Susan Glaiser

Preliminary Matters
Service
1. The Panel had before it a service bundle. This contained evidence that the Notice of Hearing had been sent to the email address the Registrant currently had registered with the HCPC on 27 February 2024.

2. The Notice contained the date of today’s hearing and the fact that it would be held remotely, invited the Registrant to respond to the HCPC to confirm whether she would be attending by 12 March 2024 and advised the Registrant of the powers available to the Panel at a review hearing. That same day, the HCPTS received confirmation of electronic delivery of the Notice of Hearing to the Registrant.

3. The Panel considered the relevant rules and was satisfied that the Registrant had been given reasonable notice of today’s hearing and concluded that the Notice of Hearing had been properly served.

4. The Registrant has not responded to the Notice.

Proceeding in the Absence of the Registrant

5. Ms Khan invited the Panel to proceed in the absence of the Registrant. She took the panel to the relevant rules and the Notice of Hearing that had been sent to the Registrant.

6. She explained that the Registrant has not responded to any correspondence sent by either the HCPC or the HCPTS. She invited them to hold the hearing today as it was in the public interest and the Registrant has voluntarily waived her right to appear and not provided any good reason for her non-attendance. She submitted that the Registrant has not engaged in the review process and not requested an adjournment. She confirmed that the HCPC system has been checked and there had been no contact from the Registrant. The hearings officer also confirmed that he had checked the system and found no contact from the Registrant.

7. The Panel accepted the advice of the Legal Assessor who drew its attention to the HCPTS Practice Note: Proceeding in the Absence of the Registrant. She reminded them that they had to strike a balance between fairness to the registrant and fairness to the wider public interest ensuring that there is an adequate focus on public protection.

8. The Panel took note that its discretion to proceed in absence should be exercised with the utmost care and caution. The Panel had regard to its responsibility for public protection, the need for expeditious disposal of this case and the Registrant’s right to a fair hearing. The Panel considered the factors identified in the cases of R v Hayward [2001] EWCA Crim. 168 and R v Jones [2002] UKHL 5 as modified for fitness to practise proceedings.

9. The Panel noted that the Notice of Hearing sent by the HCPC to the Registrant explained the procedure for today. The Registrant had been invited to tell the HCPC whether she would be attending and represented.

10. The Panel was mindful of the disadvantage to the Registrant by her non-attendance. However, the Panel was satisfied that the Registrant had been given an opportunity to participate in the hearing.

11. The Panel knows nothing of the nature and circumstance of the Registrant’s absence. The Panel noted that the first time the final hearing was listed it had to be adjourned because of the Registrant’s absence. On the second occasion the final hearing was listed, the Registrant did not attend, and the panel proceeded in her absence. There has been no contact now 12 months down the line. Therefore, the Panel inferred from this that her absences was deliberate and that she had waived her right to attend the hearing. Therefore, any disadvantage to her was an inevitable consequence of her own decisions.

12. There has been no communication at all from the Registrant with the HCPC since the final hearing. In light of the history of the Registrant’s engagement the Panel concluded that an adjournment was unlikely to secure her attendance at a later hearing.

13. The Panel considered the public interest for hearing cases without undue delay and the Registrant’s interests. The Panel determined that it was fair to proceed to conduct this mandatory review today.

Background

14. The Registrant is registered with the HCPC as an Operating Department Practitioner, having first registered on 25 September 2015. On 17 March 2020, the Registrant sent a self-referral form to the HCPC notifying them that she had been convicted of two criminal offences following an incident that had occurred on 10 March 2018. The Registrant initially engaged with the HCPC, provided an update and answered certain queries in an email dated 2 April 2020. She also consented to the HCPC obtaining a Health Reference Form from her General Practitioner (GP).

15. A final substantive hearing took place between 6-8 March 2023, the Registrant did not attend. The allegation was found proven and the Registrant was suspended for 12 months.

16. The panel recommended that a reviewing panel may be assisted by the following:
• a reflective piece addressing the deficiencies in the Registrant’s insight in relation to her misconduct;
• evidence of CPD or other actions taken by the Registrant to maintain her knowledge and skills as an Operating Department Practitioner;
• references or testimonials from people for whom the Registrant may be working in paid or unpaid employment, or from other people of good standing concerning her honesty during the period of her suspension;
• the Registrant’s attendance in person or remotely, at the review hearing to assist the reviewing panel in relation to his insight.

