Miss Laura M Tyreman

: Radiographer

: RA52761

: Final Hearing

Date and Time of hearing:10:00 22/05/2017 End: 17:00 25/05/2017

: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Suspended

Allegation

During the course of your employment as a Radiographer at Calderdale & Huddersfield NHS Foundation Trust (CHFT), you:
1. On a date unknown between 2010 and January 2014 you advised CHFT that you had been diagnosed with Leukaemia, when you had not been medically diagnosed with the condition.

2. Did not advise CHFT until 17 August 2015 that you had not been diagnosed with Leukaemia.

3. On or around the following dates you indicated that the reason for your sick leave absence was 'cancer':
i. 5 January 2011;
ii. 12 January 2011;
iii. 24 January 2011;
iv. 2 February 2011;
v. 9 February 2011;
vi. 17 February 2011;
vii. 24 February 2011;
viii. 4 March 2011;
ix. 8 March 2011;
x. 15 March 2011;
xi. 17 March 2011;
xii. 23 March 2011;
xiii. 28 March 2011;and/or
xiv. 31 October 2014.

4. On an unknown date between 2012 and August 2015, you indicated to Colleague B that you were having the following assessments and/or treatment for Leukaemia:
i. bone biopsies; and/or
ii. chemotherapy.

5. On an unknown date between 2012 and August 2015 you indicated to Colleague B that you needed time off following an infection of the cannulation site inserted for bone marrow biopsy.

6. Your actions as described in paragraph 1 - 5 were:
a. misleading; and/or
b. dishonest.

7. The matters set out in paragraphs 1 - 6 constitute misconduct.

8. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary matters
Service
1. The Panel found that there had been good service of the Notice of Hearing by a letter sent to the Registrant’s registered address dated 7 December 2016.

Proceeding in the absence of the Registrant
2. Ms Sheridan made an application for the hearing to proceed in the absence of the Registrant. She referred to an email from the Registrant dated 14 December 2016. This e-mail states:

“I am writing with regard to the above FTP hearing and confirm I will not be attending or calling any witnesses.
Due to financial and employment constraints since my employment in the NHS being terminated I can neither afford four days in London nor have the time off available to me from my new employment, I believe I have submitted all relevant documents and my statements to the panel as earlier requested.
I do not feel I can add anything to my statements and have explained the reasons behind my actions whilst employed with Calderdale and Huddersfield…I do not feel the process to be something I can withstand….”

3. An HCPC case manager replied to the Registrant on 19 December 2016 setting out further information and options available to the Registrant if she wished to attend the hearing. This letter refers to the option of making an application to the Hearings Manager for financial assistance for or towards the cost of travel and accommodation and the option of attending the hearing by telephone.

4. Ms Sheridan informed the Panel that there has been no response and no further communication from the Registrant.

5. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPC Practice Note “Proceeding in the Absence of the Registrant”.

6. The Panel decided to exercise its discretion to proceed in the absence of the Registrant. The Panel carefully considered the Registrant’s e-mail of 14 December 2016 and her lack of response to the HCPC letter setting out options which may be available, and decided that her absence was voluntary. The Registrant has not applied for an adjournment of the hearing. In the Panel’s view an adjournment would not serve any purpose because the Registrant was not likely to attend a hearing at a later date. The Panel also noted that there were three witnesses for the HCPC in attendance and who were expecting to give evidence. The Panel took into account the Registrant’s interests, but decided that they were outweighed by the strong public interest in the expeditious disposal of cases of this nature.

Amendments of the Allegation
7. Ms Sheridan made an application to amend the Allegation in the terms set out in a letter to the Registrant dated 14 June 2016. Ms Sheridan submitted that the amendments are appropriate to reflect more accurately the evidence in the case. Ms Sheridan further submitted that the Registrant communicated with the HCPC after 14 June 2016, but did not comment on the proposed amendments.

