Mr Peters O Aremu

: Biomedical scientist

: BS42055

: Final Hearing

Date and Time of hearing:10:00 19/06/2017 End: 17:00 26/06/2017

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

: Conduct and Competence Committee
: Suspended

Allegation

During the course of your employment as a Biomedical Scientist for the Croydon University NHS Hospital, between 2011 and 2013, you

1. Did not follow the Standard Operating Procedures (SOP) regarding reporting on cases in that you did not notify the Pathology IT Manager of changes made on WinPath.

2. In the period up to 19 December 2012, you did not discharge your responsibilities, in that you did not use or use correctly the I-Passport for quality control.

3. Did not perform the Quality Management System (QMS) audit assignment as scheduled in September 2012 for July 2013.

4. Did not act upon reminders given to complete the Quality Management System (QMS) audit assignment (referred to in 3 above) on:

a) 8 August 2013 and/or

b) 12 August 2013 and/or

c) 17 August 2013.

5. The matters described in paragraphs 1 - 4 constitute misconduct and/or lack of competence.

6. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary matters

Service of Notice

1. The Notice of this hearing was sent to the Registrant at his address as it appeared in the register on 26 April 2017. The Notice contained the date, time and venue of today’s hearing.

2. The Panel accepted the advice of the Legal Assessor, and is satisfied that Notice of today’s hearing has been served in accordance with Rule 6(1) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules).

Proceeding in the absence of the Registrant

3. The Panel then went on to consider whether to proceed in the absence of the Registrant pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Ms Watts on behalf of the HCPC.

4. Ms Watts submitted that the HCPC has taken all reasonable steps to serve the Notice on the Registrant. She further submitted that the Registrant has not engaged with the HCPC in any meaningful way, and that an adjournment would serve no useful purpose. His last contact with the HCPC on 2 May 2017 was by way of an email which did not address the allegation against him nor provide any representation or evidence on his behalf. Ms Watts reminded the Panel that there was a public interest in this matter being dealt with expeditiously.

5. The Panel accepted the advice of the Legal Assessor. He advised that, if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing, then the Panel had the discretion to proceed in the absence of the Registrant. He cautioned the Panel that the discretion was to be exercised with care and caution as set out in the case of R v Jones [2002] UKHL 5.

6. The Legal Assessor also referred the Panel to the case of GMC v Adeogba and Visvardis [2016] EWCA Civ 162 and advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and of the public interest. In that regard, the case of Adeogba was clear that “where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed”.

7. It was clear, from the principles derived from case law, that the Panel was required to ensure that fairness and justice was maintained when deciding whether or not to proceed in a Registrant’s absence.

8. The Panel was satisfied that all reasonable efforts had been made by the HCPC to notify the Registrant of the hearing. It was also satisfied that the Registrant should be aware of the hearing.

9. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPTS Practice Note entitled “Proceeding in the Absence of a Registrant”. The Panel weighed its responsibility for public protection and the expeditious disposal of the case with the Registrant’s right to a fair hearing.

10. In reaching its decision, the Panel took into account the following:

• The Registrant has not made an application to adjourn today’s hearing;

• There is a public interest in this substantive hearing proceeding expeditiously;

• Witnesses have attended and are ready to give evidence;

• The time that has elapsed since these matters arose.

11. The Panel was satisfied that the Registrant had voluntarily absented himself from the hearing. It determined that it was unlikely that an adjournment would result in the Registrant’s attendance at a later date, in the light of the lack of meaningful engagement from the Registrant. Having weighed the public interest for expedition in cases against the Registrant’s own interest, the Panel decided to proceed in the Registrant’s absence.

Amendment of Allegation

12. Ms Watts, on behalf of the HCPC, applied to amend the Allegation. She submitted that the amendments sought were served to clarify the allegation by giving further and better particulars. She drew the Panel’s attention to the letter from the HCPC to the Registrant dated 26 April 2017 that informed the Registrant of the HCPC’s intention to make the application and also the amendments that would be sought. She submitted that, in the light of the Registrant not indicating any objection to the application, there was tacit acquiescence on his part to the application.

