Amy L Mawson

: Occupational therapist

: OT26164

: Final Hearing

Date and Time of hearing:10:00 13/04/2016 End: 17:00 14/04/2016

: Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU

: Conduct and Competence Committee
: Suspended

Allegation

Whilst employed as an Occupational Therapist for Avon and Wiltshire Mental Health
Partnership NHS Trust:

1. Between 28 June 2013 and 3 March 2014, regarding Service User 1, you:

a. Did not complete an assessment until 9 January 2014
b. Did not record the 9 January 2014 assessment until 5 February 2014
c. Did not complete and/or record an adequate assessment in that the assessment recorded on 5 February 2014 was incomplete
d. Did not complete and/or record any contact between 27 November 2013 and 5 February 2014
e. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals
(ii) Your interventions were not personalized and/or not linked to care plan goals

2. Between 3 July 2013 and 14 April 2014, regarding Service User 2, you:

a. Did not complete an assessment until 27 January 2014
b. Did not record the 27 January 2014 assessment until 5 February 2014
c. Did not complete and/or record an adequate assessment in that the assessment recorded on 5 February 2014 was incomplete
d. Did not complete and/or record any contact between 13 March 2014 and 14 April 2014
e. Did not complete and/or record any contact between 3 July 2013 and 27 January 2014
f. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals
(ii) Your interventions were not personalized and/or not linked to care plan goals

3. Between 27 September 2013 and 18 February 2014, regarding Service User 3, you:

a. Did not complete an assessment until 30 January 2014
b. Did not record the 30 January 2014 assessment until 6 February 2014
c. Did not complete and/or record an adequate assessment in that the assessment recorded on 6 February 2014 was incomplete
d. Did not complete and/or record any contact between 30 December 2013 and 27 January 2014
e. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals
(ii) Your interventions were not personalized and/or not linked to care plan goals

4. Between 6 January 2014 and 14 April 2014, regarding Service User 4, you:

a. Did not complete an assessment until 29 January 2014
b. Did not record the 29 January 2014 assessment until 5 February 2014
c. Did not complete and/or record any contact between 5 February 2014 and 14 April 2014
d. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals
(ii) Your interventions were not personalized and/or not linked to care plan goals

5. Between 30 January 2014 and 14 April 2014, regarding Service User 5, you:

a. Did not complete and/or record an adequate assessment in that the assessment recorded on 6 February 2014 was incomplete
b. Did not complete and/or record any contact between 13 March 2014 and 14 April 2014
c. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals
(ii) Your interventions were not personalized and/or not linked to care plan goals

6. Between 5 February 2014 and 14 April 2014, regarding Service User 6, you:

a. Did not complete and/or record an adequate assessment in that the assessment recorded on 6 February 2014 was incomplete
b. Did not complete and/or record any contact between 13 March 2014 and 14 April 2014
c. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals.
(ii) Your interventions were not personalised and/or not linked to care plan goals

7. Between 16 January 2014 and 11 April 2014, regarding Service User 7, you:

a. Did not complete and/or record an assessment
b. Did not complete and/or record any contact
c. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals;
(ii) Your interventions were not personalised and/or not linked to care plan goals.

8. Between 22 January 2014 and 14 April 2014, regarding Service User 8, you:

a. Did not complete and/or record an adequate assessment in that the assessment recorded on 6 February 2014 was incomplete
b. Did not complete and/or record any contact between 7 February 2014 and 13 March 2014
c. Did not complete and/or record any contact between 13 March 2014 and 14 April 2014
d. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals
(ii) Your interventions were not personalized and/or not linked to care plan goals

9. Between 12 February 2014 and 14 April 2014, regarding Service User 9, you:

a. Did not complete and/or record an assessment
b. Did not complete and/or record any contact between 13 March 2014 and 14 April 2014
c. Did not facilitate progress towards recovery in that:
(i) You did not complete and/or record sufficient occupational therapy interventions to achieve care plan goals
(ii) Your interventions were not personalized and/or not linked to care plan goals

10. Between 9 March 2014 and 14 April 2014, regarding Service User 10, you:

a. Did not complete and/or record an assessment
b. Did not complete and/or record any contact or interventions

11. Between 11 March 2014 and 7 April 2014, regarding Service User 11, you:

a. Did not complete and/or record an assessment
b. Did not complete and/or record a care plan
c. Did not complete and/or record any contact or interventions