8. The Panel was satisfied that there was no unfairness to the Registrant if the amendments were allowed. The Registrant has made no objections and the Panel agreed that the amendments more accurately reflected the evidence. The Panel decided to allow the amendments as set out in the letter dated 14 June 2016.

9. During its deliberations, but prior to its factual determination, the Panel considered the wording of the Allegation and noted the references to “Acute Myeloid Leukaemia”. The Panel identified that the only witness who described the Registrant’s stated condition as “Acute Myeloid Leukaemia” was Colleague B whereas the Registrant had only used the word “Leukaemia” to describe her stated diagnosis.

10. The Panel accepted the advice of the Legal Assessor and decided that it was appropriate to amend Particulars 1, 2, and 4 to delete the words “Acute Myeloid”. Although the Registrant was not aware of this proposed amendment, the Panel was satisfied that there was no unfairness to her in making the amendment. The amendment did not change the essence of the Allegation, the Registrant was not misled, and the Panel concluded that it would be just to make the amendments.

Application for part of the hearing to be heard in private
11. Ms Sheridan made an application for part of the case to be heard in private. This application was limited to the evidence which concerned details of the Registrant’s health condition as set out in the GP notes and included in the Registrant’s representations.

12. The Panel decided that it was appropriate for any details concerning the Registrant’s genuine health condition to be heard in private to protect her private life.

Background
13. The Registrant was employed as a full time Band 5 Radiographer by the Calderdale and Huddersfield NHS Foundation Trust (“the Trust”). The Registrant was based at the Huddersfield Royal Infirmary from 7 August 2006. During 2010, she reported to the Trust that she had been diagnosed with Leukaemia. At that time, she was managed by a Senior Radiographer who has since retired from the Trust (Colleague A). In response to the Registrants reported health condition, the department made a referral to Occupational Health on 14 January 2011.  The initial report from Occupational Health, dated 21 January 2011, recommended adjustments should be made to the Registrant’s working arrangements. A number of adjustments were put into place with immediate effect.
           
14. In May 2012, Colleague B was appointed as Radiology Team Leader and assumed line management responsibility for the Registrant. Colleague B was aware that the Registrant had been diagnosed in 2010 with Leukaemia. Colleague B stated that in the first year of managing her, when he asked about her health, the Registrant would state that nothing had changed. Colleague B also stated that the Registrant had indicated to him that she was having bone biopsies and chemotherapy for Leukaemia however he could not recall the specific dates or number of occasions she told him this.

15. Following a change to the Trust sickness policy, Colleague B made a subsequent referral to Occupational Health in December 2014 to ensure the department was doing everything appropriately with regards to managing the Registrant’s illness. Again, on 13 March 2015, Colleague B made a further Occupational Health referral. On 16 April 2015, Occupational Health wrote to Colleague B to advise that in order to identify a prognosis, the Registrant’s health records would be requested from her GP. On 23 April 2015, Occupational Health contacted Colleague B to advise that the Registrant had withdrawn her consent to a request for a report from her GP.

16. On 6 August 2015, DR, Service Lead at the Trust, wrote to the Registrant requesting her attendance at a meeting on 20 August 2015 in order to better understand her health condition. On 17 August 2015, the Registrant contacted the department and asked to speak to DR. DR was unavailable and therefore the call was put through to EH, Service Lead. The Registrant attended the department and informed EH that she had lied in that she was not suffering from Leukaemia.

17. DR was asked to undertake an investigation with the assistance of an HR representative. The Registrant was interviewed on 14 September 2015 with her representative from the Society of Radiographers. In the interview notes (as amended by the Registrant) it is recorded that the Registrant said:

‘In 2010 I spoke to a colleague in Radiology who was also a friend and told her I had leukaemia. She told me I should tell a Senior in the department. I know I should not have said this as it was not true...I do not know why I said that I had leukaemia, other than I felt physically unwell.’ and

‘I can’t say what I did with the time I took off when I said I was attending for biopsies and chemotherapy. I did book some days off in my own time but there may possibly have been times when I went for appointments in working hours.’

