Miss Prina Karia
Profession: Hearing aid dispenser
Registration Number: HAD02970
Interim Order:
Imposed on 10 Mar 2021
Hearing Type: Final Hearing
Date and Time of hearing: 10:00 22/01/2024
End:
17:00 30/01/2024
Location:
Health and Care Professions Tribunal Service, Park House, 184-186 Kennington Park Road, London, SE11 4BU
Panel: Conduct and Competence Committee
Outcome: Struck off
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Allegation
As a registered Hearing Aid Dispenser (HAD02970) your fitness to practise is impaired by reason of misconduct. In that:
1. Between 20 October 2020 and 22 May 2021, you informed a service user that the card payment machine was not working when this was not the case.
2. Between 20 October 2020 and 22 May 2021, you requested cash payments from service users for ear wax removal, which you did not provide to your employer.
3. Between 20 October 2020 and 22 May 2021, you did not keep accurate records by stating ear wax removal was not performed on service users and no cash was taken.
4. Your conduct in relation to particulars 1, 2 and 3 was dishonest.
5. The matters set out in particulars 1, 2, 3, and/or 4 constitute misconduct.
6. By reason of your misconduct your fitness to practise is impaired.
Finding
Preliminary Matters
Application to discontinue in part and amend
1. Mr Micklewright made an application to discontinue particular 1 of the allegation and to make consequential amendments to the numbering in the ensuing particulars of the allegation. The original allegation stated as follows:
As a registered Hearing Aid Dispenser (HAD02970) your fitness to practise is impaired by reason of misconduct. In that:
1. Between 20 October 2020 and 22 May 2021, you informed a service user that the card payment machine was not working when this was not the case.
2. Between 20 October 2020 and 22 May 2021, you requested cash payments from service users for ear wax removal, which you did not provide to your employer.
3. Between 20 October 2020 and 22 May 2021, you did not keep accurate records by stating ear wax removal was not performed on service users and no cash was taken.
4. Your conduct in relation to particulars 1, 2 and 3 was dishonest.
5. The matters set out in particulars 1, 2, 3, and/or 4 constitute misconduct.
6. By reason of your misconduct your fitness to practise is impaired.
2. Mr Micklewright submitted that particular 1 of the original allegation was not supported by the evidence and should therefore be discontinued.
3. Ms Graham did not oppose the application.
4. The Panel had regard to the HCPTS Practice Note on “Discontinuance of Proceedings” and accepted the advice of the Legal Assessor. The Panel was satisfied with the HCPC’s rationale for discontinuing particular 1 and that it would not result in “under-prosecution”. Accordingly, the Panel granted the application and directed that the allegation be amended accordingly. The amended allegation is as set out above.
Application to adduce hearsay evidence
5. Mr Micklewright made an application for the Panel to admit the witness statement dated 4 June 2023 of Service User E and the witness statement of Service User B dated 20 June 2023 as hearsay evidence. He relied on his skeleton argument dated 19 January 2024, on which he elaborated in oral submissions.
6. In her witness statement, which contains a statement of truth, Service User E states that she attended an appointment at Specsavers Banbury store on 15 May 2021. She cannot remember the name or any details of the audiologist taking the appointment. She recalls that the audiologist performed an ear wax removal procedure on both her ears. She paid for the appointment in cash. She has checked her bank statement and could not find a payment to Specsavers Banbury on 15 May 2021. She believes that she paid approximately £50.
7. Service User B’s witness statement dated 20 June 2020 states that he booked an appointment at Specsavers Milton Keynes on 27 November 2020. He states that the audiologist whom he understands to be the Registrant performed a procedure to remove ear wax from his ear and he paid for the procedure in cash. The Registrant did not dispute the fact of his appointment with her but disputed that he paid cash and suggested that he might have mixed up this appointment with some other appointment.
8. The Registrant had responded to both statements in her witness statement dated 18 December 2023. It appeared from her witness statement that, in relation to Service User E, the Registrant did not dispute the fact of Service User E’s appointment with her or that she had paid cash.
9. Mr Micklewright submitted that both statements were admissible pursuant to rule 10(1) of the Health and Care Professions (Conduct and Competence) (Procedure) Rules 2003 (“the Rules”). He referred the Panel to section 4 of the Civil Evidence Act 1995 which sets out considerations relevant to the weight to be put on hearsay evidence.