12. On 5 February 2014 you indicated that you finished work at 18:29 but you recorded assessments at:

a. 19:31
b. 19:40
c. 19:46
d. 19:52
e. 19:57

13. On 6 February 2014 you indicated that you finished work at 18:32 but you recorded assessments at:

a. 18:47
b. 18:54
c. 19:26
d. 19:31

14. Your actions at paragraphs 12-13 were dishonest

15. In or around April 2010 you did not act in Service User A’s best interests and/or failed to maintain professional boundaries in that you arranged for a friend of yours to purchase a horse from Service User A

16. In or around November 2013, you failed to maintain professional boundaries in that you lent money to, and/or received money from, Service User B

17. Your actions at paragraphs 1-11 constitute misconduct and/or a lack of competence

18. Your actions at paragraphs 12-16 constitute misconduct

19. By reason of your misconduct and/or lack of competence, your fitness to practise is Impaired.

Finding

Preliminary matters:

1. Having seen copies of the Notice of Hearing dated 18 August 2015, the Registrant’s Certificate of Registration, and the proof of posting, and receiving the advice of the Legal Assessor, the Panel determined that the Notice of Hearing had been served in accordance with the applicable rules.

2. Mr Mansell applied shortly after midday for the hearing to proceed in the absence of the Registrant under rule 11 of the Health and Care Professions Council (Conduct and Competence) (Procedure) Rules 2003 (the Rules). He informed the Panel that there had been a scheduling teleconference on 18 August 2015 during which the Registrant and her chosen representative, Mr Jim Mooney, had said that the present hearing dates were convenient. Further, prior to his application being made, the HCPC hearings officer had left two telephone voice messages and sent an email to the Registrant seeking information by midday regarding any explanation for her absence, or confirmation that she and/or her representative were attending. No response had been received. Mr Mansell submitted that the Registrant had voluntarily absented herself, and that it would inconvenience the HCPC witnesses to attend again. Further, he submitted that it was unlikely the Registrant would attend if the hearing was adjourned, that the length of adjournment was likely to be quite long due to the HCPC’s listing schedule which could affect the witnesses’ recollection of events. Overall, he submitted the public interest to proceed should prevail.

3. The Panel accepted the Legal Assessor’s advice and took into account all the factors set out in the HCPC’s Practice Note “Proceeding in the Absence of the Registrant”. After considering all the circumstances, the Panel concluded that the Registrant had voluntarily waived attendance or representation at the hearing and, therefore, the public interest requirement of proceeding expeditiously with professional disciplinary hearings justified proceedings with the hearing in the absence of the Registrant.
Background:

4. The Registrant was employed by the Avon and Wiltshire Mental Health Partnership NHS Trust (the Trust) from about 1998 and was the Band 6 Occupational Therapist in the Applewood Unit at the relevant times which had 18 adult in-patient service users. These were vulnerable service users because they had mental health problems; some were detained under the Mental Health Act. The Registrant was the subject of a Trust investigation in 2010 with regard to her dealings with the rehoming of a service user’s horse. From January 2013 the Registrant had management responsibility for one Band 4 occupational therapy technician and one Band 5 part-time occupational therapist, who joined the Unit, although these responsibilities were removed within about a month. From April 2013 the Registrant was provided with support under the Trust’s “Improving Performance” Policy which continued into 2014. The Registrant’s last day at work was 14 April 2014. Her employment with the Trust ceased when she was dismissed with effect from 12 September 2014. The Trust’s concerns were referred to the HCPC.
Decision on Facts:

5. The Panel considered the hearing bundles comprising nearly 3,000 pages, a copy of which had been supplied to the Registrant.

6. The Panel heard oral evidence from KG, the Trust’s Lead Occupational Therapist (“OT”), who confirmed the contents of her witness statement dated 11 August 2015. She explained that she had known the Registrant since 2006 when KG had joined the Trust. KG became the Registrant’s informal supervisor from January 2013, and then formal professional and clinical supervisor from April 2013. Supervision sessions required her to travel for an hour to see the Registrant, but the supervision had increased over time.

7. KG told the Panel that she confirmed the deficiencies set out in Particulars 1 to 13 of the Allegation from her audits of the Registrant’s records in February 2014 and April 2014. She explained that observational service user assessments were required to be carried out within two weeks of admission onto the Unit in the MOHOST form (Model of Human Occupational Screening Tool), which would then be used to formulate a care and treatment plan. It was the Registrant who had the overall OT responsibility for all service users on the Unit. She also told the Panel about the requirement upon the whole care team to keep notes on the Trust’s electronic data recording system known as RIO, and about her performance review meetings with the Registrant on 4 December 2013, 7 February 2014 and 7 March 2014. KG also explained how it had been agreed that the Registrant could work her daily 7.5 hours flexi-time between 8am and 6pm to accommodate the Registrant’s health condition.