18. The Registrant’s GP records do not make any reference to her having a cancer diagnosis.

19. Prior to a revision in the Trust’s absence reporting process, any sickness absence lasting less than 7 days did not require the presentation of a medical note and the staff member could self-certify the absence. During her investigation DR was not able to obtain copies of the Registrant’s self-certification forms. However, DR was able to obtain the Electronic Staff Record (ESR) which recorded the dates of the Registrant’s absence and recorded a reason for each period of absence. The ESR record in the bundle set out details of absences where “cancer” was listed as all or part of the reason for absence.

Decision on facts
20. The Panel carefully read and considered the HCPC exhibits bundle. The Panel heard evidence from the HCPC witnesses Colleague B, EH and DR. The Panel found that the witnesses gave their evidence fairly and credibly, to the extent of their recollection of the events. The Panel read the witness statement of Colleague A, who was not called to give evidence. The hearsay evidence of Colleague A was not a significant element in any of the determinations made by the Panel.

21. The Panel carefully read and considered the Registrant’s written representations and supporting documents (Appendices A-G).

Particular 1 – found proved
22. The Panel found Particular 1 proved on the basis of the documentary evidence included in DR’s investigation. There was documentary evidence that the Registrant was referred to Occupational Health on 14 January 2011 because of a recent diagnosis of leukaemia. The outcome of the referral was a report from OH dated 21 January 2011 which records “As you are aware [the Registrant] was recently diagnosed with leukaemia for which she commenced treatment two weeks ago”. The Panel inferred that the information contained in these documents came from the Registrant.

23. In addition in the Registrant’s interview as part of DR’s investigation the Registrant stated that in 2010 she had told a colleague in Radiology that she had leukaemia.

24. The Registrant had not been medically diagnosed with leukaemia. This was confirmed by her GP notes.

25. The evidence was consistent with the Registrant’s written representations where she accepted that she misrepresented her health position from 2010 to 2015.

Particular 2 – found proved
26. The Panel found Particular 2 proved. In the letter from DR to the Registrant dated 6 August 2016, the Registrant was invited to a meeting to review working arrangements after the departure of Colleague B and to better understand how the department could support the Registrant’s health circumstances. It was therefore clear from that letter that at 6 August 2016 the Trust was still unaware of the true position regarding the Registrant’s health.

27. EH’s evidence was that the Registrant first admitted at the meeting with her on 17 August 2015 that she had not been diagnosed with leukaemia.

Particulars 3(i) - 3(xii) – found proved, 3(xiii) and 3(xiv) – found not proved
28. In her closing submissions Ms Sheridan indicated that she did not rely on the document at appendix 16 of DR’s report in relation to the Registrant’s absence history. Instead, she relied on the ESR record, an electronic record of data compiled from sickness absence forms filed by managers and supporting documents such as self certificates and medical certificates.

29. With the exception of one date, where contrary evidence was available, the Panel accepted that the ESR was a reliable record of the reasons given by the Registrant for her absence. Although the Panel did not have direct evidence of the way in which the Registrant indicated the reason for each period of her absence, the Panel concluded that the only reasonable interpretation of the ESR record was that the Registrant had given some indication to a manager of the reason for her absence. This indication could have been given either in a sickness certificate, in a telephone conversation, or in a return to work interview. In the ESRs included in the bundle, the Registrant indicated that the reason for her absence was “cancer”.

30. The absences in Particulars 3(i)-3(xii) were all periods of absence for which a medical certificate was not required and where the information on the reason for absence would have been indicated, either directly or indirectly, by the Registrant. The Panel found that Particulars 3(i) to 3(xii) were proved by the ESR record.