10. He referred the Panel to Thorneycroft v NMC [2014] EWHC 1565 (Admin) and El Karout v NMC [2019] EWHC 28 (Admin) in which the Court summarised the principles to be applied in determining an application whether to admit hearsay evidence, including the need to consider the fairness of admitting such evidence.
11. Mr Micklewright sought to distinguish these cases from the present case on the grounds that the rules relating to HCPC do not stipulate fairness as a prerequisite to admitting evidence.
12. Mr Micklewright submitted that, in any event, it would be fair to admit these witness statements and the weight, if any, to be attached to them could be determined by the Panel having regard to the factors set out in section 4 of the Civil Evidence Act 1995.
13. Ms Graham opposed the application to admit the witness statements of Service Users B and E as hearsay evidence on the grounds that it would be unfair to the Registrant to do so.
14. The Panel carefully considered the submissions on behalf of both parties and accepted the advice of the Legal Assessor.
15. The Panel accepted the submission of Mr Micklewright that the HCPC Rules do not incorporate the requirements of relevance and fairness for the admission of hearsay evidence and that the authorities referred to above involved a consideration of the NMC rules which did incorporate those requirements.
16. Nevertheless, the Panel was mindful that it has a discretion to exclude hearsay evidence and, in the exercise of that discretion, could take fairness to both parties into account when deciding whether to admit or exclude such evidence.
17. The Panel decided that there were no sufficient grounds for excluding either statement and in considering fairness to both parties, the balance was in favour of admitting the statements in evidence. In particular, the Panel took into account that the evidence contained in the statements was plainly relevant to the issues in dispute and to the HCPC’s case of a pattern of behaviour on the part of the Registrant. Neither statement, however, constituted the sole or decisive evidence in respect of any of the particulars of allegation. The Panel would decide what weight, if any, to give to the hearsay evidence contained in these statements in the context of all the other evidence in the case.
Background
18. The Registrant is registered with the HCPC as a Hearing Aid Dispenser and is a qualified audiologist. At the time to which the allegations relate, the Registrant was working as a locum audiologist for Specsavers at two different locations, namely Banbury and Milton Keynes.
19. The policy of Specsavers at these stores was not to charge service users, who, on examination by the audiologist, were deemed not to require ear wax removal. Those service users who underwent ear wax removal treatment were charged £55.
20. It is alleged that, in respect of five service users, who were treated by the Registrant for ear wax removal, the Registrant took cash payments, which she did not pass on to Specsavers. Of these five service users, Service Users A and E were treated by the Registrant at the Specsavers Banbury and Service Users B, C and D were treated by her at the Specsavers Milton Keynes.
21. It is further alleged that, in respect of each of these service users, the Registrant falsified their patient records to state that no treatment was carried out and that therefore no payment was due.
22. It is alleged that, in keeping the cash payments and falsifying patient records, the Registrant was dishonest.
The Hearing
23. The Panel was provided by the HCPC with a hearing bundle which contained:
• The witness statement of AK, who at all material times was employed as the Hearcare Director at the Specsavers Banbury Store
• The witness statement of CB, who at all material times was employed as the store director for Specsavers at Milton Keynes
• The witness statements of Service Users A, B, C, D and E
• The witness statement of the Registrant
• The witness statements of three character witnesses on behalf of the Registrant, namely BL, Dr Dr SG and MR.
24. The hearing bundle also contained the documentary evidence, including patient notes for the service users and records of payments received by Specsavers.
25. The Panel heard oral evidence from each of the witnesses referred to above, apart from Service Users B and E, whose statements were admitted in evidence as hearsay, as referred to above.
The evidence of AK
26. In her witness statement AK stated that she was, at the material time, the Hearcare director at the Specsavers Banbury store. She confirmed that the Registrant worked there as a locum audiologist on a few dates at the end of 2020 and on 1, 8, 15 and 22 May 2021. AK explained that, at a wax removal appointment, the audiologist would confirm the service user’s details and medical history and go over the consent form. The audiologist would then check the service user’s ears for excessive wax. If excessive wax was present, the audiologist would explain the microsuction procedure for removing excessive wax. Subject to the service user’s consent, the audiologist would then perform the procedure and take payment for it. Specsavers charged £55 for the microsuction procedure, whether it was performed on one or both ears. If no ear wax removal took place, no payment would be taken. At the Banbury store, payments could be made by both card and cash.