8. KG refuted the assertion made by the Registrant in her representations sent by email to the HCPC dated 22 April 2015 that she had treated the Registrant in a bullying way, She told the Panel that she considered that she had put considerable effort into supporting the Registrant in a positive way.

9. SW, Team Coordinator in the Trust’s Early Intervention Psychosis Team in 2010, gave oral evidence. He confirmed the contents of his witness statement dated 27 August 2015 regarding his conducting a Trust investigation regarding the Registrant’s involvement in the rehoming of service user A’s horse in April 2010, which had followed service user A’s complaint to the Trust shortly afterwards.

10. Mr Mansell submitted that there was sufficient evidence for the Panel to find all the Particulars of the Allegation proved on the balance of probabilities, including the dishonesty alleged in Particular 14 of the Allegation.

11. The Panel accepted the advice of the Legal Assessor, and carefully considered all the oral and documentary evidence, the submissions of Mr Mansell and the representations of the Registrant. The Panel bore in mind that the burden of proof rested at all times on the HCPC and the standard of proof required was on the balance of probabilities.
Particular 1a – found proved

12. The Panel accepted the evidence of KG, whom the Panel found to be a balanced, consistent and credible witness who was trying in her evidence to be fair, for instance, acknowledging there had been improvement at times in the Registrant’s performance after supervision. KG had told the Panel, which the Panel accepted, that it was the Registrant who entered the date of her assessment of a service user on the RIO system, but it was the RIO system which automatically inputted the date and time of the Registrant’s entry of the note on the system.

13. The Panel had seen a copy of the RIO entry and, accordingly, the Panel accepted that the assessment for Service User 1 was not completed by the Registrant until 9 January 2014 for Service User 1 who had been admitted onto the Unit on 28 June 2013.

Particular 1b – found proved

14. For the same reasons as in Particular 1a above the Panel accepted that the Registrant had not recorded the 9 January 2014 assessment until 5 February 2014.
Particular 1c – found proved

15. The Panel considered the copy of the assessment and accepted KG’s evidence that the assessment was inadequate because none of the comment boxes had been completed by the Registrant to explain the ratings given by the Registrant.
Particular 1d – found not proved
 
16. The Panel rejected Mr Mansell’s submission on the meaning of this allegation was to exclude the beginning and end dates alleged. The Panel considered that the ordinary meaning was that it was alleged that there was no contact in the whole period alleged i.e. the beginning and end dates were to be included. The Panel concluded the ordinary meaning to be inclusive after considering other examples – the museum is open between Monday and Friday, and choose a number between 1 and 10. The Panel took into account the public interest of its duty to protect service users and its duty to ensure fairness in proceedings of this type.

17. There is a recorded contact with Service User 1 on the RIO system made by the Registrant on 27 November 2013 so, accordingly this allegation was not proved.
Particular 1e(i) – found not proved

18. The Panel has considered the care plan and has noted that the Registrant has recorded interventions on 10 July 2013, 7 August 2013, 29 August 2013, 30 August 2013, 3 October 2013, 4 October 2014, 8 October 2013, 17 October 2013, 18 October 2013, 27 November 2013 and 27 February 2014. Given those interventions the Panel considered that there was a lack of evidence from KG as to the insufficiency of these interventions to achieve the care plan goals.
Particular 1e(ii) – found not proved

19. The Panel concluded that some of the recorded interventions were personalised and/or linked to the care plan goals. For instance, that on 18 October 2013 related to service user 1’s involvement in the baking group and the use of her right shoulder.
Particular 2a – found proved

20. Service User 2 was admitted onto the Unit on 8 April 2013 and the assessment was not completed until 27 January 2014.
Particular 2b – found proved

21. The Registrant’s own notes in RIO show that she did not record the assessment until 5 February 2014.
Particular 2c – found proved

22. The Panel considered the copy of the assessment and accepted KG’s evidence that the assessment was inadequate for a vulnerable service user, because none of the comment boxes had been completed by the Registrant to explain the ratings given by the Registrant.
Particular 2d – found not proved

23. There was a recorded contact on 13 March 2014 so, for the same reasons as in particular 1d above, this allegation was not proved.
Particular 2e - found not proved

24. Accordingly, as the assessment was recorded as having taken place on the first of the dates alleged, 27 January 2014, the allegation was not proved.
Particular 2f(i) – found not proved

