Miss Karen M Dean

Preliminary Matters
Service
1. The Panel was satisfied that service of notice of today’s hearing had been effected in accordance with the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”). In took into account that the Notice of Hearing had been sent by the HCPC Hearings department to the Registrant’s registered email address on 16 October 2024. Further, the Panel was provided with confirmation from Microsoft Outlook, sent the same day, that: “Delivery to these recipients or groups is complete, but no delivery notification was sent by the destination server.”
2. In addition, the Panel noted that the Registrant had emailed the HCPC Hearings department on 17 October 2024, apparently in response to the Notice of Hearing, stating the following:
“As I have previously informed you, at the original hearing that resulted in a one year suspension –
I will not be engaging in this or any further hearings. I have been stalked and harassed by [EB] for over 4 years now and, for the preservation of my mental health, I will not subject myself to anything regarding this subject.
I informed you in November 2023 that I had no desire or intention to practice as an orthoptist and requested that my name be removed from the register. You declined and informed me that I would have to have this hanging over my head for a further 12 months.
I now request that my name be removed from the register. I have a new job, I’m very happy and have no intention to return to orthoptics. I would like to put this nightmare behind me (although I am still being stalked by EB and be allowed to get on with my life.
I have provided a court certified drug test for the 12/12 prior to the complaint being made, I believe this is evidence enough that I am clearly not a person who takes any illegal substances. That, along with my flawless work record/attendance should also attest to this.
EB was discredited repeatedly during this process and also has a police record for harassment, violence and criminal damage attaining to another lady who also reported stalking.
Nevertheless, I have moved on with regards to my career and request to remove myself from the register.”
3. The Panel therefore was satisfied that the Notice of Hearing had been delivered to the Registrant’s email address on the register in accordance with the Rules and that she had acknowledged receipt thereof.
Proceeding in absence

4. The Registrant did not appear nor was she represented.

5. On behalf of the HCPC, Ms Sampson applied for the hearing to be conducted in the absence of the Registrant under Rule 11 of the Rules, on the basis that all reasonable steps had been taken to serve the Notice of Hearing on the Registrant and therefore that the Registrant had been notified of the time and date of the hearing at her registered email address. In addition, the Panel was to note that an HCPC Case Manager had subsequently emailed the Registrant on 28 October 2024 (in response to the Registrant’s email of 17 October 2024, set out above) stating:

“Thank you for your email dated 17 October 2024.

I understand that you no longer wish to be on the HCPC register. I have attached a Practice Note on Voluntary Removal Applications (VRA) which may interest you. This is an option that may be explored after the hearing on 13 November 2024, [the Panel’s emphasis] depending on the outcome. If you are interested in a VRA, please let me know and we can discuss the process further.

Please note all communications in this email will be put forward to the Panel.

If you have any questions or concerns, please don't hesitate to contact me.”

6. The Panel also noted that the Registrant had replied to that email, later the same day, stating:

“I cannot see an attachment but I have worked in my new role for almost 12 months and will continue to do so for the foreseeable future.

Therefore, I do not wish you to remain on the register as my role does not require it. I have no interest or intention to return to orthoptics and would appreciate an end to this nightmare.

Four years of torment is punishment enough and I would like to be allowed to move on with my life.”

7. Finally, the Panel noted that today’s Hearings Officer had emailed the Registrant the day before the hearing, 12 November 2024, at 11.22 am to advise her about joining the hearing remotely. The Registrant responded by email the same day, at 16.27 pm as follows:

“Please can you stop sending me these invitations.

I have already informed you on multiple occasions that I will not be involved in this any further.

I have a fantastic new job that does not require HCPC and have no intention of practising as an orthotics let again.

I ask that you allow me your put this nightmare behind me. This has bern going on since 2018 with [EB] and I believe that is enough for anyone to deal with.

Imagine going to court, being handed a punishment, serving your time and then being tried all over again.

This whole nightmare continues to be an assault on my mental health, I believe that I have been punished more than anyone deserves.

Respectfully, please do not contact me again.”

8. Accordingly, Ms Sampson submitted that all reasonable steps had been taken by the HCPC to bring this matter to the Registrant’s attention. The Registrant had: acknowledged receipt of the original Notice of Hearing; subsequently responded to an email (albeit relating to a different subject, namely a VRA) which referred to today’s hearing; and had responded to an email sent the day before the hearing by the Hearings Officer, all indicating that she had no intention of attending today’s hearing.