13. The Panel accepted the advice of the Legal Assessor, who advised that it was open to the Panel to amend the Allegation, provided no injustice would be caused by the amendment. The Panel considered that the amendments did not change the substance of the Allegation, served to clarify it and would not cause injustice. The Panel therefore allowed the amendments to be made. The amended Allegation is as set out above.

Telephone evidence

14. Ms Watts applied for the evidence of HK to be received by telephone link. She informed the Panel that HK was a Consultant Histopathologist at the Trust. Due to miscommunication, HK was unable to attend the hearing to give evidence in person. This was because he was on duty and there was no other Consultant to cover his duties. However, he was available and willing to give evidence by way of telephone link.

15. The Panel accepted the advice of the Legal Assessor. Rule 10(b) sets out that the rules of evidence governing Civil Proceedings apply, and therefore the principles of Relevance and Fairness apply. The Panel bore in mind its overarching objective of protection of the public and of the public interest.

16. The Panel had sight of HK’s statement and considered that the evidence of HK was relevant to the proceedings.

17. The Panel also determined that it was fair, and would not cause any injustice, to receive HK’s evidence by way of telephone evidence. The Panel would be able to question the witness and to test the evidence. The Panel recognised there are limits on how far it can go to test the evidence on behalf of an absent Registrant.

Background

18. The Registrant joined the Croydon NHS Hospital Trust (the Trust) in 2010 and became a full-time member of staff in 2011. He was employed as a biomedical scientist in the Cytology Department. He was responsible for Cytology screening for hospital and General Practitioner (GP) services. As the lead Biomedical Scientist, the Registrant was in charge of the day-to-day functioning of the Cytology department, maintaining Standard Operating Procedures (SOPs) and Policies, conducting audits and ensuring only controlled documents were being used in the lab and as such, one of his key roles was preparation for the Clinical Pathology Accreditation (CPA) assessment.

19. HK is a Consultant Histopathologist now based at St George’s Hospital. From 2007-2014 he had a clinical supervisory role at Croydon Hospital and as such he also had overall responsibility for the Registrant, although he did not have day-to-day contact with the Registrant. The Registrant’s line manager was SP, Clinical Scientist, Departmental Manager, until she left in 2013. In 2013, HK took over the management of the laboratory at a professional level, together with DC, who took a more traditional line management role.

20. From around 2011, the Registrant’s relationship began to break down with some of his colleagues. As a result, there were a number of internal investigations and concerns about the Registrant’s practice. These emerged throughout his employment period (2011-2013).

21. The issues with the Registrant’s practice did not resolve and these matters were referred to the HCPC.

Decision on Facts

22. The Panel considered all the evidence in this case, together with the submissions made by Ms Watts on behalf of the HCPC.

23. The Panel accepted the advice of the Legal Assessor, who reminded the Panel that the burden of proof rests with the HCPC, and that the Registrant need not disprove anything. The Legal Assessor also reminded the Panel that the standard of proof is the civil standard, namely the ‘balance of probabilities’.

24. The Panel heard oral evidence from the following witnesses on behalf of the HCPC:

• HK, Consultant Histopathologist in the Cytology Department at the time;

• RU, registered Biomedical Scientist, who was the Pathology Quality Manager at the Trust at the relevant time;

• DC, registered Biomedical Scientist, who was the Pathology Service Delivery Manager at the Trust at the relevant time; and

• SP, who at the relevant time was a registered Biomedical Scientist and Clinical Scientist Departmental Manager at the Trust.