31. In respect of Particular 3(xiii) the Panel closely examined the ESR and was not satisfied that the entry made in respect of the reason for that period of absence was accurate. An entry for 28 March 2011 in the ESR stated that the reason for absence was “benign and malignant tumours cancers” and also recorded that the absence was supported by a “Medical Certificate (day 8 onwards)”. The Panel considered the Registrant’s GP notes and could find no evidence that such a medical certificate was issued. Certainly no medical certificate was issued in relation to cancer or tumours, because that would clearly not be consistent with the other evidence in the case. The Panel therefore decided to disregard the entry for 28 March 2011 because it was unreliable and found Particular 3(xiii) not proved.

32. There is no ESR entry for 31 October 2014 and the Panel found Particular 3(xiv) not proved.

Particular 4 – found proved
33. The Panel found Particular 4 proved both in respect of bone biopsies and chemotherapy. The Panel accepted the clear evidence of Colleague B. This evidence was corroborated by the evidence of the Registrant’s interview with DR in which she admitted that she told Colleague B that she was “having chemotherapy in tablet form and…that I was having bone biopsies and going to ward 3 for chemotherapy”.

Particular 5 – found proved
34. The Panel found Particular 5 proved. The Panel accepted the clear evidence of Colleague B. This was corroborated by the evidence of the Registrant’s interview with DR where she admitted that she self-certified between 23 February 2015 and 9 March 2015 due to “infection of cannulation site inserted for bone marrow biopsy”.

Particular 6 – found proved
35. The Panel noted that in her written submissions the Registrant stated that at the relevant time she was fearful of disclosing to her manager that she was suffering from her true health condition. She attributed this to her genuine health conditions. She was then unable to be honest and correct the position because she was fearful of the potential consequences.

36. The Panel also noted the evidence of DR that she did not believe that the Registrant was motivated by achieving adjustments to her working conditions, but rather that it was attention seeking behaviour by the Registrant.

37. While the Panel accepted that the Registrant’s fears and concerns may have been genuine, and that she may not have had in mind the adjustments that would be made to her working conditions, the key issue for the Panel to assess was whether the Registrant knew at the time that what she was doing was wrong in that she was making false statements. The Panel had no doubt that she did. She herself described her conduct as “lying” and she accepted in her representations that had known as soon as she told the lie that it was wrong.

38. In the Panel’s judgment the whole of the Registrant’s conduct, including each Particular found proved, was clearly dishonest. The conduct would plainly be regarded as dishonest by honest and reasonable members of the profession and the Registrant knew that it was dishonest by those standards.

39. The Panel also found that the Registrant’s conduct, by its nature, was misleading.

Decision on grounds
40. There is no statutory definition of misconduct, but the Panel had regard to the guidance of Lord Clyde in Roylance v GMC (No2) [2001] 1 AC 311:

“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard 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”.

The conduct must be serious in that it falls well below the required standards. The question of whether the proven facts constitute misconduct is for the judgment of the Panel and there is no burden or standard of proof.

41. The Panel took into account the context and surrounding circumstances. The Panel acknowledged that the Registrant was suffering from a genuine health condition. This may have affected her decision making and judgment. This context has some relevance to the seriousness of the dishonesty in this case, but it does not excuse the Registrant’s conduct.

42. In the Panel’s judgment the Registrant’s conduct was sufficiently serious to constitute misconduct. Her conduct fell well below the standards that are expected of all health professionals. The dishonesty was a serious breach of the HCPC Standards of conduct, performance and ethics, particularly standard 3 and standard 13. Honesty is essential for all professionals and the Registrant was in breach of that fundamental requirement. The Registrant’s managers expected and relied on the Registrant’s honesty. Her dishonesty persisted over a period of time of at least four years. The Registrant only admitted her lie after she had been invited to an interview to discuss her health condition, where her conduct might have been uncovered.

43. The Registrant’s dishonest conduct had an impact on the Registrant’s colleagues and on the care of patients. The adjustments made for the Registrant included that she should not have contact with patients where there was an infection risk. There were therefore restrictions on the Registrant’s work, particularly work in theatre or mobile examinations. The Registrant therefore did not carry out any out-of-hours work where she was required to work alone, and this work was shared by other Radiographer colleagues. If this infection risk work was required when the Registrant was working, it would be necessary to find another Radiographer to carry out the work. This caused some delays in providing treatment for patients.