25. The Panel heard from KG that there were “minimal contacts” recorded in respect of this service user. Given that there are several interventions made by the Registrant recorded on RIO, the Panel considered there was a lack of evidence as to their insufficiency.
Particular 2f(ii) – found not proved

26. Some of the recorded interventions on RIO made by the Registrant in respect of this service user were personalised and linked to the care plan goals e.g. 11 February 2014 and 13 March 2014.
Particular 3a - found proved

27. Service User 3 was admitted to the Unit on 27 September 2013 but the Registrant did not complete an assessment until 30 January 2014 according to her own note on RIO.
Particular 3b – found proved

28. The Registrant’s own note on RIO shows that the Registrant did not record the assessment until 6 February 2014.
Particular 3c – found proved

29. The Panel considered the copy of the assessment and accepted KG’s evidence that the assessment was inadequate for a vulnerable service user, because none of the comment boxes had been completed by the Registrant to explain the ratings given by the Registrant.
Particular 3d – found not proved

30. There was a recorded contact on both 30 December 2013 and 27 January 2014 so, accordingly, this allegation was not proved for the reasons set out under Particular 1d above.
Particular 3e(i) and (ii) – found not proved

31. The Panel consider the Registrant’s RIO entries for 15 October 2013, 18 October 2013, 30 December 2013 and 27 January 2014, The Panel considered that these were personalised interventions and linked to service User 3’s care plan goals, which had not been established by the HCPC evidence to be insufficient.
Particular 4a – found proved

32. Service User 4 was admitted to the Unit on 6 January 2014 but the Registrant did not complete an assessment until 29 January 2014 according to her own note on RIO.
Particular 4b – found proved

33. The Registrant’s own note on RIO shows that the Registrant did not record the assessment until 5 February 2014.
Particular 4c – found proved

34. There is no record on RIO of any contact by the Registrant with Service User 4 between 5 February 2014 and 14 April 2014.
Particular 4d(i) and (ii) – found not proved

35. The Registrant involved Service User 4 in the breakfast club on 7 January 2014. The Panel considered that there was a lack of HCPC evidence to establish either the insufficiency of interventions, or the lack of personalisation and lack of link to the care plan goals alleged.
Particular 5a – found proved

36. The Panel considered the copy of the assessment and accepted KG’s evidence that the assessment was inadequate for a vulnerable service user, because none of the comment boxes had been completed by the Registrant to explain the ratings given by the Registrant.
Particular 5b – found not proved

37. The Registrant recorded contact with Service User 5 on 13 March 2014 so, accordingly, this allegation was not proved for the reasons set out under Particular 1d above.
Particulars 5c(i) and (ii) – found not proved
38. The Panel noted that the Registrant had recorded contact with Service User 5 on 31 January 2014, 5 February 2014, 11 February 2014 and 4 March 2014
Particular 6a – found proved

39. The Panel considered the copy of the assessment and accepted KG’s evidence that the assessment was inadequate for a vulnerable service user, because none of the comment boxes had been completed by the Registrant to explain the ratings given by the Registrant.
Particular 6b – found not proved

40. The Registrant recorded contact with Service User 6 on 13 March 2014 so, accordingly, this allegation was not proved for the reasons set out under Particular 1d above.
Particulars 6c(i) and (ii) – found not proved

41. The Panel considered Service User 6’s care plan and the Registrant’s interventions recorded by her on 4 and 13 March 2014 together with KG’s evidence that another OT carried out some interventions with Service User 6. The HCPC evidence therefore did not establish that the Registrant’s interventions were either insufficient or not personalised or linked to the care plan goals.
Particular 7a – found proved

42. The Panel was satisfied that there was no evidence that the Registrant had made any assessment of Service User 7.
Particular 7b – found proved

43. The Panel was satisfied that there was no note in RIO of any contact made by the Registrant about Service User 7 between Service User 7’s admission on to the Unit on 4 February 2014 and his leaving the Unit on 20 March 2014.
Particular 7c(i) and (ii) – found proved

44. The care plan required support of the OT, in this case the Registrant, within 4 weeks of 19 February 2014. The Registrant failed to provide any contact which was insufficient and not personalised or linked to the care plan goals.
Particular 8a – found proved

45. Service User 8 is recorded as having been admitted under a diagnosis of schizophrenia. The Panel considered the copy of the assessment and accepted KG’s evidence that the assessment was inadequate for this vulnerable service user, because none of the comment boxes had been completed by the Registrant to explain the ratings given by the Registrant.
Particular 8b – found not proved