25. The Panel received a bundle of documentary evidence that included:

• Internal correspondence of the Trust relating to these matters;

• The contemporaneous reports of the investigation interviews carried out by the Trust in relation to these matters;

• The final investigation report carried out by the Trust in relation to these matters;

• One Standard Operating Procedure (SOP) of the department at the time;

• The Cytopathology Audit schedules for 2011 to 2013; and

• The Registrant’s job description.

26. HK’s evidence was credible and convincing. Whilst he was concerned that he might not be able to fully recollect events as they had occurred almost four years ago, his oral evidence was consistent with the other evidence in the case.

27. RU was clearly enthusiastic about the I-Passport system and her role. She acknowledged that there was a personality clash with the Registrant and neither was willing to compromise. She told the Panel that she had not removed the Registrant’s access to the system at any time.

28. DC’s evidence was that he did not work directly with the Registrant, but he told the Panel that he did have good conversations with the Registrant about the systems and that the Registrant appeared to take on board what was being said. DC told the Panel that unfortunately, the Registrant would promise to put the matters discussed into practice but then would fail to do so.

29. SP told the Panel of her experience of line managing the Registrant. She told the Panel of the conflict between RU and the Registrant and how that working relationship had broken down. She told the Panel that she had to act as an intermediary between RU and the Registrant despite repeatedly directing the Registrant to speak to and work with RU. SP told the Panel that as RU was from another department, she had no managerial oversight of RU’s work or attitude.

30. SP told the Panel that the Registrant’s standard of work was acceptable to her but not to the “gold standard” expected by RU. She attributed this, in part, to the difficult relationship the Registrant had with RU. SP told the Panel that RU expected an objective gold standard from everyone and that SP thought this was unrealistic in the light of the varying experience and level of seniority of the staff.

31. SP recognised that the Registrant did not have good communication skills, but did not see it as her role as his line manager to put in place any support mechanism without his request because the Registrant’s job was of such seniority that, if he needed assistance, he was expected to come to her. She told the Panel that she did try to coach him on a daily basis but he would not take on board her suggestions or constructive criticisms.

32. The Panel considered each of the particulars and made the following findings:

Particular 1 – Proved

1. Did not follow the Standard Operating Procedures (SOP) regarding reporting on cases in that you did not notify the Pathology IT Manager of changes made on WinPath.

33. DC told the Panel that WinPath was a Laboratory Information Management System. It was the reporting system where Biomedical Scientists in the department would upload their results in order to produce reports for GPs and clinicians. DC told the Panel that when the results were processed a report would be sent to the Primary Care Support Services (PCSS). He told the Panel that if there were any cases where the results required an amendment it was the responsibility of the Registrant, as the Chief Biomedical Scientist, to notify the Pathology IT Manager of the changes so that an updated report could be sent to the PCSS.

34. The evidence of the witnesses were consistent in that the Registrant had made amendments to the results on WinPath but did not inform the Pathology IT Manager of the changes he had made.

35. The witnesses also gave evidence that if amendments were made, the normal procedure was to notify the Pathology IT Manager of the changes. This is in line with the SOP which states, in relation to amendments, “The staff creating the files for the PCT should be informed so that they include this request in the next file sent to the PCT.” The term “request” in that statement was used in reference to any amendment to the results on WinPath.

36. Accordingly, the Panel finds Particular 1 proved on the evidence before it.

Particular 2 – Proved

2. In the period up to 19 December 2012, you did not discharge your responsibilities, in that you did not use or use correctly the I-Passport for quality control.

37. In relation to this Particular, the evidence was consistent in showing that the Registrant did not use the I-Passport system for quality control. The documentary evidence also contained emails to the Registrant making reference to him not using the I-Passport system as he should have been.

38. RU told the Panel that her role as Quality Manager was to help implement and maintain I-Passport in the department. She told the Panel that I-Passport was to be used by staff members of the department.

39. RU stated that “All relevant senior pathology laboratory staff members, including [the Registrant], were given intensive training” to enable them to understand the system and to train others. She told the Panel that in the circumstances, she was not going to retrain the Registrant and there was no money to retrain him.