44. In the Panel’s judgment the Registrant’s conduct in Particulars 1-6 constitutes misconduct.

Decision on impairment
45. The Panel applied the guidance in the HCPC Practice Note “Finding that Fitness to Practise is impaired” and accepted the advice of the Legal Assessor. The Panel considered the Registrant’s fitness to practise at today’s date.

46. The Panel first considered the personal component, which is the Registrant’s current competence and behaviour. In its assessment the Panel took into account the Registrant’s written submissions. The Panel’s view was that the Registrant has very limited insight. It was positive that the Registrant had demonstrated an understanding that her conduct was wrong. She had also given some thought to the reasons for her conduct. However, there has been no acknowledgment of the impact of her misconduct on her colleagues, the department, the profession, or on patients. In her written submissions she even questioned how anyone is able to say that there was any impact on patient safety. The Registrant focussed solely on the impact of her conduct on herself and her career.

47. Given the Registrant’s very limited insight and the persistence of her past dishonest behaviour the Panel identified that there is a risk of repetition of similar misconduct. The Panel therefore concluded that the Registrant’s fitness to practise is currently impaired on the basis of the personal component.

48. The Panel next considered the wider public policy considerations including the need to protect service users, maintain public confidence in the profession and to uphold standards of conduct and behaviour. The Panel considered that the Registrant’s dishonest conduct and the risk of repetition would cause concern to an informed member of the public. Members of the public place their trust in the honesty of health professionals and would not expect the Panel to allow the Registrant to be free to practise without restriction. A finding of impairment is also necessary to declare and uphold proper standards, express clear disapproval of the Registrant’s misconduct, and maintain public confidence in the profession and the regulatory process.

49. The Panel therefore concluded that the Registrant’s fitness to practise is currently impaired on the basis of the public component.

Decision on sanction
50. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPC Indicative Sanctions Policy (ISP). The purpose of a sanction is not to punish the Registrant, though it may have that effect. The purpose of a sanction is to protect the public. The Panel should also give appropriate weight to the wider public interest, which includes the deterrent effect to other registrants and the need to maintain public confidence in the profession and the regulatory process.

51. The Panel applied the principle of proportionality, balancing the Registrant’s interests against the public interest.

52. The Panel identified the following aggravating circumstances:
• repeated dishonesty over a long period of time;
• the impact on patient care and the Registrant’s colleagues;
• the Registrant has demonstrated very limited insight.

53. The Panel identified the following mitigating circumstances:
• the Registrant has expressed some remorse, although this is very limited;
• the Registrant clearly accepts and understands that what she did was wrong;
• the motivation for dishonesty does not appear to have been for material gain;
• the Registrant’s professional competence is recognised as being of a high standard;
• no evidence of previous disciplinary or regulatory matters;
• evidence from the Registrant’s representations corroborated by the GP records of the Registrant’s health problems.

54. In the Panel’s view the most important mitigating feature was the evidence of the Registrant’s health problems. It appeared to the Panel that there was a strong possibility that the Registrant’s health problems may have affected her state of mind, both when she embarked on her course of conduct and when she continued that course of conduct.

55. The Panel considered the available sanctions in ascending order of severity, taking into account the principle that the sanction should be the least restrictive which is sufficient to satisfy the purposes of a sanction as set out in the ISP. The Panel decided that taking no action or a Caution Order would not be sufficient. These options would not satisfy the requirement of protecting the public against the risk of repetition, and they would manifestly not address the wider public interest, given the seriousness of the Registrant’s misconduct.

56. The Panel next considered a Conditions of Practice Order. The Panel decided that there are no workable and appropriate conditions that could address the Registrant’s behaviour. The Registrant’s dishonesty was also at a level of seriousness, that conditions would not be sufficient to ensure that a clear message is given to the public that such behaviour is entirely unacceptable for a Radiographer.