9. Ms Sampson asked the Panel to note that the Registrant had not attended the original substantive hearing and had not otherwise engaged with the HCPC. The Registrant had not asked for an adjournment and Ms Sampson submitted that an adjournment would not be likely to result in the Registrant’s attendance on a later date – indeed, she had indicated that she wanted nothing more to do with the HCPC. Accordingly, she submitted that it was in the public interest for the hearing to proceed expeditiously, bearing in mind, not only that this was a mandatory review, but also that the order would lapse on 13 December 2024 if there were further delay, especially as it would be unlikely to reschedule this hearing before then.

10. Having considered the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant” and the advice of the Legal Assessor on the case of GMC v Adeogba [2016] EWCA Civ 162, the Panel determined that there was a burden upon a registrant to keep her contact details updated and to engage with their regulator. The Panel therefore accepted that the HCPC had “taken all reasonable steps” to serve the Notice of Hearing upon the Registrant.

11. The Panel noted that the Registrant had been unequivocal in stating that she did not intend to attend the hearing and, in particular, had not applied for an adjournment. Further, the Panel noted that the Registrant had not otherwise engaged with the regulatory process nor had she attended the previous substantive hearing in November 2023. The Panel therefore concluded that she had voluntarily absented herself and had waived her right to appear. The Panel also reminded itself of the overriding public interest in dealing with matters in a timely manner and that this was a mandatory review. In balancing the Registrant’s interests and the public interest, the Panel decided that the matter should be heard in the absence of the Registrant.

Background

12. The Panel took account of the previous Panel’s summary of the background to this matter, together with some of the summary of the evidence, all as set out in its determination from November 2023, as follows:

“10. The HCPC opened the case on the basis that the Registrant took a substance that she purported to be cocaine at a house-party. This party was held at her house and it was said that she supplied the substance that she and others inhaled.

11. The HCPC case is that it rejects the Registrant’s contention that the substance ground and inhaled was an anti-histamine. While the HCPC does not have scientific evidence of the substance’s composition, it contends that inferences may be made and that such behaviour was not consistent with required standards of conduct…

…12. The Panel first heard from the HCPC witness EB. EB adopted her statement. This was supplemented with additional information. She indicated that four adults were at the Registrant’s party and five to eight children were playing amongst themselves unsupervised simultaneously. She said she could not remember why she took videos but it was her habit to take lots of photos and videos as other people did. She said that she was open about the fact that she was filming and that while she had deleted some of the photos and videos that she had taken to free up space in her phone she had kept some photos and videos of this party, without editing either of the videos.

13. She was asked about the possibility that the Registrant was making a joke but she could not recall what it was. She said the Registrant and Person A and B may have made a joke before her filming started but she did not recall the subject matter. However, she could say that it was definitely not about the substance being Benadryl and that the substance was definitely cocaine. She said that the Registrant did have an allergy to horses but was not suffering from an allergy at the time.

14. There was exploration of dates, and with the assistance of her telephone which was checked, EB confirmed that the relevant party was in August 2019, but by the end of that month she had fallen out with the Registrant. Her statement set out the nature of this falling out, when she indicated that the Registrant attempted to blackmail her about a personal matter and would not stop.

15. Panel questions related to a number of different matters and elicited the following information:

a. EB explained that the Registrant was in the kitchen when she announced that her dealer was coming to the house and that she was going to buy cocaine. She clearly said this and was offering to get some for Person A or B. This was not the first time that she had made this offer to them. She said that they provided £15-20 each, sometimes in cash and sometimes via bank transfer. She saw notes being placed on the table.

b. The dealer’s car was a dark BMW, one series, it contained a male with dark hair. She said that she was holding open the front door as the Registrant would be locked out if the door closed. EB indicated that there is a gate and wall in front of house, with a drive that allows for four cars to park. There is a 15 ft gate that obscures the view from the street. This occurred in the daytime, approximately noon in August. She said that the road is not a busy one but quite secluded but the gate, large shrubs, and tall gate would block the view from the street to the house. She said that she was no more than two/three feet away from the driver, and was not obstructed in her view. She saw the Registrant hand over cash and receive a white substance which she understood to be cocaine. There was a small matchbox size amount of white powder, within a bag that could comfortably contain that amount.

c. She indicated that the Registrant called out: “got it, got it,” “got the coke,” “got the lemo,” once she returned to the house. EB said that the Registrant referred to cocaine as lemo often. The Registrant didn’t offer it to her because she was aware that EB does not take drugs. She tried it herself before offering it to Person A and B. They said it was “good lemo and not cut with much”.

d. Para 28: She said that her threat to send the video to the Registrant’s employers followed the Registrant’s threat to her and that the Registrant would not leave her alone. She set out how the blackmail attempts continued and the timeline was established after she checked her telephone. The two friends fell out at the end of August 2019 and by April 2020 were not talking.

e. She explained how the Registrant had tried the cocaine straight way and had a “quick one” declaring it to be good. However, the children came into the kitchen, so it was put away. She saw Person A, Person B and the Registrant attempt to use the downstairs bathroom but because a child was in there all four adults went to the family bathroom upstairs as she did not want to be the only adult alone. She at different times saw the bag in the Registrant’s hand, watched her put it into her pocket and later removed and take cocaine from it. She was content that the bag was the same one each time, as it had stripes across it with a K for Karen on it. She said that she knew it was the same bag, with a K on it, because the Registrant was in her sight at all times.”

