Mr Steven H Knowles

: Operating department practitioner

: ODP12930

: Final Hearing

Date and Time of hearing:10:00 03/03/2017 End: 17:00 03/03/2017

: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Suspended

Allegation

Allegation (as amended at the outset of this hearing):

Between 17 December 2014 and 6 January 2015, during the course of your employment as an Operating Department Practitioner by Sherwood Forest Hospitals, NHS Foundation Trust you:

1. Posted inappropriate and/or offensive comments on social media in that;

a. 17 December 2014 - "you as a local paper are totally oblivious to the fact that your hospital Is (if not already) near the brink of total melt down! (Tweet to Mansfield Chad paper)

b. 17 December 2014 - "Staffing levels are so low that it's effecting staff health! Some staff are doing in some cases 24 hours! I hope you really suffer Hunt!” (Tweet)

c. 18 December 2014 - "Hunt are you so retarded you allow this to happen! I will gladly put a bullet through your head!" (Tweet to Jeremy Hunt).

d. 18 December - "Hunt you are a murderer and I would gladly blow your brains out" (Tweet).

e. 20 December 2014 - "Dear Santa, please could you inflict some health problem on the HUNT family, just so that they could wait MORE THAN 4H0URS ON A TROLLEY" (Tweet).

f. 6 January 2015 - "Why is Kings Mill Hospital on black alert?" (Tweet)

2. The matters described in paragraph 1 constitute misconduct.

3. By reason of your misconduct, your fitness to practise is impaired.


 

Finding

Preliminary Matters:

Amendment:

1. At the outset of the hearing, Ms Chaker, on behalf of the HCPC, made an application to amend the allegation as set out above and offer no evidence in relation to 1a. The Registrant  had been notified of Ms Chaker’s application by letter dated 10 September 2015. Ms Chaker submitted that allegation 1a was repeated in 1c and that the proposed amendments brought clarity to the HCPC’s case. On behalf of the Registrant , Mr Clayton did not object to the application. The Panel agreed with Ms Chaker’s submissions and decided the Registrant  would suffer no injustice or prejudice if the amendments were made.

Proceeding in Private:

2. The Panel wished to ask questions of Witness 1 (during her evidence) and the Registrant  (during his evidence), which related to the Registrant ’s health. The Panel heard submissions from Ms Chaker and Mr Clayton and accepted the advice of the Legal Assessor. The Panel accepted that there is a presumption that the hearing should take place in public.  However, it accepted Mr Clayton’s submission that those parts of Witness 1’s evidence and those parts of the Registrant ’s evidence, which referred to his detailed health conditions, should be heard in private, in order to protect his private life. The Panel therefore heard those parts of the evidence which related to the Registrant ’s detailed health conditions in private.

Proceeding in Absence on 20 December 2016:
3. The Registrant  was unable to attend the hearing in person or by telephone, on 20 and 21 December 2016. Mr Clayton explained to the Panel that the Registrant  was under severe financial pressures. The Panel agreed, in those circumstances, that it would receive written submissions from Mr Clayton in relation to Stage 1 and Stage 2 on 20 December. Ms Chaker provided Mr Clayton with her written submissions in draft form electronically on 19 December and Mr Clayton provided written submissions to the Panel electronically on 20 December 2016. The Panel accepted the advice of the Legal Assessor. The Panel exercised its discretion to proceed in the absence of the Registrant  with the utmost care and caution. The Panel’s overriding concern was to ensure that the hearing, if conducted in the absence of the Registrant , would be as fair as circumstances permitted and lead to a just outcome. The Panel concluded that the Registrant  had voluntarily absented himself from the hearing on 20 and 21 December and had waived his right to appear. The Panel also concluded that in all the circumstances the Registrant  would not be at a disadvantage as he had given his evidence on 19 December in respect of Stage 1 and Stage 2 and Mr Clayton had provided full written submissions on the Registrant ’s behalf. The panel concluded that it was in the public interest and in the interests of the Registrant  to proceed in his absence. 
  


Background:

4. The Registrant  was employed as an Operating Department Practitioner (Band 5) at Kings Mill Hospital, by Sherwood Forest Hospitals, NHS Trust (the ‘Trust’) on 5 October 2005. 