46. Contact by the Registrant is recorded on 7 February 2014 and 13 March 2014 so, accordingly, this allegation was not proved for the reasons set out under Particular 1d above.
Particular 8c - found not proved

47. Contact by the Registrant is recorded on 13 March 2014 so, accordingly, this allegation was not proved for the reasons set out under Particular 1d above.
Particulars 8d(i) and (ii) – found not proved

48. The Panel considered Service User 8’s care plan and determined that the commencement date for the 4 weeks referred to in it could not be ascertained. It could therefore not be proved that the 2 interventions by the Registrant with Service User 8 were either insufficient or not personalised or linked to the care plan goals.
Particular 9a – found proved

49. There was no record of an assessment being made by the Registrant of Service User 9.
Particular 9b - found not proved

50. There was a record on RIO of contact between the Registrant and Service User 9 on 13 March 2014 so, accordingly, this allegation was not proved for the reasons set out under Particular 1d above.
Particulars 9c(i) and (ii) – found not proved

51. The Panel considered the RIO entries for 17 February 2014, 3 March 2014 and 13 March 2014 of interventions by the Registrant. It noted that Service User 9 is recorded as not wanting to come out of her room. KG’s evidence was that Service User 9 had a long-standing diagnosis of paranoid schizophrenia with predominantly negative symptoms which impacted on her engagement with professionals. In these circumstances, the Panel was not satisfied on the evidence that the Registrant’s interventions were insufficient or not personalised or linked to Service User 9’s care plan goals.
Particular 10a - found proved

52. There was no record of an assessment being made by the Registrant of Service User 10.
Particular 10b – found proved

53. The Panel was satisfied that there was no note in Rio of any contact between the Registrant and Service User 10 between Service User 10’s admission on to the Unit on 9 March 2014 and the Registrant’s last day at work on 14 April 2014.
Particular 11a – found proved
54. There was no record of an assessment being made by the Registrant of Service User 11.
Particular 11b – found proved

55. There are no OT goals set out in Service User 11’s care plan. The Panel accepted KG’s evidence that this was the Registrant’s responsibility but the Registrant did not see Service User 11 at all between her admission on 11 March 2014 and 7 April 2014.
Particular 11c – found proved

56. The Panel was satisfied that there was no contact between the Registrant and Service User 11 between 11 March 2014 and 7 April 2014.
Particular 12 – found proved

57. The Panel has seen the Registrant’s email dated 5 February 2014 timed at 18:29 saying “Leaving”. The Panel has also seen the 5 entries on RIO that same day timed between 19:31 and 19:57 when the Registrant recorded the 5 assessments. The Panel accepted the evidence of KG that her supervision of the Registrant with regard to her time-management during her flexible hours between 8:00am and 6.00pm had led to the Registrant agreeing to email KG each day when she was starting and finishing work. The agreement had been reached subsequent to the first performance review meeting on 7 December 2013, but not formally recorded until the review on 7 February 2014. This is corroborated by the very fact that the Registrant sent the email to KG on 5 February 2014. The Registrant must have remained at work, though, because she only had access to the RIO system whilst at work.
Particular 13 – found proved

58. The Panel has seen the Registrant’s email dated 6 February 2014 timed at 18:32 saying “Leaving”. The Panel has also seen the 4 entries on RIO that same day between 18:47 and 19:31. This was therefore found proved.
Particular 14 – found not proved
 
59. The Registrant knew that she was to have a second performance review on 7 February 2014 and, it is clear that she knew that she was very behind in recording her assessments of service users which would be covered in that review. There is plenty of evidence that the Registrant had poor time management for a prolonged period. In these circumstances, although the Panel has not had any evidence from the Registrant, the Panel infers that the Registrant would naturally have been panicking knowing that she was not up to date with her assessment recording during her normal working hours. In this situation, the Panel concluded that staying late on the two evening preceding the review and entering up assessments that were overdue, would not be regarded as dishonest behaviour by ordinary and honest OTs. The Panel’s view was that an OT would find this behaviour understandable and not culpable in the context of someone with poor time-keeping and organisational skills, who was anxious about her forthcoming performance review and was not up to date with her records. This being so, the allegation of dishonesty could not be established.
Particular 15 – found proved

60. Service User A was not an inpatient at the time and the Registrant was not her OT, but she had been involved in Service User A’s care on a number of previous occasions. The Registrant also knew Service User A because they both had horses liveried at the same stables. The Panel considered the Registrant’s own account given on 1 September 2010 to the Trust’s investigation officer, SW. The Registrant understood from a note left for her at the Unit by Service User A, followed by a telephone call, that Service User A wanted to rehome her horse as she felt she could not look after it properly. It seems that this was not Service User A’s first such request, but previously the Registrant had refused to help.

