Adrian Patrick

Preliminary Matters
Service
1. The Panel noted that the Notice of Hearing, specifying the date, time and method of this review of substantive order, had been sent on 8 February 2024 to the Registrant at his registered email address, previously notified to the HCPC. The notice contained the required particulars.

Proceeding in the Registrant’s absence

2. Mr Barnfield, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor, who advised in accordance with the cases of GMC , Adeogba [2016] EWCA Civ 162 and R v Jones [2002] UKHL 5, including that the Panel should exercise its discretion to proceed in a Registrant’s absence with great care and caution.

3. The Panel noted that no communications had been received from the Registrant in response to the notice of hearing. It considered that he had been afforded the opportunity to engage and attend the hearing, as required, but had not taken that opportunity. He had not requested an adjournment and the Panel did not consider that there was any good reason to adjourn, or that an adjournment would secure his attendance at a future date. The Panel concluded that the Registrant had voluntarily absented himself from the hearing, thereby waiving his right to attend.

4. The Panel bore in mind that this was a mandatory review of a substantive order which was required before its expiry. In balancing the Registrant’s rights against those of the public interest, the Panel was satisfied that it was appropriate and fair to proceed in the Registrant’s absence.

Background
5. The Registrant is a registered Biomedical Scientist who was previously employed by Nottingham University Hospital NHS Trust (the Trust) within the Microbiology Department (the Department). The Registrant began working for the Trust in 1998.

6. From 2 December 2019, the Registrant was working in the Serology section of the Department, where he was the Specialist Biomedical Scientist with responsibility for supervising serology testing, which meant he was responsible for interpreting serology results and authorising reports in line with serology algorithms and Standard Operating Procedures.

7. A core part of the Registrant’s role was the interpretation of test results and specific test results including Hepatitis B Surface Antigen Testing (HBsAg) using, at that time, a Centaur XPT analyser to perform the tests.

8. The process for completing HBsAg testing was, in summary, for serum samples to be loaded into an analyser that had already been loaded with the correct assay kit which tested for a specific antigen that is looked for when these tests are carried out. The Centaur would then process the sample and provide a negative, positive, reactive or indeterminate result. If the result was negative, the Biomedical Scientist would, unless there were any other concerns, authorise the report. Equally, if the result was positive, and related to a patient known to be positive for the HBsAg then they would also authorise the result. However, if there were any concerns about a sample, if it was reactive or insufficient, or if there was a positive result for a new patient, not known to be positive for that antigen, the sample would be added to an authorisation queue for consideration, review, and authorisation by a Duty Virologist.

9. On 21 July 2020, the Band 8a Deputy Service Manager for the Registrant’s Department, was informed of concerns that her colleague, a Consultant Clinical Scientist within the Department, had about the wording of a result for a HBsAg test carried out by the Registrant. The wording was “insufficient sample to confirm the HBsAg result”.

10. The factual particulars that the substantive hearing panel found proved were that the Registrant had failed to document whether there had been any HBsAg reactivity in the sample when he should have done and that he should, having noted that the sample size had been insufficient, have flagged this with the Duty Virologist by adding a code on the Trust’s internal reporting system. Escalation of the result was required to ensure that a further sample was obtained from the patient to avoid any delay in diagnosis or treatment. The Duty Virologist was concerned that the Registrant stated, “I was trying to remind people to send sufficient samples for the test they are requesting, rather that continually asking for a repeat sample”.

11. An internal Trust investigation was conducted, which concluded on 6 September 2020. On 15 January 2021, in written correspondence with the Trust, the Registrant accepted the allegations against him and as a result, a written warning was issued. On 1 February 2021, the Registrant retired from the Trust.

12. Between 5 and 8 September 2023, a panel of the Conduct and Competence Committee of the HCPC was convened and a substantive hearing was held in respect of the matter. The Registrant did not attend the hearing, nor did he provide any written submissions or evidence for that panel to consider. The factual allegations were found proved against him and that they amounted to the statutory ground of misconduct.

13. In respect of insight, the substantive panel had found that there was some insight, as the Registrant had recognised and accepted the concerns, although he had told the Trust’s investigator that he did not know why he had failed to follow the Standard Operating Procedures and could not explain why he had not done so. That panel noted that the Registrant had also told the Trust’s investigator that he had completed a period of self-reflection. However, the substantive panel had not been provided with any evidence of such self-reflection or any other evidence of developed insight. It therefore concluded that the Registrant’s insight was limited. In respect of remediation, the substantive panel concluded that there was no evidence before it that the Registrant had taken steps to address the concerns.

14. In respect of public confidence, the substantive panel concluded that, given the nature of the misconduct, not to make a finding of impairment would undermine public confidence in the profession, and in the regulator, as well as fail to declare and uphold proper professional standards.