5. The Panel carefully scrutinised all the written and oral evidence adduced on behalf of the HCPC, the Registrant ’s written statement in the form of an email dated 16 March  2015, prepared in respect of the Trust’s investigation, and his oral evidence he gave on 19 December 2016.

6. Before the Panel sets out its findings of fact, the Panel wishes to state for the avoidance of doubt that it had regard to following matters:-

(1) The burden of proof is on the HCPC to prove the allegations to the requisite civil standard, namely the balance of probabilities. There is no burden on the Registrant  to disprove the allegations.

(2) The Panel has considered each matter separately.

(3) Five admissions were made in respect of the particulars in this allegation by the Registrant . The Panel considered those admissions. For the avoidance of doubt, the Panel has, in addition, scrutinised all the evidence before it and the Panel based its findings on the oral and written evidence adduced on behalf of the HCPC.

7. The Panel heard oral evidence from one witness on behalf of the HCPC;

• SB, Investigating Officer;

8. SB, provided a written statement. SB, at the relevant time, was the Acting Matron for General Surgery and Orthopaedics at the Trust and carried out an investigation into this matter. The Panel found SB to be impartial, fair-minded, consistent, reliable and credible. In particular, the Panel accepted SB’s evidence about the clinical qualities of the Registrant . In summary, she stated that the Registrant  was an excellent practitioner and she would have been content to be taken care of by him.
9. The Panel considered carefully the oral and written evidence of the Registrant  who gave evidence on oath. The Panel found the Registrant  to be honest in his evidence and concluded that he did his best to assist the Panel. Nevertheless, the Panel found that he struggled to give clear and direct answers to some of the questions asked of him.
10. The Panel therefore decided to retire and consider whether the alleged facts had been proven to the requisite standard and if so, whether the allegation was well founded.
 
Decision on Facts:
Particular 1a-Proved
Between 17 December 2014 and 6 January 2015, during the course of your employment as an Operating Department Practitioner by Sherwood Forest Hospitals, NHS Foundation Trust you:

I. Posted inappropriate and/or offensive comments on social media in that;

a. 17 December 2014 - "you as a local paper are totally oblivious to the fact that your hospital Is (if not already) near the brink of total melt down! (Tweet to Mansfield Chad paper)
11. The Panel found the fact of this particular proven to the requisite standard. The Panel had sight of a copy of this tweet, posted from the Registrant ’s twitter account. The Panel accepted the Registrant ’s admission in respect of Particular 1a. The Panel found this tweet to be inappropriate in all the circumstances. The Panel accepted the evidence from SB that a member of the public and in particular, a patient about to be admitted to the hospital, would lose confidence in the Trust if they had seen this tweet. The Panel also accepted the evidence from SB that the tweets could be identified as coming from an employee within the Trust.

Particular 1b Proved
b. 17 December 2014 - "Staffing levels are so low that it's effecting staff health! Some staff are doing in some cases 24 hours! I hope you really suffer Hunt!” (Tweet)

