profession at large that such behaviour was wholly unacceptable. The Panel, therefore, did not consider that a Suspension Order would be a sufficient sanction in the circumstances of this case.

65. In reaching this decision the Panel also took into account paragraph 82 of the ISP which echoed the case of Fleischmann referred to above, where the High Court stated that as a matter of general principle, where a registrant had been convicted of a serious criminal offence, she should not be permitted to resume her practice until she had satisfactorily completed her sentence. This had direct relevance to this case because the Registrant has been convicted of a serious criminal offence and her prison sentence will not be completed until February 2024.

66. The Panel therefore looked at the guidance in the ISP on making a Striking Off Order to decide whether such an Order would be appropriate. The guidance states that,

“A striking off order is a sanction of last resort for serious, persistent, deliberate or reckless acts involving:

• dishonesty;

• abuse of professional position, including vulnerability;

• criminal convictions for serious offences;

• violence.

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; or

• is unwilling to resolve matters.”

67. The Panel finds that this case is characterised by the blurring of professional boundaries, an abuse of trust and a very violent offence of the utmost gravity directed at a vulnerable, former patient suffering from an enduring mental health issue that the Registrant was aware of. Notwithstanding the element of stalking, the Registrant was safe in her house with Person A outside and yet took the decision, against the clear advice of the 999 call handler, to go outside, having selected a kitchen knife, and stabbed Person A in the back. She then appeared to return calmly to the house and did not call an ambulance. She has not provided any evidence of insight or remediation and thus a willingness to resolve matters. There is also an element of dishonesty in the false account she put forward.

68. The Panel concluded that in all the circumstances, the only appropriate sanction in this case was to make a Striking Off Order. The Panel considered that, notwithstanding the mitigation in this case, the Registrant’s behaviour was fundamentally incompatible with being a registered Occupational Therapist. The Panel took into account the impact this would have upon the Registrant, but concluded that the need to protect the public, which includes maintaining high standards and public confidence in the profession, outweighed her interests and that no other sanction would adequately protect the public.

69. Accordingly, the Panel makes a Striking Off Order and directs the Registrar to remove Annabelle Mitchell’s name from the Register.

The Registrar is directed to strike the name of Mrs Annabelle Mitchell from the Register on the date this Order comes into effect.

Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Interim Order Application:

Proceeding in Absence/Application for an Interim Order:

70. The Panel heard submissions from Mr D’Alton on proceeding to hear an application for an Interim Order in the absence of the Registrant and also on the need for an Interim Order to cover the period during which an appeal may be made and, if one is made, whilst that appeal is in progress. The Registrant was not present and therefore the Panel had, in accordance with the HCPTS Practice Note, first to decide whether to proceed to consider the Interim Order application in the absence of the Registrant. The Panel heard and accepted the advice of the Legal Assessor.

Panel’s decision:

71. The Panel decided that it was appropriate to consider the Interim Order application in the absence of the Registrant. In reaching this conclusion the Panel took into account the contents of the Notice of Hearing sent to the Registrant on 27 April 2023, where it is stated under the heading “Interim Orders”, “Please note that if the Panel finds the case against you is well founded and imposes a sanction which removes, suspends or restricts your right to practise, it may also impose an interim order on you (under Article 31 of the Health and Social Work Professions Order 2001). An interim order suspends or restricts a registrant’s right to practise with immediate effect.” The Panel was satisfied this meant the Registrant was on notice that this was a possible outcome at this hearing.

72. The Panel remained satisfied that the Registrant had waived her right to be present at the hearing by her clear indication, via her solicitors, that she would not be attending the hearing. The Panel could see no reason to adjourn the hearing in order to allow the Registrant to participate on a later date because there was no indication that she would do so on any other occasion. The Panel took into account the fact that it had identified there to be a continuing risk to the public if the Registrant were allowed to practise without restriction and decided it was clearly in the public interest to consider the Interim Order application today, even if that meant it was conducted in the absence of the Registrant.

73. The Registrant has been convicted of stabbing a former patient in the back using a kitchen knife and sentenced to a period of imprisonment, albeit suspended for two years. This was most serious behaviour and the Panel had identified an ongoing risk to the public, and in particular those in the Registrant’s care. The Panel therefore concluded that an Interim Order was necessary to protect the public from the risks it had identified, during the 28 day appeal period, or the time taken to conduct any appeal, in the event that one is made.

74. The Panel is also of the view that, given the nature and seriousness of the offending behaviour in this case, public confidence in the regulatory process would be undermined if the Registrant were allowed to remain in practice on an unrestricted basis during any appeal period. The Panel therefore determined that an Interim Order is otherwise in the public interest.

75. The Panel first considered whether a Conditions of Practice Order would be sufficient. However, for the same reasons as dealt with at the sanction stage, the Panel concluded that conditions would not be appropriate or proportionate in this case.

76. The Panel therefore decided to make an Interim Suspension Order under Article 31(2) of the Health and Care Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. The Panel decided that this Order should be for the maximum period of 18 months to allow sufficient time for any appeal to be made.

77. 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 Mrs Annabelle Mitchell