57. The Panel considered the more serious sanctions of a Suspension Order or a Striking Off Order. The Panel carefully considered the ISP and took the view that the guidance for both a Suspension Order and a Striking Off Order could apply to the circumstances of this case. This is because the Panel do not know whether or not there is a realistic prospect of remediation in this case. The Panel has identified that there was a strong possibility that the Registrant’s health condition had a significant impact on her state of mind at the relevant time. If this was the case, the Panel’s view was that there may be a realistic prospect of remediation, if the Registrant were to address those underlying issues and develop insight.

58. The Panel noted from the GP records and from the Registrant’s representations that there appears to be evidence that at the time of admitting her deception, she was already taking some steps to address her underlying health problems more effectively. It is unfortunate that the Panel has no further information.

59. The Registrant has not engaged with this hearing and in failing to engage she has placed herself at significant risk of a Striking Off Order being made. However, this is not a case where the Registrant has not engaged with the HCPC at all. She has provided written representations and in those representations she states that she wishes to continue her career. She recognises that she will need to regain the trust that she recognises she has lost.

60. Given the information available to the Panel about the Registrant’s health problems and the Registrant’s stated reasons for her reluctance to admit her problems, the Panel decided that a measured approach was appropriate. The Panel noted that contributory factors in the Registrant’s failure to attend this hearing could include her health problems or her attitude towards those problems. Although there is no evidence in relation to the Registrant’s current health, the Panel was prepared to accept that the Registrant’s failure to engage with this hearing might be as a result of her health.

61. In these circumstances the Panel’s judgment was that the public interest would be best served by giving the Registrant an opportunity to remediate her past misconduct, if that is possible. The Panel could give her that opportunity without a risk to public safety by making a Suspension Order which will be subject to review. If the Panel made a Suspension Order the Registrant would be unable to practise and would not be able to return to practise unless and until a review Panel is satisfied that she has addressed and effectively negated the risk of repetition.

62. The Panel considered the wider public interest considerations and particularly whether a Suspension Order rather than a Striking Off Order would be detrimental to the public interest. The Panel recognised that a Suspension Order would not send a message to the public which is as clear as a Striking Off Order, the sanction of last resort. Nevertheless, the Panel’s view was that informed members of the public and the profession would understand the Panel’s reasons for giving the Registrant an opportunity to demonstrate remediation, and would recognise that a Suspension Order provides sufficient protection for members of the public, which is the primary purpose of a sanction.

63. Furthermore, it was the Panel’s view that on balance the public interest would be best served by allowing the potential return to practice of a highly trained and competent professional, once she has shown she is safe to do so.

64. The Panel decided that the appropriate and proportionate sanction is a Suspension Order.

65. The Panel decided that the appropriate length of the Suspension Order in this case is the maximum period of twelve months. The maximum period is appropriate and proportionate, in circumstances where the Registrant is at significant risk of a Striking Off Order. It gives the Registrant time to reflect on the decision made by the Panel and to take remedial action, if she decides to do so.

66. The Suspension Order will be reviewed before it expires. A future review Panel may be assisted by:
• independent professional evidence on how the Registrant has addressed her health issues;
• evidence on how the Registrant has maintained her professional competencies and kept up to date;
• evidence on the Registrant’s development of insight (such as a reflective written piece);
• attendance of the Registrant at the review hearing.

Order

The Registrar is directed to suspend the name of Laura M Tyreman from the register for a period of 12 months from the date this order takes effect.

Notes

The order imposed today will apply from 21 June 2017 (the operative date).
This order will be reviewed again before its expiry on 21 June 2018.

Hearing history

History of Hearings for Miss Laura M Tyreman

Date Panel Hearing type Outcomes / Status
22/05/2017 Conduct and Competence Committee Final Hearing Suspended