12. The Panel found the fact of this particular proven to the requisite standard. The Panel had sight of a copy of this tweet, posted from the Registrant ’s twitter account. The Panel accepted the Registrant ’s admission in respect of Particular 1b. The Panel found this tweet to be inappropriate and offensive in all the circumstances. In addition, the Panel found this tweet to be threatening. The Panel also accepted the evidence from SB that a member of the public and in particular, a patient about to be admitted to the hospital, would lose confidence in the Trust if they had seen this tweet.
Particular 1c-Proved
18 December 2014 - "Hunt are you so retarded you allow this to happen! I will gladly put a bullet through your head!" (Tweet to Jeremy Hunt).
13. The Panel found the fact of this particular proven to the requisite standard. The Panel had sight of a copy of this tweet, posted from the Registrant ’s twitter account. The Registrant  contended that he was not the author of this tweet, but that he had ‘retweeted’ the tweet. The Panel found his action, namely retweeting the tweet, to be inappropriate and offensive. The Panel also found this tweet to be threatening.
Particular 1d-Proved
18 December - "Hunt you are a murderer and I would gladly blow your brains out" (Tweet).
14. The Panel found the fact of this particular proven to the requisite standard. The Panel had sight of a copy of this tweet, posted from the Registrant ’s twitter account. The Panel accepted the Registrant ’s admission in respect of Particular 1d. The Panel found this tweet to be inappropriate and offensive. In addition, the Panel also found this tweet to be threatening.
Particular 1e-Proved
20 December 2014 - "Dear Santa, please could you inflict some health problem on the HUNT family, just so that they could wait MORE THAN 4H0URS ON A TROLLEY" (Tweet).
15. The Panel found the fact of this particular proven to the requisite standard. The Panel had sight of a copy of this tweet, posted from the Registrant ’s twitter account. The Panel accepted the Registrant ’s admission in respect of Particular 1d. The Panel found this tweet to be inappropriate and offensive in all the circumstances. The Panel accepted the evidence from SB that a member of the public and in particular a patient, would lose confidence in the Trust if they had seen this tweet. In addition, the Panel found this tweet to be threatening.
Particular 1f-Proved
6 January 2015 - "Why is Kings Mill Hospital on black alert?" (Tweet)
16. The Panel found the fact of this particular proven to the requisite standard. The Panel had sight of a copy of this tweet, posted from the Registrant ’s twitter account. The Panel accepted the Registrant ’s admission in respect of Particular 1f. The Panel considered this tweet in the context of the previous tweets and that it was inappropriate for the Registrant  to tweet in this particular fashion. 
Decision on Grounds:
17. The Panel heard oral evidence from the Registrant  at the same time as he gave evidence as to Stage 1. The Panel found the Registrant ’s oral evidence once more to be honest, although the Panel found that he still struggled to give clear and direct answers to some of the questions asked of him.
18. After reading the written submissions from Ms Chaker and hearing her oral submissions and reading the written submissions from Mr Clayton, the Panel went on to consider whether the allegation is well founded. The Panel adopted the following approach, namely:
• whether the proven facts amount to misconduct as far as the Registrant  is concerned;
• The issue of misconduct is a matter entirely for the Panel to consider, exercising its professional judgement. At this stage in the proceedings, the issue of proof does not arise.
1. For the avoidance of doubt, the Panel has considered once more each particular separately.
2. The Panel accepted the advice of the Legal Assessor.

3. The Panel applied the following general legal principles as far as misconduct is concerned:-

(a) ‘Misconduct is a word of general effect involving some act or omission which falls short of what would be proper in the circumstances. The standards of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner in the particular circumstances’. Roylance v. GMC [2001] AC 311;

(b) the conduct which falls short must be ‘serious’ or ‘grave’. Doughty v GDC (1987) 3AER 32;

(c) as to seriousness, Collins J, in Nandi v General Medical Council [2004] EWHC (Admin), described it as ‘conduct which would be regarded as deplorable by fellow practitioners’;

(d) the Panel may take a failure to meet the HCPC’s standards into account, but such failure will not be taken of itself to amount to misconduct.

19. The Panel has been careful to examine whether the facts found to be proved, result in the Registrant  failing to meet the HCPC’s Standards of conduct, performance and ethics (2012). In particular, the following standards:-