13. Following the HCPC investigation, the matter proceeded to the hearing in November 2023, at which the Registrant did not attend, The Substantive Hearing Panel found all the following Particulars of the Allegation (as set out above) proved,

14. The Substantive Hearing Panel subsequently found that the Registrant was impaired on the basis of her misconduct and went on to consider the level of restriction that was appropriate and proportionate in all the circumstances of this case. In deciding to impose a Suspension Order for a period of twelve months, the Substantive Hearing Panel stated:

“76. The Panel began its deliberations on sanction by considering the mitigating factors. The Panel acknowledged that the Registrant had practised for many years and had no previous regulatory findings recorded against her.

77. The Panel next considered aggravating factors and reminded itself of its finding at the impairment stage; the misconduct was considered remediable, but limited evidence that any remedial action had been taken was put before it, as this was confined to a single drug test result. The Panel did not have any updated information to take into account as to whether the Registrant had reflected and whether she had further developed any insight. This meant that a risk of repetition remained. The Panel considered that the Registrant appears to have been less than frank in her communication and there is evidence of potential harm to other members of the public. Further although the Allegation is drafted to reflect the video evidence on a single day, there is more than one instance of the Registrant supplying drugs, and this involved both Person A and B. Children were present in the house at this time and unsupervised. The Registrant has not expressed remorse.

78. The Panel next considered the sanctions in ascending order of gravity.

79. The Panel found that it is not appropriate to make no order because of the serious nature of the Allegation found as well as its findings on facts, misconduct and impairment.

80. A Caution Order is not appropriate because the conduct found proved was serious and not minor in nature. There also remained a risk of repetition as there was lack of insight. There was no evidence of what the Registrant had done since this incident and limited evidence of remediation.

81. The Panel next considered a Conditions of Practice Order. Whilst the misconduct was capable of being remediated, the Registrant had not engaged to the extent that she had provided evidence of what steps she had taken and her attitude and approach to the Panel’s findings. Accordingly, the Panel could not be confident that the Registrant would comply with any conditions formulated. The Panel had also found a lack of insight. The Registrant’s misconduct was serious and there was a risk of repetition. The Panel did not consider there were any conditions that could be formulated that would be proportionate, appropriate and workable. In the circumstances, the Panel determined that a Conditions of Practice Order was inappropriate.

82. The Panel next considered a Suspension Order. The Panel noted the serious breach of a professional standard, the lack of insight and thus the risk of repetition.

83. The Panel noted the potential risk to members of the public and the reputation of the profession caused by the Registrant’s failure to adhere to Standard 9.1. When looking at the circumstances of the case, the Panel noted that the Registrant sought to deny any wrongdoing. The Panel determined that notwithstanding the risk of repetition, there was a possibility of the Registrant being able to remediate and demonstrate insight to address the risk of possible repetition.

84. The Panel was mindful that a Suspension Order deprived the Registrant of the opportunity to practise in her chosen profession, but considered that no lesser sanction was sufficient to mark the seriousness of the breach and reinforce the need to engage with and maintain the regulatory requirements.

85. The Panel did discuss a Striking Off Order and considered paragraph 131 of the HCPC’s Sanction Guidance, which stated as follows; “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.”

86. The Panel was fully aware that a Striking Off Order “is a sanction of last resort for serious, persistent, deliberate, or reckless acts” (paragraph 129 of the HCPC’s Sanction Guidance). The Panel was satisfied that a lesser sanction would suffice, namely a Suspension Order. The Panel considered it would be disproportionate to issue a Striking Off Order as the misconduct concerns a single day insofar as the Allegation is drafted. The Registrant also had a long unblemished career without any fitness to practise concerns being raised.

87. The Panel determined that a Suspension Order was the more appropriate and proportionate outcome. It would protect the public and the reputation of the profession sufficiently until such point that the misconduct was remedied. It would also serve to allow the Registrant an opportunity to attend a future review hearing and engage, demonstrating the development of insight.