27. Specsavers used an online patient record system called Sycle. Each audiologist had their own password to gain access to the system, in which they recorded all relevant details relating to the appointment with each service user, including whether they had undergone wax removal treatment. The system prompted the audiologist to indicate whether there had been any “purchases” – i.e. wax removal treatment - or products purchased, for which payment was required. If there had been any “purchases”, the system prompted the audiologist to state whether payment was made by cash or card and generated an invoice for the audiologist to complete.
28. At the end of the working day, the audiologist should record how many receipts for card payments they had taken and how much cash they had taken. If payment was made by cash, an invoice should be produced.
29. AK stated that on 24 May 2021, she received a telephone call from Service User A concerning some issues following a microsuction ear wax removal on 22 May 2021. AK reviewed the patient notes for Service User A which recorded that Service User A’s appointment had been with the Registrant, who had recorded that she had not performed ear wax removal on Service User A, as she was able to use oil to remove the wax from Service User A’s ears.
30. AK then reviewed other recent ear wax removal appointments that the Registrant had conducted to check whether the incident with Service User A was an isolated occurrence. She then telephoned the service users to whom the patient notes related.
31. AK’s investigations indicated that the Registrant had performed ear wax removal on Service User E on 15 May 2021 and Service User A on 22 May 2021 and had taken cash payments from each service user but in their respective patient notes had recorded that no such treatment had been performed and no payment taken. AK exhibited copies of each service user’s notes by way of confirmation.
32. AK checked the payment records for 15 and 22 May 2021 and ascertained that there was no record of any cash being taken by the store on either of these dates.
33. In her oral evidence, she stated that the Registrant was advised to record in the diary attached to a clipboard what cash had been taken for the day and to put any cash behind the clipboard together with any invoices.
34. AK stated that she had provided the Registrant with an induction when the Registrant started work at the Banbury store and explained the procedures. This included making out an invoice for any cash payment received and handing over the cash to a senior manager.
35. She stated that the Registrant was the only audiologist working at the store on 15 and 22 May 2021, being Saturdays.
36. AK was asked by Ms Graham about the audiologist room in which the Registrant saw service users. AK stated that the room was not secured and that anyone might have access, including the cleaners. She denied the suggestion that there was a drawer in the audiology room in which the Registrant could have placed any cash.
37. She stated that she did not recall contacting CB, the store director at Milton Keynes, but was not sure.
The evidence of CB
38. In his witness statement, CB stated that, at the material time, he was employed as a store director for Milton Keynes, Newport Pagnell and Stevenage. He stated that the Registrant worked as a locum in his stores for approximately five months from November 2020.
39. He described similar procedures for treating service users for ear wax removal to those pertaining at the Banbury store, included the online record system known as Sycle. The price of ear wax removal was £55. In the event cash payments were made these would always be given by the audiologist to the manager on the day. However, he explained due to Covid that his store decided not to take cash payments if at all possible. Card payments should be taken wherever possible.
40. He said that he was contacted by AK who advised him to review the Registrant’s appointment records at Milton Keynes. He said that this would have been before 29 March 2021. He said that he was very surprised to hear this as he thought it extremely unlikely that the Registrant would have recorded incorrect notes.
41. He stated that he then compiled a list of customers with whom the Registrant had conducted an appointment and recorded that no wax removal had taken place. He then telephoned the customers and asked them about their appointments, including whether wax removal had been performed and, if so, how they had paid for it. He exhibited his notes of the customers’ responses.
42. His investigation showed that that the store takings for 17 and 29 January 2021 recorded that no cash payments were taken on those days, whereas at least £55 should have been recorded for each of those days.
43. The remaining appointments for which the customers stated that they paid in cash took place on 27 November 2020, when according to the record of store takings which he exhibited, no cash payments were taken.
44. CB copied and pasted the notes of appointments for the relevant service users made by the Registrant at the time of their respective appointments. These notes recorded that no ear wax removal had been carried out, contrary to the testimony of the service users in question that they had undergone ear wax removal and paid for that treatment in cash.
45. CB stated that, following his investigation, he drove with his business partner to the Stevenage store on 29 March 2021, where the Registrant was working, and told her that she would not be asked to work at the stores again. The Registrant asked why and what had happened, and CB told her that there were some issues with service users which he did not wish to discuss.