• 3 - You must keep high standards of personal conduct

You must keep high standards of personal conduct, as well as professional conduct. You should be aware that poor conduct outside of your professional life may still affect someone’s confidence in you and your profession.
• 13 - You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.
You must justify the trust that other people place in you by acting with honesty and integrity at all times. You must not get involved in any behaviour or activity which is likely to damage the public’s confidence in you or your profession.
20. The Panel concluded that these inappropriate and offensive tweets should not have been sent and should have not been put into the public domain. The Registrant  himself agreed that the tweets to Mr Hunt and his family were ‘unsavoury.’ He also conceded he had fallen short ‘in the way the HCPC requires all healthcare professionals to act and be seen in the public eye’. He also conceded that the misconduct ‘constitutes a serious falling short of what would be proper in the circumstances’.
21. The Panel concluded that the Registrant ’s actions are an example of ‘some act or omission which falls short of what would be proper in the circumstances’. (per Lord Clyde in Roylance above). The Panel found that the evidence disclosed that both Standards, set out above, were not met.
22. The Panel concluded therefore that the Registrant ’s omissions amounted to misconduct, which was serious and would be regarded as deplorable by fellow practitioners.
Decision on Impairment
23. The Panel went on to consider the question of current impairment, namely whether the Registrant ’s fitness to practise is impaired, by reason of his misconduct. For the avoidance of doubt, the Panel had regard to the following matters:
(i) In relation to impairment, the Panel reminded itself that the test of impairment is expressed in the present tense, that fitness to practise ‘is impaired’.
(ii) Whether the Registrant ’s fitness to practise is impaired, by reason of his misconduct, is a matter entirely for the Panel to consider, exercising its professional judgement. At this stage in the proceedings, the issue of proof does not arise.
(iii) The HCPC Practice Note ‘Finding that Fitness to Practise is Impaired’ (July 2013).
(iv) Cohen v GMC [2008] EWHC 581 (Admin), where Silber J at paragraph 65 stated “it must be highly relevant in determining if…fitness to practise is impaired that…first the conduct which led to the charge is easily remediable, second that it has been remedied and third that it is highly unlikely to be repeated”
(v) CHRE v Grant [2011], where Cox J referred at paragraph 76 to Dame Janet Smith’s Fifth Shipman Report, at paragraph 25.67.
Cox J stated that Dame Janet Smith ‘identified the following as an appropriate test for panels considering impairment of a doctor's fitness to practice…
“Do our findings of fact in respect of the doctor's…misconduct…show that …his fitness to practise is impaired in the sense that he:
a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or
b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or
c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession’’
(vi) Kimmance v GMC [2016] EWHC 1808 (Admin), where Kerr J at paragraph 66 stated:-

“There was indeed no evidence of insight and remediation in this case. I do not much like those jargon words. They do not do much to illuminate the reality, which is that a doctor or other professional who has done wrong has to look at his or her conduct with a self-critical eye, acknowledge fault, say sorry and convince a panel that there is real reason to believe he or she has learned a lesson from the experience…..”

(vii) Rule 9 of the Health and Care Professions Council (Conduct and  Competence Committee) (Procedure) Rules 2003 as amended, which provides ‘where the Committee has found that the health professional has failed to comply with the standards of conduct, performance and ethics established by the Council under Article 21(1)(a) of the Order, the Committee may take that failure into account, but such failure will not be taken of itself to establish that the fitness to practise of the health professional is impaired’.

(viii) The advice of the Legal Assessor.


24. In particular, the Panel considered the personal component, namely, the current behaviour of the Registrant  and the public component, namely, the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.
The Personal Component

25. The Panel considered that the Registrant  was showing developing, but not yet mature, signs of insight as far as his misconduct is concerned. The Registrant  was no longer using his twitter account. Although the Registrant  had acknowledged he was at fault and had apologised, the Panel concluded that he had looked at his conduct with only a limited self-critical eye.

26. The Panel concluded that the Registrant ’s conduct is easily remediable but that it had only been partially remedied. Although the Registrant  accepted in oral evidence that he would report immediately to his line manager any future frustrations he may feel whilst working for the NHS and that he would look for support in the future, the Panel could not be satisfied that the Registrant  would not repeat his actions in a similar way. The Registrant  focused primarily on the personal impact his failings had had on him. He did not provide any reflection on the wider implications of his actions, including the threatening language he used in his tweets. The Panel found no evidence of any consideration, on the Registrant ’s part, of the impact these inappropriate, offensive and threatening tweets may have had on Mr Hunt and his family, the public, the Registrant ’s colleagues and the reputation of the Trust.

27. The Panel was therefore not convinced that there was real reason to believe the Registrant  had learned a lesson from the experience.
The Public Component
28. As far as the public component is concerned, the Panel found there had been a breach of the fundamental tenets of the profession. The Panel had particular regard to the observations by Cox J in paragraphs 71 and 74 in Grant (above), namely:

‘71… However it is essential, when deciding whether fitness to practise is impaired, not to lose sight of the fundamental considerations……. namely the need to protect the public and the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession.

74  … In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances’.

29. The Panel found that the Registrant ’s acts in respect of the particulars of the allegation found proved would have impacted on public confidence in the Operating Department Practitioner profession; the public would expect an Operating Department Practitioner not to send inappropriate and offensive tweets which were threatening. Moreover, a finding of current impairment is also required, in order to uphold proper standards of conduct and behavior.