61. The Registrant did ascertain from a medical professional that Service User A had capacity to act, but was not able to discuss any possible involvement in this rehoming with her line manager or Service User A’s care coordinator, because both were on leave. Despite this, the Registrant arranged the sale of the horse to a friend of hers, and the Panel has seen the bill of sale of Service User A’s horse for £20 to that friend of the Registrant dated 9 April 2010. The Registrant informed both the Crisis Team and ward staff of this.

62. Service User A had soon decided that she was upset by the sale and wanted the horse returned. Service User A complained in writing to the Trust about the Registrant’s involvement at a time when Service User A considered herself vulnerable and emotional. Service User A later told SW that she was so upset she had attempted to commit suicide. A return of the horse to Service User A was achieved by negotiation with the Registrant’s friend.

63. The Panel is satisfied that the Registrant’s involvement with the rehoming of Service User A’s horse, however well-intentioned, was a failure to act in Service User A’s best interests and a failure to maintain proper professional boundaries between an OT and a vulnerable service user.
Particular 16 – found proved
 
64. The Registrant’s own notes entered on RIO at 16:32 on 4 November 2013 record that Service User repaid £20 from his benefits to the Registrant which he owed her, and the Registrant records the repayment of a further £5 to another staff member. KG had told the Panel that staff knew that they should not lend money to service users, instead they should use the Unit’s emergency fund and properly document each transaction. KG added that because the service users were vulnerable it was very important for the proper procedures to be followed.

65. The Panel accepted KG’s evidence and determined that the Registrant had failed to keep proper professional boundaries by lending Service User B £20 and then receiving repayment of that £20.
Interim Order (following findings on fact):
   
66. Mr Mansell submitted that in the light of the facts found proved, although the further stages of the hearing needed to be adjourned because the allocated hearing time has been exhausted, the HCPC made no application for an interim order.

67. The Panel took into account the HCPC’s Practice Note “Interim Orders” September 2015 and accepted the advice of the Legal Assessor.

68. The Panel determined that because of the Registrant’s lack of insight there was a real risk of repetition of the misconduct. There was therefore a need for an order both to protect the public and otherwise being in the public interest to maintain confidence in the profession. The Panel determined that an Interim Conditions of Practice Order would not be sufficient due to the lack of engagement of the Registrant in this hearing or previous indication of willingness to abide by conditions. The Panel therefore determined to make an Interim Order of Suspension for 18 months.

Interim Order: The Registrar is directed to suspend the name of Mrs Amy L Mawson from the Register on an interim basis for a period of 18 months.

Right to Apply to the Court:
Under Article 31(12) of the Health and Social Work Professions Order 2001, you may apply to the appropriate court to terminate the order.


At the reconvened hearing on 13 April 2016:

Decision on Grounds:

69. Mr Mansell submitted on 20 November 2015 that if the facts were proven they demonstrated both matters of lack of competence and of misconduct sufficient to call into question the Registrant’s fitness to practise.

70. The Panel carefully considered all the evidence about the circumstances of the proven facts and the Registrant’s own submissions contained in her email to the HCPC dated 22 April 2015 in which she said she considered that she struggled at work, not through lack of ability, but because of her health.

71. The Panel first considered whether any of the proven facts in Particulars 1 to 16 amounted to misconduct. The Panel accepted the Legal Assessor’s advice that the misconduct had to be serious in order for it to call into question the Registrant’s fitness to practise.

72. The Panel took account of, and placed reliance on, KG’s oral evidence where her opinion was that the Registrant was aware of what was expected of her, but repeatedly failed to do this. The Panel accepted KG’s evidence that the Registrant was a very bright lady with a lot of skills, knew what to do, but just did not do it. She further told the Panel that the Registrant found it difficult to balance her personal and work commitments. The Panel took into account all the evidence about the high level of support that the Registrant had received in regular supervision, and the enhanced supervision, dating from 2010. Having seen KG give her evidence, the Panel rejected the Registrant’s suggestion that KG’s supervision had amounted to bullying and harassment of the Registrant: it was the complete opposite.

73. After careful consideration of all the evidence, the Panel determined that the proven facts set out below amounted to serious breaches of the HCPC’s applicable standards 1, 7 and 10 as set out in “Standards of conduct, performance and ethics” 2008 and amounted to misconduct.