46. In his oral evidence, CB stated that, before these concerns had been raised, he had no concerns about the Registrant and thought that she was “brilliant” at her job. He had wanted to keep her on and was very shocked and in disbelief when he heard that there were concerns about her patient records.
47. Under cross-examination by Ms Graham, CB was referred to some email correspondence between him and the Registrant on 26 and 27 March 2021 in which she raised concerns about there being too much pressure of time to see service users and lack of time for a proper or timely lunch break.
48. It was put to CB that it was as a result of the Registrant’s complaints that she was dismissed. CB said that, after such a long passage of time, he could not recall the reason for dismissing the Registrant.
49. CB was asked by the Panel whether patient notes on the Sycle system could be edited. He confirmed that they could be edited but that the original note would not be eradicated and any editing would be apparent on the face of the record.
50. He confirmed that each user of the Sycle system would have a unique password which they would choose themselves.
The evidence of Service User A
51. In his witness statement, Service User A stated that he made an appointment with the audiologist at the Banbury Store at 3.30 pm on 22 May 2021. He could not remember her name but remembered that the audiologist was a woman. The audiologist told him that there was a lot of wax in his ears and performed ear wax removal in both ears. On completing the procedure, the audiologist asked if he would like to pay by cash or card. As the audiologist was unsuccessful in taking a card payment, Service User A offered to pay in cash. He believed that he paid approximately £45. He later checked his bank statements but could find no record of a payment to Specsavers Banbury, thereby confirming his recollection that he had paid in cash.
52. In oral evidence, Service User A stated that he had arrived about 10 minutes early for his appointment. He described the procedure for the removal of ear wax in graphic detail.
53. He was referred to patient notes in relation to his appointment. He was adamant that the note stating that no wax removal treatment was required was incorrect. He described the wax in one of his ears as having been “rock solid” and that both ears had required wax removal.
54. He could not remember having seen a receipt for his treatment.
55. He had no recollection of having telephoned AK on 24 May 2021 or at all.
The evidence of Service User C
56. In his witness statement Service User C stated that he attended an appointment with an audiologist at Specsavers Milton Keynes on 17 January 2021. He did not know the name of the audiologist but she was a woman who appeared to be of Indian descent and he understood that she was from Leicester.
57. Having performed ear wax removal, the audiologist in the same room asked him for payment. She attempted to take payment by card but, having failed to do so, he paid her in cash. He recalled that it cost approximately £60. He also recalled thinking it strange that the audiologist did not try another card payment machine in the store.
58. About two months later, Service User C received a telephone call from Specsavers, asking him for his feedback on the appointment.
59. In his oral evidence, Service User C was referred to the record of his appointment in the patient notes. He confirmed that the record related to his appointment but that it was incorrect in stating that he had not received treatment for the removal of ear wax.
60. He confirmed that he was “100 per cent sure” that he paid in cash. In particular, he remembered that, very unusually, he had a £50 note in his wallet, which he used in part-payment for his treatment.
61. He stated that he was sure that the person to whom he paid cash was the same person who removed the wax from his ear.
62. He stated that he could confirm for a fact that the appointment took place on 17 January 2021 because he took a photograph of the wax removed from his ear to show to his wife and the date on the photograph was 17 January 2021.
63. He stated that he did not think that he was given a receipt for his payment.
The evidence of Service User D
64. In his witness statement, Service User D stated that he had attended an appointment with an audiologist at Specsavers Milton Keynes on 29 January 2021. He said that the audiologist was a woman but he did not know her name. The audiologist confirmed that he needed wax removed and performed microsuction on both of his ears. The audiologist told him that there was a problem with the payment system and he would need to pay in cash. He did not have enough cash and said that he would need to go to a cash machine. The audiologist said that there was no need for that and asked him how much cash he had on him. When he told her the amount, which was between £30 and £40, she told him that she would give him a discount because she had found wax in only one of his ears.
65. Service User D further stated that, at the time, he thought it strange that the audiologist was able to offer him a lower price. He also thought it odd when he saw her put the cash in a drawer in the consulting room and when she told him that she could not give him a receipt for his payment because of the problem with the payment system.
The evidence of Service User B
66. In his witness statement, Service User B stated that he had an appointment on 27 November 2020 with an audiologist at Specsavers Milton Keynes. He stated that the audiologist was a woman in her thirties. He stated that the audiologist carried out wax removal treatment and that he had paid her in cash.