30. For the avoidance of doubt, the Panel placed limited weight on the hearsay evidence adduced on behalf of the HCPC from TJ and DG. The evidence related to the investigation conducted on behalf of the Trust. No statements had been taken from those two witnesses for the purpose of this hearing and the Panel concluded that the Registrant  was unable to cross-examine those witnesses on matters which may have related to the issue of impairment. The Panel concluded it would have been reasonable and practicable for the HCPC to have taken statements from those witnesses and that it would also have been reasonable and practicable to have produced those witnesses to give evidence before the Panel.
31. It follows that the allegation is well founded and the Panel must proceed to consider the issue of sanction.
Decision on Sanction:
32. The hearing reconvened on Friday 3 March 2017 in order to consider sanction.  The Registrant attended the hearing with his partner.  The Panel heard submissions from Ms Chaker for the HCPC and from the Registrant, who also produced a helpful written document.  
33. The Panel considered the Indicative Sanctions Policy of the HCPC and accepted the advice of the Legal Assessor.   The Panel then identified the principal aggravating and mitigating factors in this case before reaching its decision on sanction.
34. The aggravating feature is the extremely offensive nature of the six tweets that were sent or retweeted by the Registrant over the course of four dates (17, 18, 20 December 2014 and 6 January 2015).  The Panel found that the Registrant lacked a full appreciation of the wider impact of these threatening tweets on his intended target, his colleagues and members of the public, or the wider effect of such misconduct on public confidence in the profession.
35. The Panel acknowledged that there were strong mitigating features in this case.  This was a course of conduct that was wholly out of character that the Registrant now profoundly regrets.  He expressed his shame and remorse in the detailed written submission that he put before the Panel.  He has deleted his Twitter account, which reduces the risk of repetition.
36. Although he resigned his position in April 2015, the Registrant told the Panel that he obtained work as an Operating Department Practitioner for another employer for five months. The fact of these proceedings has made it difficult for him to find other similar work from his agency.  He has therefore been working as a lorry driver, but he wishes to return to the profession.   The witness who worked with him at Sherwood Forest Hospitals NHS Foundation Trust was very positive in her praise of his professionalism.  The Panel was also encouraged by the Registrant’s submission that he had given 30 years of his working life to his profession and by his stated commitment to returning to work as an Operating Department Practitioner. The Panel also noted that there had been no previous findings against him.
37. The Panel then considered the various sanctions that are available. The nature of the misconduct is too serious to make no order or to consider mediation.  The Panel considered whether to impose a Caution Order, but decided that it was inappropriate, because this was not one isolated occurrence and there remained concerns as to the Registrant’s level of insight into the wider impact of his misconduct on the public.
38. The Panel then considered carefully whether a Conditions of Practice Order was appropriate or workable, but concluded that such an order is neither workable nor verifiable at this stage.  The Panel acknowledges that the Registrant has made some effort to maintain his professional training, but he has no immediate plans to return to the profession and he is currently employed in other work.  He is also experiencing difficult personal circumstances.  It is not necessary to elaborate on those personal matters here.  The Panel also found that such an order would not meet the gravity of the misconduct.  
39. The Panel therefore concluded that a Suspension Order of 12 months duration was the appropriate and proportionate sanction that best reflects the gravity of the misconduct. The Panel is satisfied that this Order will protect the public and maintain the confidence of the public in the regulator and the profession. 
40. The Registrant’s failings are capable of remedy, so it is not necessary to impose a more severe sanction.  The Panel decided that the sanction of last resort of Striking-Off was unnecessary and disproportionate, bearing in mind the significant mitigating factors and the absence of actual harm to service users.   It was also in the public interest that the Registrant should be able to return to his profession.
41. The Panel considered a future review panel would be assisted by evidence from the Registrant in relation to the following:
a) Evidence of training or other professional development that he has undertaken with a view to eventually returning to his profession.
b) A short written statement reflecting on the negative impact of social media when it is used to target individuals, which shows his understanding of the effect of such conduct on the wider public.
c) Character references in relation to any paid or unpaid employment.

Order

That the Registrar is directed to suspend the registration of Steven H Knowles for a period of 12 months from the date this Order comes into effect.

The Order imposed today will apply from the expiry of the 28 day appeal period on 31 March 2017 (the operative date).

Notes

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 Mr Steven H Knowles

Date Panel Hearing type Outcomes / Status
03/03/2017 Conduct and Competence Committee Final Hearing Suspended