40. RU told the Panel that the Registrant had made it clear in conversations with her that he did not want to use the I-Passport system as he did not consider it useful. SP told the Panel that she had sent the Registrant a formal letter advising him that he was to use the I-Passport system. A copy of that letter was produced to the Panel.

41. Based on the evidence before it, the Panel determined that Particular 2 is proved, in that the Registrant did not use the I-Passport for quality control and therefore he did not discharge his responsibility to do so.

Particular 3 – Proved

3. Did not perform the Quality Management System (QMS) audit assignment as scheduled in September 2012 for July 2013.

42. The evidence of the witnesses and the documentary evidence is that the Registrant was to complete an audit assignment in July 2013. It is also consistent with the evidence that this was scheduled in September 2012. From the evidence, there appears to be no dispute that the Registrant was to perform the QMS audit assignment due in July 2013.

43. The evidence of the witnesses and the documentary evidence is also clear that by August 2013, the Registrant had not completed the audit assignment due in July 2013. In particular, HK told the Panel of the discussions in August 2013 in relation to the said audit assignment as to why it had not yet been completed.

44. Accordingly, the Panel finds Particular 3 proved.

Particulars 4(a), 4(b) and 4(c) – Proved

4. Did not act upon reminders given to complete the Quality Management System (QMS) audit assignment (referred to in 3 above) on: (a) 8 August 2013 and/or (b) 12 August 2013 and/or (c) 17 August 2013.

45. HK told the Panel that on the dates specified, he requested the Registrant by email to complete the said audit assignment. He told the Panel that the Registrant made excuses for not completing the said audit and also asserted that he should not be forced to do the audit as it would be unfair to him. HK told the Panel that the Registrant should have completed the audit in time as it had been scheduled in September 2012, and his emails were reminders to do so.

46. HK told the Panel that from February 2013, he became more involved with the performance of the Biomedical Scientists due to the retirement of SP. He told the Panel that the Registrant had had a period of absence of almost 6 months and when the Registrant returned in April 2013, he undertook the required training program of re-induction. The Registrant was provided with an independent mentor and said he was happy with the arrangement put in place.

47. In August 2013, the performance management screening statistics revealed that the accuracy of the Registrant’s reporting fell below the expected norm for a Biomedical Scientist. HK told the Panel that this was an indication that the Registrant had missed some abnormal cases in his diagnostic screening. As a result the Registrant was told that he should not “double check samples” any further and that his cases would be “double screened”.

48. HK told the Panel that thereafter, the Registrant’s behaviour and attitude deteriorated and adversely affected that working relationship within the department.

49. HK told the Panel that at the time he felt that the Registrant was being obstructive in not completing the audit due in July 2013, but in hindsight he now feels that perhaps the Registrant did not have confidence in his ability to complete the audit. He told the Panel that on or around 7 August 2013, the Registrant approached him and explained that he did not know which SOPs to sign, and HK requested other members of staff to give the Registrant the relevant information. The signing of the SOPs would have formed part of the audit due in July 2013.

50. The Panel determined that this Particular is found proved.

Decision on Grounds

51. The Panel then went on to consider whether the factual particulars found proved amounted to misconduct and/or lack of competence. The Panel heard submissions from Ms Watts on behalf of the HCPC.

52. Ms Watts submitted that the evidence of the witnesses regarding the circumstances at the time and of the training received by the Registrant in relation to the systems in question meant that there was no issue with the competence of the Registrant in using those systems. She further submitted that misconduct was the appropriate statutory ground to be applied in this case in the light of the evidence.

53. The Panel accepted the advice of the Legal Assessor.

54. The Panel was aware that misconduct is “a word of general effect, involving some act or omission, which falls short of what would be proper in the circumstances.” It is also aware that it was stressed that misconduct is qualified by the word “serious”. It is not just any professional misconduct which will qualify.