The evidence of Service User E
67. In her witness statement, Service User E stated that she had an appointment with the audiologist at Specsavers Banbury on 15 May 2021. The audiologist performed ear wax removal on both ears. Service User E paid for the appointment in cash. She subsequently checked her bank statement and could find no payment to Specsavers Banbury on 15 May 2021.
The evidence of the Registrant
68. In her witness statement, the Registrant gave details of her qualifications as an audiologist and stated that she had never been investigated by the police or had any adverse disciplinary hearings.
69. She confirmed that she started locum shifts at Specsavers Banbury on 11 September 2020. She stated that she had received no induction of any kind. She was simply shown to the room where she would be working. She was aware that the charge for ear wax removal was £55 and that, if no microsuction was performed, there would be no charge.
70. She stated that she was aware that payments could be made by service users in cash but was not told what to do with any cash payments that she might receive. The procedure she adopted was to place any cash taken that day in an envelope. She would write the date and service user’s name on the front of the envelope and then seal the back of the envelope and sign her name across the seal. She would then place sellotape across her signature and would put the envelope in the drawer in the room when she left at the end of the day.
71. She did not work at the Banbury store from October 2020 because AK temporarily lost her NHS contract but resumed locum shifts there in May 2021. She confirmed that she undertook shifts there on 15 and 22 May 2021.
72. On 24 May 2021, AK without any explanation dispensed with her services.
73. She stated that, if it was correct that any of the service users had paid her (which she did not accept), then she did not know what happened to the cash which she left in the drawer. She stated that the room was not secure, was accessible to other members of staff and to cleaning staff at night. She stated that she was never asked by AK what she was doing with cash payments, so the issue did not come up. She was unaware of the allegations until informed of them by the HCPC in March 2022.
74. With regard to Milton Keynes Specsavers, the Registrant confirmed that she undertook locum shifts from November 2020.
75. She stated that on 6 November 2020, which was her first shift, she took a cash payment from a customer and handed it to CB’s assistant and notified CB at the end of the shift that one of the customers had paid in cash. She was then told that Milton Keynes was not accepting cash payments due to Covid-19. She stated that, from that point onwards, she did not take any cash payments from service users at Milton Keynes.
76. In December 2020 she underwent an operation on her Achilles tendon. She was initially in plaster but from January 2021 this was replaced with an orthopaedic boot, which she continued to wear until March 2021.
77. She stated that the work at Milton Keynes and Stevenage became increasingly pressurised and stressful. She was concerned that her 30-minute appointments were being cut down to 15 minutes. She contacted CB to raise her concerns in March 2021, as evidenced by email communications dated 26 and 27 March 2021. She stated that the response by CB on 29 March 2021 was summarily to terminate her shifts.
78. With regard to the evidence of Service User A, the Registrant did not deny that he had an appointment with her on 22 May 2021 at 3.30 pm. She suggested, however, that the patient record which she completed for Service User A might have related to another service user whom she had seen previously.
79. She stated that, if Service User A was correct in stating that he had paid her in cash, she would have put it an envelope and left it in the drawer, as previously described.
80. With regard to the statement Service User B, she did not dispute that she had seen him at an appointment on 27 November 2020 or suggest that she did not perform ear wax removal on him. She stated, however, that, as she did not take any cash payments at Milton Keynes Specsavers after 6 November 2020, he must have been confused in stating that he paid cash.
81. With regard to Service User C, the Registrant did not dispute that he had an appointment with her on 17 January 2021, but she denied having taken cash from him, because she was not taking cash from any service user at Milton Keynes. She suggested that he might have confused this appointment with some other appointment.
82. With regard to Service User D, the Registrant acknowledged that she was working at Milton Keynes on 29 January 2021 when he had his appointment but appeared to suggest that he might have seen another audiologist. She stated that she would not have taken cash from him and that he might have confused this with another appointment.
83. With regard to Service User E, the Registrant acknowledged that the patient notes on Sycle indicated that she treated Service User E at Banbury on 15 May 2021. The Registrant suggested that she might have entered the wrong person’s notes for Service User E.
84. With regard to Service Users C and D, the Registrant made the point that, at the material times, she had been wearing an orthopaedic boot, which, when giving evidence, neither of them recalled.