Submissions
17. Ms Khan, on behalf of the HCPC, explained that this was the first review of the suspension order imposed on the Registrant by the Conduct and Competence Committee panel. She submitted that the Panel’s role today is to review the Registrant’s impairment based on the evidence today. In doing so she invited the Panel to “consider whether all the concerns raised in the original finding of impairment have been sufficiently addressed”. She reminded the Panel that in practical terms there is a persuasive burden on the Registrant to demonstrate at a review hearing that she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement…”

18. Ms Khan submitted that considering the two components of the test for impairment, personal component and the public component, the Registrant had remediated neither.

19. She invited the Panel to the view that there is not yet sufficient evidence before it to indicate a sustained and maintained change, or to demonstrate that all the concerns raised in the original finding of impairment have been sufficiently addressed and therefore, Ms Khan submitted, the Registrant has not discharged the persuasive burden referenced in Abrahaem v GMC.

20. Ms Khan drew the Panel’s attention to some of the examples provided by Dame Janet Smith in the 5th Shipman Report adopted by the High Court in Cheatle v GMS [2009] EWHC 645 Admin. She submitted that the Registrant still presents a risk to patients, has brought the profession into disrepute, had breached a fundamental tenet of the profession and her integrity cannot be relied upon.

21. She submitted that the Registrant has simply not engaged at all therefore a further period of suspension would not make a difference to her.

Decision

22. The Panel accepted the advice of the Legal Assessor. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive appraisal of the Registrant to determine whether she is fit to return to unrestricted practice. Its role was not to conduct a rehearing of the allegation nor was it to go behind the previous findings. She advised that in carrying out this assessment, the Panel must exercise its own independent judgment.

23. The Panel had regard to the HCPTS Practice Note on “Review of Article 30 Orders” and to the Sanctions Policy.

24. The Panel bore in mind the principles of fairness and proportionality and had regard to the Indicative Sanctions Policy document issued by the HCPC. The Panel was also aware that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or is otherwise in the public interest.

25. In reaching its decision today the Panel considered all the information before it, including the submissions on behalf of the HCPC. The Panel also made sure that it did its best to mitigate any inevitable disadvantage to the Registrant by her non-attendance.

26. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel had it firmly in mind that the persuasive burden is upon the Registrant to demonstrate that her fitness to practise is no longer impaired. The Panel had regard to the decision of the substantive panel decision, however, it comprehensively reviewed the matter and exercised its own judgment in reaching its decision.

27. The Panel considered impairment first of all. The Panel considered the findings of the panel at the substantive hearing which had found the Registrant impaired on both the public and personal component.

28. In terms of the convictions, the previous panel found that the Registrant had remedied her substance use and therefore she was no longer impaired on the personal component but was in relation to the public component. However, in relation to the misconduct, which was her dishonesty, the panel concluded that the Registrant had not expressed any remorse nor reflected on her conduct in any meaningful way. The panel concluded that the Registrant had failed to understand her duty to disclose her convictions to the HCPC and therefore there was a risk that this misconduct could be repeated. The Panel considered these factors and had no evidence before it to suggest that the Registrant had altered her position or deepened her understanding of her obligations to her regulator. As the Panel had no evidence that the Registrant had gained any insight into the nature of these concerns it determined that the she remained impaired in relation to the personal component. The Panel is concerned that the Registrant’s failure to engage suggests that the position is intractable.

29. The Panel considered whether the Registrant was impaired on the basis of the public component. The previous panel determined that the Registrant’s conviction and misconduct had brought the Operating Department Practitioner Profession into disrepute. It determined that the public is entitled to rely on registered professionals to conduct themselves appropriately not only when acting in the course of their profession, but also in their personal lives.

30. The Panel agrees with the conclusions reached by the previous panel. It also finds that a reasonable and informed member of the public would be shocked if there were no finding of impairment where a health professional had been convicted of driving whilst unfit through drugs and the possession of ketamine.

31. Furthermore, the regulator needs to be able to rely on registrants to be honest and abide by its codes and rules. The healthcare professions, including Operating Department Practitioners, rely on trust and expertise.

32. The Panel went on to consider the current position as to impairment on the public component. The Panel took into account all the circumstances which included the robust findings made by the previous panel. It is now 12 months after the Registrant was notified of the findings of her regulator and she has chosen not to address the concerns or engage with the regulator. Therefore, the Panel concluded that it would send out the wrong message to the wider profession and the public if a finding of current impairment were not made and would undermine public confidence in the profession.

33. The Panel determined that a reasonable and informed member of the public would be very concerned if there is no finding of impairment in this case where the Registrant having found to have dishonestly and deliberately decided not to inform her regulator of criminal convictions until some 18 months later then decided not to engage at all with the regulatory process or take any steps to recognise or address the concerns that were clearly spelt out to her in the panel’s decision following the substantive hearing.