• 1 - You must act in the best interests of service users.

• 7 - You must communicate properly and effectively with service users and other practitioners.

• 10 - You must keep accurate records.

74. The relevant proven facts which amount to misconduct are those in Particulars:
1a, 1b, 1c, 2a, 2b, 2c, 3a, 3b, 3c, 4a, 4b, 4c, 5a, 6a, 7a, 7b, 7c(i), 7(c)(ii),8a, 9a, 10a, 10b, 11a, 11b,11c, 15 and 16.

75. With regard to the ground of lack of competence, the Registrant had been in post on the Unit at the Trust as an OT for 10 years (at the relevant time she was a Band 6 OT). The Panel accepted the evidence of KG that the Registrant knew what to do, but just did not do it. In these circumstances, the Panel determined that there was no proven lack of competence.
Decision on impairment:
 
76. The Panel went on to consider whether the Registrant’s fitness to practise was currently impaired by reason of her misconduct as determined above. In so doing it carefully considered all the evidence, the submissions of Mr Mansell, the representations of the Registrant in her email of 22 April 2015, and the HCPC’s Practice Note “Finding that Fitness to Practise is ‘Impaired’” July 2013.

77. The Panel first considered what is termed the personal component in the HCPC’s Practice Note. The Panel considered that the Registrant’s representations dated 20 April 2015 showed little insight into her wide-ranging misconduct. The Panel accepted KG’s evidence that the Registrant was never dishonest about her shortcomings, but the Registrant always felt it was more the Trust’s issue than her own. KG had also told the Panel that the Registrant had insight into the effect it had on service users and on the reputation of the profession. KG had said: “I don’t think she ever took the performance management very seriously.”

78. In considering remediation, there was no evidence before the Panel from the Registrant to demonstrate her addressing any of those misconduct issues. The Panel accepted KG’s evidence that the Registrant had “completely given up at the end…by her own admission she had not done any work…” The Registrant has not engaged recently with the HCPC to provide any up to date evidence of remediation, for example, further relevant training, a written reflection, references and testimonials from any work undertaken since the incidents.

79. In all these circumstances, the Panel concluded that there was a real risk of repetition of the misconduct issues. These involved the failure to undertake assessment of some vulnerable service users for months on end in contravention of the Trust’s requirement for assessments to be completed within two weeks of admission onto the Unit. An assessment is an integral part of occupational therapy. The Registrant failed to promptly record the assessments she did, in contravention of a requirement to record them within 24 hours. Many of the assessments recorded have been found to be incomplete because of the absence of her justification for the ratings. The Panel concluded that the Registrant was aware of the expectations of her in her role, but consciously failed to undertake these tasks in a timely and proper manner. Any repetition could have a serious impact on service users. The Panel accepted KG’s evidence that “anything that delays anyone’s care pathway is obviously slowing their time to discharge.”

80. In addition, there is the issue of not maintaining proper professional boundaries which occurred twice. The Panel considered the lending and receiving of money in respect of Service User B in November 2013, to be aggravated by the fact that the Registrant had already had the issue of maintaining professional boundaries highlighted.

81. In 2010 there was the incident about rehoming Service User A’s horse. The Panel considered that there must be a real risk of repetition of this type of misconduct and any repetition could have a serious impact on service users.

82. In her oral evidence KG stated that the Registrant was remorseful over the allegation concerning the rehoming of the horse, but the Registrant felt that she had acted in Service User A’s best interests. However, in these circumstances, the Registrant should have contacted Service User A’s care coordinator. The Panel accepted SW’s oral evidence that this incident was a traumatic experience for Service User A. In respect of the lending and receiving of money concerning Service User B, the Panel accepted KG’s oral evidence that the Registrant struggled to see why this was wrong.

83. As regards the public component, the Panel recognised that the misconduct was wide-ranging and concerned fundamental aspects of OT work. As such, not to find impairment risked the undermining of public confidence in the profession and would amount to a failure on the part of the Panel to appropriately declare and uphold proper standards of conduct for OTs.

84. Accordingly, the Panel determined that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction:

85. Ms Thompson submitted that, in accordance with the HCPC’s “Indicative Sanctions Policy” September 2015, because of the Registrant’s lack of insight, the extent of the misconduct over a considerable period of time, and the risk of repetition of the misconduct it was not appropriate to take no further action; otherwise the matter of sanction was a judgement decision for the Panel.