85. In her oral evidence, the Registrant acknowledged the need for an audiologist to keep full, clear and accurate patient records.
86. With regard to the Sycle recording system, she confirmed that she did not seek any support or training in its use.
87. When asked about cash payments, the Registrant stated that she never asked AK or anyone else what she should do with cash payments received from service users. Nor did she inform AK or anyone else about the procedure she followed for putting cash payments in an envelope in a drawer. She said that she did not ask because no concerns were raised. She acknowledged that the room where she left the cash payments was insecure and could have been accessed by anyone. She never enquired as to what had happened to any of the cash payments which she had left in the drawer.
88. With regard to the patient notes, she agreed that she was told to change the password on the Sycle system to her own individual password and had done so. She did not point to anyone who had entered notes for any service user on her behalf, nor did she raise any concerns in that regard.
89. She agreed that the relevant patient notes had been made in her name. She could not explain why the notes would have recorded that service users had not had ear wax removal treatment if they had such treatment.
The evidence of the character witnesses on behalf of the Registrant
90. The Panel heard oral evidence from BL, Dr Dr SG and MR, each of whom confirmed the contents of their respective witness statements. They each attested to the Registrant’s good character, honesty and integrity.
Decision on Facts
91. The Panel was mindful that the burden of proof in relation to the facts is on the HCPC and the standard of proof is on the balance of probabilities. With regard to the allegation of dishonesty, the Panel accepted the advice of the Legal Assessor that it should apply the definition based on the decision of the Supreme Court in the case of Ivey v Genting Casinos [2017] UKSC 67.
Particular 1 – Proved
Between 20 October 2020 and 22 May 2021, you requested cash payments from service users for ear wax removal, which you did not provide to your employer.
92. The Panel accepted the evidence of Service Users A and E that they had been treated by the audiologist for ear wax removal at Specsavers Banbury and had paid in cash. The Panel accepted the evidence of AK that the Registrant was the only audiologist working at the store on these dates.
93. The Registrant did not dispute their evidence but stated that she would have put any cash payments in an envelope in a drawer in the unsecured room where she worked and assumed that someone would collect them. The Panel considered it very unlikely that, without telling anyone, the Registrant would have left cash payments in an unsecured room, as described by her. The Panel also noted that there was no record of cash payment having been received by Specsavers on the relevant dates. The Panel preferred the evidence of AK who stated that she had explained to the Registrant at the outset that she should attach any cash payments to the clipboard with the invoice and diary entry and hand the cash to a senior manager at the end of the day.
94. The Panel considered it more likely than not that the Registrant had kept these cash payments for herself.
95. Service Users C and D each gave clear, detailed and cogent evidence that they had been treated for ear wax removal by a female audiologist at Specsavers Milton Keynes on 17 January and 29 January 2021 respectively and had paid in cash. The Registrant did not dispute that that she had treated either of these service users but asserted that they must have been mistaken that they paid her in cash, because she did not take cash payments at Specsavers Milton Keynes at that time. The Panel preferred the evidence of Service Users C and D that they had made payments of cash to the audiologist.
96. With regard to the hearsay evidence of Service User B, the Registrant did not dispute the fact that she had treated him for ear wax removal on 27 November 2020 but suggested that he was confused about paying her in cash. Given the Panel’s findings in relation to the other service users, the Panel was inclined to believe the evidence of Service User B.
97. It was noteworthy that the Registrant did not directly challenge the evidence of Service Users B, C or D but suggested that they might have been confused about giving her cash payments.
98. The Panel was satisfied on the evidence that each of the Service Users A, B, C, D and E gave the Registrant cash payments for ear wax removal treatment and that she did not provide the cash to her employer.
Particular 2 – Proved
Between 20 October 2020 and 22 May 2021, you did not keep accurate records by stating ear wax removal was not performed on service users and no cash was taken.
99. Having determined that each of Service Users A, B, C, D and E were treated by the Registrant for ear wax removal and that they paid her in cash, it follows that the Registrant did not keep accurate records in that she stated in respect of each of these service users that ear wax removal was not performed and that no cash was taken.
100. The Registrant acknowledged that the patient notes for each of these service users appeared to have been made by her.
101. In respect of Service Users A and E the Registrant suggested that she might have entered the notes for a previous service user and, if so, her records were not accurate.