88. In considering the length of any period of suspension, the Panel determined that the Suspension Order should last for 12-months given the seriousness of the matter and the need to protect the public. This would give the Registrant time, should she wish, to develop insight and evidence the same.”

15. Finally, that Panel suggested:

“89. A review would take place shortly before the expiry of the Suspension Order. The Panel considered a future reviewing panel may be assisted, but are not bound, by the following:

• Evidence that the Registrant has not taken illegal drugs, which may include drug test results;

• A reflective piece from the Registrant, which includes reflections on what illegal drug taking and supply means for others and the reputation of the profession;

• Any testimonials from colleagues in relation to conduct and working relationships, which may be from paid or unpaid roles;

• Evidence of continuous professional development; and

• Any other information that the Registrant considers would assist the reviewing panel.”

Submissions

16. Ms Sampson reminded the Panel of the factual background to the case, the decision of the previous panel, and the Panel’s powers as to extending, continuing, varying or revoking the current Order. She referred the Panel to the HCPTS Practice Note on “Review of Article 30 Sanction Orders” and submitted that the key issue to consider was what had changed since the Order was imposed. The reviewing panel’s task was to “consider whether all the concerns raised in the original finding of impairment have been sufficiently addressed”. The Practice Note explicitly set out relevant factors to take into account, which included: “the steps taken to address specific failings or other issues identified in the previous decisions; the degree of insight shown and whether this has changed…whether any other fitness to practice issues have arisen; and whether the Registrant has complied with the existing Order.”

17. Moreover, Ms Sampson submitted that, as the decision in Abraheam v GMC [2008] EWHC 183 (Admin) indicated, in practical terms there was a “persuasive burden” on the Registrant to demonstrate at a review hearing that she had fully acknowledged the deficiencies which led to the original finding and had addressed that impairment sufficiently “through insight, application, education, supervision or other achievement…”. However, she contended that there had been a total absence of engagement on the Registrant’s part other than to indicate that she now had another career and did not want to have anything to do with the HCPC. In particular, the Registrant had not addressed the recommendations made by the previous panel. There was, accordingly, no evidence of improvement, insight or remediation. The Registrant had failed to take the opportunity: to engage; to remedy the concerns; or to show any renewed commitment to the profession. Ms Sampson therefore contended that the Registrant had not discharged the persuasive burden to address the concerns about her fitness to practise.

18. Ms Sampson therefore submitted that the Registrant’s fitness to practise remained impaired on a personal basis because the risk of harm to the public remained high in the absence of any new information about her practice. She further contended that a finding of impairment was necessary in order to maintain public confidence in the profession.

19. In relation to sanction, Ms Sampson reminded the Panel to consider not only the need to balance the rights of the Registrant against the duty to protect the public, but also the wider public interest, together with the perception of the profession and regulatory process. She referred to the HCPTS’ Practice Note entitled “Sanctions Policy” and made the following submissions.

20. Ms Sampson maintained that, considering the serious nature of the Registrant’s misconduct, the risk of repetition, the Registrant’s failure to engage with these proceedings, and her lack of insight, remorse or remediation, to take No Action or to make a Caution Order would not be in the public interest. Further, she argued that public confidence in the profession would be undermined by imposing either of these sanctions.

21. Ms Sampson went on to submit that there were no workable conditions that could be formulated in the circumstances where the Registrant was not engaging with these proceedings and might not be willing to comply with any conditions imposed. The Registrant had stated that she has no intention of engaging with any further hearings and has no desire or intention to practice as an orthoptist. Therefore, Ms Sampson submitted that a Conditions of Practice order would not address the risks that had been identified.

22. Ms Sampson additionally submitted that a further suspension order would serve no useful purpose as it was unlikely that the Registrant would be willing to remedy her failings or engage with these proceedings in the future. The email correspondence from the Registrant indicated that she would not be engaging in this or any further hearings, that she had a new job and had no desire or intention to return to practise as an orthoptist. The Registrant had said that she had moved on and wished her name to be removed from the Register.

23. Accordingly, Ms Sampson maintained that, considering all the information currently before the Panel, it was the HCPC’s submission that the most appropriate and proportionate order today, was a Striking Off order. In support of that submission, Ms Sampson referred the Panel to paragraph 131 of the HCPC Sanctions Policy which highlighted that:

“A striking off order is likely to be appropriate where the nature and the 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
• matters Is unwilling to resolve.”

24. Ms Sampson stated that it was the HCPC’s respectful submission that the Panel might think that the Registrant’s failure to engage with these proceedings, the absence of any evidence of remediation and insight and the Registrant’s unwillingness to resolve matters, was incompatible with continuing to be a registered professional. Additionally, the Registrant had highlighted in her emails her wish to come off the register. Ms Sampson therefore invited the Panel to impose a Striking Off Order on the Registrant today.