55. The Panel was also aware that not every instance of falling short of what would be proper in the circumstances, and not every breach of the HCPC standards, would be sufficiently serious such as to amount to misconduct in this context. Therefore, the Panel has had careful regard to the context and circumstances of the matters found proved. The Panel considered each of the factual particulars in the light of the following circumstances demonstrated by the evidence:

(a) The Registrant was a Grade BMS3 Chief Biomedical Scientist in Cytology, who had joined the Cytology Team in 2009 as a locum. His line manager was SP, who told the Panel that, at that time, the Registrant’s work was “entirely satisfactory and his position was later made permanent”;

(b) Apart from HK’s evidence of the quality of the Registrant’s work declining in the period leading up to August 2013, there was no evidence of any issue with the Registrant’s ability previously;

(c) The Registrant’s working attitude changed around 2011 and his working relationship with his colleagues and his line manager deteriorated thereafter;

(d) The evidence clearly demonstrated that the Registrant and RU did not have any semblance of a working relationship. SP described it as a personality clash in which they did not like each other, and neither the Registrant nor RU was willing to compromise or assist each other. SP’s evidence was of a situation where they avoided each other and worked to undermine each other. RU, for her part, told the Panel that at the time she was not going to retrain the Registrant and that there was no money to retrain him;

(e) The Registrant received training in how to complete an audit and audits would have been part of his role as the BMS3 in the Cytology Team.

56. The Panel determined that in the light of the above factors, the competence of the Registrant was not an issue in this case. It was safe to infer that the Registrant was, at the very least, a competent Biomedical Scientist.

57. The Panel considered each of the factual particulars found proved in turn, and considered whether they amounted to lack of competence or misconduct.

Particular 1

58. The Registrant’s failure to notify the Pathology IT Manager of changes made on WinPath was misconduct. The Panel heard that his failure involved 35 cases, three of which required a re-evaluation and change in the patients’ medical management. His omissions had put patients at risk of harm, and the three patients whom were most affected were also put at real risk of emotional and psychological harm.

59. Furthermore, the misconduct was compounded by the fact that the Registrant, as a BMS3 Biomedical Scientist in the Cytology Team, was a senior member of staff. His failure to follow the SOP was therefore more serious since it was incumbent upon him to show leadership and be an example of good practice. It was part of his main duties to “ensure and participate in the production, implementation and adherence to SOPs”.

60. The Panel determined that in the light of the above evidence, Particular 1 amounted to the statutory ground of Misconduct.

Particular 2

61. The I-Passport system was the de facto system to be used by the Pathology department to ensure that the SOPs were up-to-date, and that up-to-date versions were easily accessible and used. The Registrant’s failure to use the system gave rise to the risk of out-of-date SOPs being used, and also to the lack of conformity of practice in the team.

62. The Panel also took into consideration the lack of cooperation between RU, who was in charge of the I-Passport system, and the Registrant. It also noted the evidence of SP that when SOP documents are amended, it is not as if the entire document is changed because good practices continued.

63. The Panel determined that the Registrant’s failure to use, or use correctly, the I-Passport was misconduct in the circumstances. The misconduct was again compounded by the fact that the Registrant, as a BMS3 Biomedical Scientist on the Cytology Team, was a senior member of staff. It was his responsibility to ensure that he and his team followed the most up-to-date practice and procedures. His failure could have put patients at risk of harm, and could also have opened members of his team to the risk of disciplinary action if they did not follow the most up-to-date SOPs.

 64. The Panel determined that in the light of the above evidence, Particular 2 amounted to the statutory ground of misconduct.

Particular 3

65. In considering this Particular, the Panel took into account that the Registrant received audit training. Further, it was also part of his duties as the BMS3 on his team to carry out audits and assist in the external accreditation exercises.

66. The Registrant had been told in the previous year that he had been assigned that audit and it was necessary that he undertook the audit which contributed to the external accreditation.