102. With regard to Service Users B, C and D the Registrant suggested that they were mistaken about having given her cash payments but could give no credible explanation as to why her notes indicated that they had not received treatment.
103. The Panel concluded that the Registrant made inaccurate patient notes in respective of each of Service Users A, B, C, D and E in order to conceal the fact that she had taken cash payments for ear wax removal treatment.
Particular 3 – Proved
Your conduct in relation to particulars 1 and 2 was dishonest.
104. In respect of particular 1, the Panel concluded that the Registrant did not pass on to Specsavers the cash payments made to her by Service Users A, B, C, D and E. In respect of particular 2, the Registrant incorrectly recorded in the patient notes of the same service users that she had not carried out wax removal treatment and that no payment was due. The Panel was satisfied that the Registrant entered false information to cover up her theft of the cash payments and that in respect of both particulars 1 and 2 she was dishonest.
Decision on Grounds
105. The Panel went on to consider whether the facts found proved in particulars 1,2 and 3 of the allegation amounted to misconduct as alleged in particular 4.
106. The Panel had regard to the submissions of Mr Micklewright and Ms Graham and accepted the advice of the Legal Assessor.
107. The Panel was mindful that this is a matter for the Panel’s professional judgment, there being no standard or burden of proof.
108. Misconduct was defined in Roylance v GMC (No 2) [2000] 1 A.C. 311 as:
“a word of general effect, involving some 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. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the conduct to the profession…... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious …”
109. In the case of Nandi v GMC [2004] EWHC 2317 (Admin), the court stated that:
“The adjective ‘serious’ must be given its proper weight, and in other contexts there has been reference to conduct which would be regarded as deplorable by fellow practitioners”.
110. The Panel found the Registrant to have been in breach of the following standards of HCPC Standards of Conduct, Performance and Ethics (2016):
• Standard 9.1: You must make sure that your conduct justifies the public’s trust in you and your profession.
• Standard 10.1: You must keep full, clear and accurate records for everyone you care for, treat, or provide other services to.
111. In respect of each of the proven particulars the Panel found that the Registrant’s practice fell seriously below the standards of conduct expected of her as a Hearing Aid Dispenser. She effectively stole cash from her employer over a period of approximately five months and falsified patient records to conceal her thefts. By stating in the patient records that she had not conducted ear wax removal, she falsified their medical history. The result of her so doing was that those treating the service users in the future would not have an accurate record of past treatment received. This could potentially result in harm to the health and welfare of the service users. The Registrant also caused reputational damage to Specsavers and to her profession.
Decision on Impairment
112. The Panel carefully considered the submissions by Mr Micklewright and Ms Graham. The Panel had regard to the HCPTS Practice Note on “Fitness to Practise Impairment” and accepted the advice of the Legal Assessor.
113. In determining whether the Registrant’s fitness to practise is impaired, the Panel took into account both the personal and public components of impairment of fitness to practise. The personal component relates to the Registrant’s own practice as a Hearing Aid Dispenser, including any evidence of insight and remorse and efforts towards remediation. The public component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.
114. The Panel found that the Registrant’s fitness to practise was and remains impaired having regard to the personal component. The Registrant has denied all the particulars and, to date, has shown no evidence of remorse, insight, reflection or remediation. Whilst the Panel was aware that the Registrant had undertaken training in record keeping since the relevant incidents, such training had no relevance to remediation given that that the Registrant had deliberately falsified patient records. In the Panel’s judgement, the Registrant’s dishonest misconduct was attitudinal and there was therefore a significant risk of repetition.
115. With regard to the public component of impairment, the Panel considered that, given the risk of repetition, a finding of current impairment is necessary to protect the public. In addition, the Panel was mindful of the need to maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour on the part of registrants. The Panel considered that the Registrant’s misconduct represented a serious departure from the standards to be expected of a member of the profession. In the Panel’s judgement, public confidence in the profession and in the HCPC as its Regulator would be undermined if there were no finding of impairment.
116. Accordingly, the Panel found he Registrant’s fitness to practise to be impaired having regard to both the personal and public components.
Decision on Sanction
117. The Panel considered the submissions of Mr Micklewright and Ms Graham. The Panel also had regard to the supporting testimonial evidence of the Registrant’s three character witnesses.