Decision

Decision on Impairment

25. In reaching its decision, the Panel considered the previous panel’s decision and had regard to the principles set out in the HCPTS Practice Notes entitled “Fitness to Practise Impairment” and “Review of Article 30 Sanction Orders”. The Panel accepted the advice of the Legal Assessor, who confirmed that the Panel would be entitled to presume impairment and see whether there have been any changes in the Registrant’s situation since the last hearing. Further, it was to have regard to the HCPTS’ “Sanctions Policy”.

26. The Panel also had regard to the case of Abrahaem v GMC 2008 EWHC 183 (Admin) in which it was held that there is in practical terms a “persuasive burden” on a registrant to address the concerns that were highlighted by previous panels. This required the Registrant to acknowledge the deficiencies which led to the original findings and to address impairment through evidence or material demonstrating insight, application, education, supervision or some other achievement.

27. The Panel noted that the Registrant had not submitted any such evidence or material to indicate any insight or reflection, or any indication that she had addressed her misconduct. The Panel reminded itself that the Registrant had not only been in possession of a controlled drug, cocaine, but had also been found to have supplied it to others, which was a criminal offence and therefore which impacted upon the reputation of the profession. Further, she had not responded to any of the recommendations made by the previous panel and effectively continued to deny the Allegation.

28. Accordingly, in answer to the key question, namely “what had changed since the Order was imposed” the Panel had little hesitation in concluding that nothing had changed. There was no evidence of remediation and therefore there was still a risk of repetition.

29. The Panel therefore concluded that the Registrant remained impaired in relation to both the personal and the public components of impairment. It therefore moved on to consider what the appropriate sanction should be in this case.

Decision on Sanction

30. The Panel considered the Sanctions Policy of the HCPTS and accepted the advice of the Legal Assessor that a sanction should be the least that is necessary to ensure public protection. The Panel reminded itself that the purpose of a sanction is not to punish the Registrant and that a sanction must be reasonable and proportionate.

31. The Panel determined that the nature of the concerns in this case were too serious to make No Order.

32. The Panel next considered whether to impose a Caution Order but decided that it was inappropriate since it would not provide sufficient public protection nor would it reflect the seriousness of the Registrant’s misconduct.

33. Further, the Panel determined that a Conditions of Practice Order was not appropriate because the Registrant had not shown insight and had not engaged with her regulator to any relevant degree – indeed, she had made it clear that she wanted nothing further to do with the HCPC and was no longer interested in pursuing a career as an Orthoptist. Accordingly, the Panel concluded that a Conditions of Practice Order would not be workable or verifiable in the absence of engagement on the part of the Registrant.

34. The Panel then considered an extension of the current Suspension Order. It noted, however, that, since the imposition of the suspension order in November 2023, the Registrant had failed to engage with the process (other than to confirm that she did not intend to attend today’s hearing or any future hearing) or to demonstrate insight, reflection and remediation. The Panel also reminded itself that these matters had first arisen in 2019, some five years ago, so the Registrant had arguably had sufficient time to address her failings, so the Panel felt entitled to wonder what benefit there would be to the profession and/or to the public by further extending the current Suspension Order. Having considered all the circumstances of this case, the Panel was led to the conclusion that imposing a further suspension would serve no useful purpose.

35. The Panel therefore went on to consider a striking off order. It noted, in particular, that the Sanctions Policy, in paragraph 131, stated:

“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.”

36. The Panel considered that: the Registrant’s failure to engage to any significant degree with the HCPC; her continued lack of insight; and her unwillingness to resolve matters, was incompatible with continuing to be a registered professional. Accordingly, a Striking Off Order would be justified. In addition, the Panel also noted paragraph 130 of the Sanctions Policy, which stated: “A striking off order is a sanction of last resort…”. The Panel considered that the Registrant had been given every opportunity to resolve matters but had made it clear that she was unwilling to do so. Accordingly, the Panel considered that the point of no return had been reached and that the Registrant should therefore be Struck Off the HCPC’s Register. The Panel reached this conclusion with some regret since it was apparent that the Registrant had practised without any concerns for several years but, in the circumstances where she had indicated that she was no longer interested in practising as an Orthoptist, it considered that it was left with no other option.

37. Accordingly, the Panel directs that the Registrant be Struck Off the HCPC’s Register.

ORDER: The Registrar is directed to strike the name of Karen M Dean from the Register on the date this Order comes into effect

The Order imposed today will apply from 13 December 2024

History of Hearings for Miss Karen M Dean