15. The substantive panel found that the Registrant’s fitness to practise was impaired on both the personal and public components.

16. In respect of sanction, the substantive panel imposed a Suspension Order for a period of 6 months. Mindful that the Order would be reviewed by a future reviewing panel before its expiry, the substantive panel set out some recommendations for the Registrant as to what may assist the future reviewing panel as follows:
• The Registrant’s attendance at future reviews;
• A reflective statement addressing the issues of record keeping and communication;
• Any practical steps taken to address maintaining professional standards and any evidence of CPD addressing the issues;
• Testimonials

Decision
17. Mr Barnfield, on behalf of the HCPC, submitted that the Registrant’s fitness to practise was still impaired as there had been no real change since the Suspension Order had been imposed. He submitted that the appropriate and proportionate response was to extend the Suspension Order for a similar period, as this would continue to achieve the necessary level of public protection.

18. The Panel heard and accepted the advice of the Legal Assessor. It exercised its independent judgement in determining whether or not the Registrant’s fitness to practise remains impaired as of today. It understood that the persuasive burden, at a review, was on a Registrant to demonstrate that his fitness to practise was no longer impaired.

19. The Panel had regard to the findings of the substantive panel, in particular those relating to the Registrant’s insight and remediation. The Panel considered that the situation had not changed since the substantive hearing. In the time that had passed since the Suspension Order had been imposed, the Registrant had had the opportunity to demonstrate that he had achieved greater insight and remediation but had not provided any evidence of reflections or the practical steps that he had taken to address the misconduct. He had not engaged with the process at all and had taken no steps to remedy the issues proved and which had the potential to place service users at risk of harm.

20. The Panel also bore in mind that the longer the passage of time without the issues being addressed, the greater the risk of the Registrant becoming de-skilled, which in turn could increase the risk of repetition and the consequent risk of harm to service users.

21. Accordingly, the Panel is of the view that the risks identified by the substantive panel remain, and that as a result, the Registrant’s fitness to practise remains impaired on the grounds of both public protection and in the wider public interest in maintaining public confidence in the profession and declaring and upholding proper professional standards.

22. In relation to sanction, it was the Panel’s view that a sanction was required, which would provide public protection and would otherwise address the public interest, including maintaining public confidence, and upholding professional standards. The Panel therefore concluded that the options of taking no further action or imposing a Caution Order would not achieve this, as neither would restrict the Registrant’s practice.

23. Given the Registrant’s lack of engagement, the Panel was not reassured that the Registrant was willing or able to comply with a Conditions of Practice Order. In light of this, the Panel did not consider that such an order was either appropriate or proportionate, as it would not achieve the required public protection or address the public interest considerations of maintaining public confidence or upholding professional standards.

24. The Panel next considered whether extending the current Suspension Order was appropriate and proportionate in the circumstances of this case. It noted that the substantive panel had imposed a 6 months’ Suspension Order which it had considered would allow the Registrant to engage with the HCPC if he wished and would allow him time for reflection on the impact of his conduct on the reputation of the profession and risk to service users. The substantive panel had also set out recommendations to help signpost for the Registrant the matters which may assist a future reviewing panel. However, the Panel had no evidence that the Registrant had engaged with the HCPC or followed any of the recommendations.

25. The Panel bore in mind that it was required to impose the least onerous sanction in the circumstances which would achieve the necessary level of public protection and address the public interest considerations. In the Panel’s judgement, a Suspension Order would achieve the necessary level of public protection for the period of time which it was in force. Further, at this time, the Panel was also satisfied that a Suspension Order would address the public interest concerns.

26. Accordingly, the Panel determined to impose a further Suspension Order for a period of 6 months. In addition to protecting the public and addressing the public interest concerns, the Panel considered that this length of time would be sufficient for the Registrant to engage with the HCPC and to address the concerns, if he chose to do so. The Panel endorsed the recommendations of the substantive panel and considered that they may assist a future reviewing panel.

27. Given the ongoing lack of engagement from the Registrant, both at the substantive hearing and this review, the Panel considered whether or not to impose a Striking Off Order. It noted that two of the factors which may indicate that a Striking Off Order may be appropriate appeared potentially relevant in this case, namely that the Registrant “lacks insight” and “is unwilling to resolve matters”. Whilst this Panel is satisfied that a Suspension Order is the appropriate and proportionate sanction at this time, it noted that a future reviewing panel may take a different view.

ORDER: The Registrar is directed to suspend the registration of Mr Adrian Patrick for a further period of 6 months on the expiry of the existing order.

The Order imposed today will apply from the end of 6 April 2024.

This Order will be reviewed again before its expiry at the end of 6 October 2024.

History of Hearings for Adrian Patrick