86. The Panel fully reviewed its findings and earlier determinations set out above. It bore in mind, as advised by the Legal Assessor, the guidance in the “Indicative Sanctions Policy” September 2015.  The purpose of a sanction is not to punish the Registrant, but to protect the public and the wider public interest. Further, in imposing any sanction, the Panel should exercise the principle of proportionality, so that it only imposes the minimum sanction necessary to achieve the requisite protection of the public and the public interest in this particular case.

87. The Panel considered that there were a number of aggravating features;

• The failure to respect professional boundaries occurred twice, the second time occurred despite retraining after the first occasion.

• The repeated failures in completing and recording of assessments gave rise to the risk of harm to this group of service users. Service users were deprived of engagement with relevant services and as a consequence there were potential delays in their discharge.

• All the service users involved were particularly vulnerable.

• There was actual emotional harm to Service User A.

• The Registrant’s failures affected the reputations of the Trust and the profession.

88. There were several mitigating factors identified by the Panel:

• The Registrant had shown some insight by admitting her shortcomings whilst still at the Trust and initially engaging in this regulatory process

• The Registrant, although misguided, had clearly been motivated by good intentions in her actions regarding the rehoming of Service User A’s horse

• The Registrant had had to cope with health issues.

89. The Panel first concluded that to take no action, mediation or to make a caution order, would be wholly inappropriate and inadequate given the wide-ranging misconduct of an OT towards the care of service users, and the proper observance of professional boundaries involving two vulnerable service users.

90. The Panel next considered a conditions of practice order, but concluded that there were no suitable and workable conditions that could drafted at the present time to sufficiently protect the public from the risks posed by repetition of the misconduct. The Trust had already provided the Registrant with extensive and supportive supervision and retraining at the relevant time, but that had not achieved remediation of the shortcomings which had continued during that employment. The Panel was also influenced by the lack of up-to-date engagement of the Registrant in the regulatory process, and the absence of any current expression of willingness to comply with a conditions of practice order.

91. The Panel moved on to consider a suspension order. The Panel considered that the proven deficiencies in the Registrant’s practice were remediable. The Panel also considered that a suspension order would achieve public protection and meet the wider public interest of upholding professional standards and the reputation of the profession. It took account of paragraph 34 of the HCPC’s “Indicative Sanctions Policy” which indicates that a suspension order may be suitable where there are no psychological or other difficulties preventing the Registrant from understanding and seeking to remedy the identified failings. The Panel had not received any evidence to counter this.

92. The Panel therefore concluded that a suspension order would be a sufficient, and an appropriate, sanction in this case.

93. The Panel determined that the appropriate duration of the suspension order would be 12 months. This period would enable the Registrant to take steps to remediate the identified shortcomings in her practice.

94. Towards the end of that 12 month period, the suspension order will be reviewed. That review Panel may be assisted by evidence of relevant training or other steps taken to remediate the Registrant’s recognition of proper professional boundaries and compliance with the requirements for the proper completion and recording of assessments. A reflective log completed by the Registrant may also assist that review Panel.

Order

That the Registrar is directed to suspend the Registration of Amy L Mawson for a period of 12 months from the date this order comes into effect.

Notes

Right of appeal:
You may appeal to the appropriate court against the decision of the Panel and the order it has made against you.  In this case the appropriate court is the High Court in England and Wales.
Under Articles 29 and 38 of the Health and Social Work Professions Order 2001, an appeal must be made to the court not more than 28 days after the date when this notice is served on you.  The order made against you will not take effect until that appeal period has expired or, if you appeal during that period, until that appeal is disposed of or withdrawn.
Application for an Interim Order to cover the appeal period:
Ms Thompson submitted that in the light of the Panel’s decision to impose an order of suspension, the HCPC applied for the question of an interim order to be considered by the Panel to cover the period before the substantive order of suspension took effect
The Panel took into account the HCPC’s Practice Note “Interim Orders” September 2015 and accepted the advice of the Legal Assessor.
The Panel determined that because of its finding that there was a risk of repetition of the misconduct which posed a risk to the public, there was a need for an interim suspension order, both to protect the public and otherwise being in the public interest to maintain confidence in the profession. The Panel determined that an Interim Suspension Order would be for a period of 18 months.
Interim Order:
The Panel makes an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.  This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

 

Hearing history

History of Hearings for Amy L Mawson

Date Panel Hearing type Outcomes / Status
04/01/2018 Conduct and Competence Committee Review Hearing Struck off
31/03/2017 Conduct and Competence Committee Review Hearing Suspended
13/04/2016 Conduct and Competence Committee Final Hearing Suspended