67. The Panel took into account the evidence that the Registrant had told HK that he did not feel that it was fair for HK to insist that the Registrant complete the audit exercise. The Registrant stated that this was because he had been away and therefore his knowledge of the departmental procedures was “sparse”. The Panel did not consider this excuse to be reasonable in the circumstances nor sufficient to absolve him from his responsibility to complete the audit as directed. The Registrant had returned to work in April 2013 and had undergone a prescribed training program of re-induction. Furthermore, he had been provided with a mentor who had been a Senior Biomedical Scientist, and was “neutral” in that she was a locum who had not been employed prior to the Registrant’s period of absence. He was the BMS3 and if he felt that his knowledge of the department was so sparse that he could not carry out an audit, it was incumbent upon him to rectify that shortcoming or, in the alternative, consider whether he should remain as the Chief Biomedical Scientist in Cytology in light of all the duties and responsibilities that role entailed. There was no evidence that the Registrant’s knowledge of the department was “sparse” at that time, nor was there evidence that he had taken any steps, or sought assistance, to rectify that deficiency if it was so.

68. In relation to Particular 3, the Panel determined that the Registrant’s conduct, taken in context of the circumstances at the time, was sufficiently serious to amount to the statutory ground of misconduct.

Particular 4

69. In relation to this Particular, the Panel determined that in the circumstances, the three requests by HK for the Registrant to complete the Audit exercise were reasonable. HK had taken over SP's role as the Registrant’s line manager.

70. As stated above, the Registrant was the BMS3 and if he felt that his knowledge of the department was so sparse that he could not carry out an audit, it was incumbent upon him to rectify that shortcoming or, in the alternative, consider whether he should remain as the Chief Biomedical Scientist in Cytology in light of all the duties and responsibilities that role entailed. As part of his role he should have been “able to recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes”.

71. The Panel noted that HK had stated that he initially felt that the Registrant was being obstructive in not completing the audit due in July 2013, but in hindsight he now feels that perhaps the Registrant did not have the confidence in his ability to complete the audit. Nevertheless, the fact that the Registrant appears not to have taken steps to rectify the situation makes his failure to carry out the requests by HK serious enough to amount to the statutory ground of misconduct.

72. The Panel considered that on the facts found proved, the Registrant had breached the following paragraphs of the HCPC’s standards of conduct, performance and ethics:

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

5 You must keep your professional knowledge and skills up-to-date.

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

73. The Panel considered the Registrant had breached the following paragraphs of the HCPC’s “Standards of proficiency for Biomedical Scientists” (2007 edition, as amended in 2012 to reflect the change of name from HPC to HCPC):

1a.1 be able to practise within the legal and ethical boundaries of their profession - understand the need to act in the best interest of service users at all times

1a.8 understand the obligation to maintain fitness to practise - understand both the need to keep skills and knowledge up-to-date and the importance of career-long learning

1b.1 be able to work, where appropriate, in partnership with other professionals, support staff, service users, and their relatives and carers - understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team

2b.2 be able to draw on appropriate knowledge and skills in order to make professional judgements - be able to demonstrate a level of skill in the use of information technology appropriate to their practice

2c.1 be able to monitor and review the ongoing effectiveness of planned activity and modify it accordingly - recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes

2c.2 be able to audit, reflect on and review practice - be aware of the role of audit and review in quality management, including quality control, quality assurance and the use of appropriate outcome measures - participate in quality assurance programmes, where appropriate

Decision on Impairment

74. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of his misconduct. The Panel heard the submissions of Ms Watts, and it accepted the advice of the Legal Assessor.

75. The Legal Assessor drew the Panel’s attention to the approach set out in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin), and reminded the Panel that there was a personal and public component when considering whether the Registrant’s fitness to practise was currently impaired.