34. The Panel is satisfied that the Registrant’s fitness to practise is impaired by reason of her conviction and misconduct on the public component.

35. The Panel then went on to consider the sanctions available to it today and considered them in order of ascending gravity in accordance with the HCPC’s Sanction Policy.

36. The Panel is aware that the purpose of any sanction it imposes is not to punish the Registrant, although it may have that effect, but it is to protect the public, to maintain confidence in the Operating Department Practitioner profession and to uphold its standards of conduct and behaviour.

37. The Panel noted the aggravating factors that had been found by the substantive hearing panel:
• that these proceedings are the second time the Registrant’s fitness to practise has been found to be impaired in relation to ketamine;
• that the Registrant has shown no insight, remorse or any reflection on the matters found to amount to misconduct;
• that the Registrant has not taken any steps to remediate her misconduct;
• that the misconduct arose in a work-related context and involved the Registrant’s regulator.

38. The Panel agrees with those but also notes that it is now 12 months after these matters were brought to the attention of the Registrant. The Registrant’s approach has been to fail to:
• engage with the process;
• attempt to show any better insight; or,
• remediate the regulatory concerns.

39. The Panel reminded itself that the previous panel had found that the Registrant’s dishonesty was an “isolated” incident of dishonesty by omission persisting over a period of 18 months. The Registrant did not admit her dishonesty to the previous panel and has continued not to do so.

40. The serious nature of the misconduct means that it is not appropriate or proportionate to take no further action or to impose a Caution Order. The Panel went on to consider a Conditions of Practice Order. However, the Registrant had not been working. The Panel was concerned that any conditions they might be able to formulate would be so restrictive that this would in effect be a Suspension by the back door. The Panel also noted, as did the previous panel, that the Sanctions Guidance suggests that conditions are less likely to be appropriate in more serious cases and gave the example of cases involving dishonesty which this clearly is. These were not minor convictions. In relation to the misconduct the previous panel could not conclude that it was unlikely to be repeated. This Panel concurs with this view.

41. The Panel went on to consider whether to impose a further Suspension Order and considered carefully paragraph 121 of the Sanctions Policy which provides examples of when such an order may be appropriate including cases where:
• the concerns represent a serious breach of the Standards of conduct, performance and ethics;
• the registrant has insight;
• the issues are unlikely to be repeated;
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.

42. The Panel accepted the previous panel’s findings that the Registrant had insight into her convictions and that these were unlikely to be repeated. It also noted that the previous panel determined that the Registrant’s misconduct was capable of being remediated. However, the Panel finds that the position has changed since last year’s final hearing. The passage of 12 months without any engagement with the HCPC suggests to this Panel that the Registrant is either unwilling or incapable of remedying her misconduct. She has made no efforts to show that she is capable of proper reflection or developing any insight into her behaviour.

43. A Suspension Order was imposed on the last occasion to allow the Registrant time to properly reflect on her misconduct and achieve proper insight. Whether or not she has done this, she has not provided any evidence of such reflection to the Panel.

44. Therefore, the Panel did not think that a Suspension Order would be appropriate.

45. The Panel went on to consider a Striking Off Order and had regard to paragraph 131 of the Sanctions Policy which set out examples when one might be appropriate:
“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:
• lacks insight;
• continues to repeat the misconduct or, where a registrant has been suspended for two years continuously, fails to address a lack of competence; or
• is unwilling to resolve matters.”

46. The Panel gave careful thought to the fact that a striking off order removes a registrant’s name from the Register and prohibits the registrant from practising their profession and that it is a sanction of last resort. The previous panel concluded that the Registrant was neither unwilling nor incapable of resolving matters and that there had been no repeat of the misconduct.

47. This Panel considers that the position has now changed. It recognises that there has been no repeated misconduct. However, the Registrant now has a history of a prolonged and persistent lack of engagement with the regulatory process. The Panel considered that this is now intractable and it can see no prospect of the Registrant engaging to remediate the regulatory concerns in the future. The Registrant has been given clear direction about what was expected from her and 12 months in which to take the necessary steps. From her inaction the Panel can only conclude that she is unwilling to resolve matters and has no intention of taking any steps to develop her insight. The Panel has taken into account the significant impact that taking away the Registrant’s profession and her ability to earn a living through her profession has on her along with the impact to her reputation.

48. But in the circumstances the Panel has determined that a Striking Off Order is the only proportionate sanction that it can impose.

ORDER: The Registrar is directed to strike the Registrant’s name from the Register.

The Order imposed today will apply from 5 April 2024.

History of Hearings for Susan Glaiser