118. The Panel took into account the HCPC’s Sanctions Policy and accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of a sanction is not to punish the Registrant but to protect the public and the wider public interest by upholding proper standards of conduct and behaviour and maintaining public confidence in the profession and the Regulator.
119. The Panel considered the available sanctions in ascending order of seriousness and applied the principle of proportionality, balancing the respective interests of the Registrant and the public.
120. In the Panel’s judgement, the aggravating factors in this case are the following:
• The Registrant abused her position of trust to steal money from her employer
• The thefts took place over a period of several months
• The Registrant falsified patient records to conceal her thefts
• Falsification of patient records had the potential to put at risk the health and safety of service users
• The Registrant in the course of these proceedings has shown no evidence of remorse, insight or relevant remediation.
121. With regard to mitigating factors, the Registrant was previously of good character and had an unblemished record as a Hearing Aid Dispenser and audiologist until the events with which this case is concerned. She has since practised subject to conditions of practice without any concerns about her conduct. Witnesses for the HCPC, as well as the Registrant’s own character witnesses praised the Registrant’s clinical competence and her manner in providing care for patients.
122. The Panel considered the various options by way of disposal in ascending order of seriousness as follows.
123. The case is too serious for the Panel to take no action, as it involves dishonesty.
124. Mediation is not relevant.
125. A Caution Order is not appropriate because of the serious nature of the Registrant’s misconduct. A Caution Order would not place any restriction on the Registrant’s ability to practise as a Hearing Aid Dispenser.
126. A Conditions of Practice Order is not appropriate because the case does not relate to the Registrant’s competence as a Hearing Aid Dispenser but rather to her dishonesty and her suitability to be a member of the profession. The Panel was not satisfied that workable conditions could be formulated to address such concerns.
127. The Panel considered the criteria for imposing a Suspension Order but concluded that the Registrant’s misconduct was so serious as to be fundamentally incompatible with her remaining on the Register. The Panel concluded that the Registrant by the serious nature of her dishonesty has demonstrated that she is not trustworthy.
128. The Panel was mindful that a Striking Off Order is a sanction of last resort and should be used where there is no other way to protect the public. In the Panel’s judgment, the nature and seriousness of the Registrant’s misconduct is such that she is not fit to be a member of the profession. In coming to this conclusion, the Panel considered that notwithstanding the Registrant’s previous good character and clinical competence, her breach of trust in relation to the theft from her employer and falsifying patient notes to cover her misconduct is so serious that only a Striking Off Order is appropriate in this case. Further, public confidence in both the profession and the Regulator would be undermined if she were allowed to continue in practice. In all the circumstances, the only appropriate and proportionate sanction is a Striking Off Order.
Order
The Registrar is directed to strike the name of Ms Prina Karia from the Register on the date this order comes into effect.
Notes
Interim Order
1. Mr Micklewright made an application for an Interim Suspension Order for a period of 18 months to cover the appeal period or until any appeal that may be lodged has been determined.
2. Ms Graham did not make any submissions other than to request that any interim order made should be as short as possible.
3. The Panel noted the submissions by both parties and accepted the advice of the Legal Assessor.
4. Given the Panel’s decision to impose a Striking Off Order, it would be inconsistent not to impose some form of interim order. The Panel, for the same reasons it identified above, came to the conclusion that it is impracticable and inappropriate to formulate interim conditions of practice in this instance.
5. The Panel therefore makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being in the public interest, having regard to the Panel’s findings of fact and determination as to impairment and sanction.
6. 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. This Interim Suspension Order is made for the maximum period of 18 months.
Hearing History
History of Hearings for Miss Prina Karia
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 22/01/2024 | Conduct and Competence Committee | Final Hearing | Struck off |
| 13/11/2023 | Conduct and Competence Committee | Interim Order Review | Interim Conditions of Practice |
| 15/08/2023 | Conduct and Competence Committee | Interim Order Review | Interim Conditions of Practice |
| 09/06/2023 | Conduct and Competence Committee | Interim Order Review | Adjourned |
| 06/03/2023 | Conduct and Competence Committee | Interim Order Review | Interim Conditions of Practice |
| 08/12/2022 | Investigating Committee | Interim Order Review | Interim Conditions of Practice |
| 16/09/2022 | Investigating Committee | Review Hearing | Interim Conditions of Practice |
| 10/03/2022 | Investigating Committee | Interim Order Application | Interim Conditions of Practice |