76. For this purpose, the Panel adopted the approach formulated by Dame Janet Smith in her fifth report of the Shipman inquiry by asking itself the following questions:

“Do our findings of fact in respect of the Registrant’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 service users at unwarranted risk of harm; and/or b) has in the past brought and/or is liable in the future to bring the Biomedical Scientist 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 Biomedical Scientist profession?”

77. The Panel determined that the answers to all the above questions were in the affirmative in relation to past, and future possible conduct. In coming to its decision it took into account the following factors:

(a) The direct consequence of amending results of tests and not informing the relevant parties of such amendments affected the clinical care and treatment patients were receiving, or should have been receiving;

(b) The Registrant’s actions in relation to the amendment of the test results had brought the Biomedical Science profession into disrepute, as well as tarnishing the reputation of that Department;

(c) The Registrant has failed to engage with the process and has not attended today to tell the Panel what, if any, insight he has gained into his actions. The Panel has no information as to the current circumstances of the Registrant;

(d) There is very limited evidence of any insight on the part of the Registrant. Taking a generous view, the Panel consider that the Registrant may be aware of the causes of his misconduct, but he has not demonstrated that he is aware of what actions to take to avoid such situations in future. This is a matter of misconduct, and there can only be very limited remediation without insight. There has been no evidence of any action taken by the Registrant to remediate his misconduct. Therefore there was a real risk of repetition of the misconduct on the part of the Registrant, if faced with a similar situation.

78. The Panel also determined that the Registrant’s misconduct was such that the need to uphold professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in these circumstances.

79. Therefore, the Panel determined that the Registrant’s fitness to practise is currently impaired on both personal and public interest considerations.

Decision on Sanction

80. The Panel heard the submission of Ms Watts with regard to sanction.

81. The Panel accepted the advice of the Legal Assessor. The Panel had regard to all the evidence presented, and to the HCPC’s Indicative Sanctions Policy. The Panel reminded itself that a sanction is not meant to be punitive, although it may have a punitive effect. The Panel bore in mind the principles of fairness and proportionality when determining what the appropriate sanction in this case should be.

82. The Panel considered the aggravating factors in this case to be:

a) The Registrant has not demonstrated any appreciable insight or remorse into his misconduct and its possible effects on patients and colleagues;

b) The Registrant’s misconduct put patients at risk of harm;

c) The Registrant’s misconduct involved a wide range of elements of his practice over a significant period of time;

d) Whilst the Registrant could have addressed his training needs, he did not seek any training that could have prevented some of the misconduct in this case.

83. The Panel considered the following to be mitigating features in this case:

a) The Registrant is of good character;

b) The witnesses said the Registrant was competent in his technical practice;

c) The Panel had heard evidence that RU’s behaviour towards the Registrant was robust and uncompromising, just as his was towards her. She was also a senior member of staff and this relationship may have exacerbated the situation.

84. In considering the matter of sanction, the Panel started with the least restrictive, moving upwards.

85. The Panel first considered taking no action but concluded that, given the seriousness of the Registrant’s misconduct and his lack of insight, this would be wholly inappropriate.

86. The Panel then considered whether to make a caution order. The Panel was mindful of its finding that the Registrant was likely to repeat his misconduct. Furthermore, these matters are not minor in nature. The Registrant’s lack of insight makes a Caution Order, even for the maximum period of five years, inappropriate in this case and would not protect the public nor satisfy the public interest.

87. The Panel next considered the imposition of a Conditions of Practice Order. The Panel has found that the Registrant has not demonstrated insight into his misconduct. This was not a case where the Registrant’s technical skills are in question. Whilst the Registrant might benefit from re-training in conducting audits, the main cause of the Registrant’s misconduct involves attitudinal issues, which cannot be properly addressed by the imposition of conditions of practice in the absence of insight.

88. As indicated by the Indicative Sanctions Policy, for the sanction of Conditions of Practice to be appropriate in any case, there has to be a commitment on the part of the Registrant to resolve matters. The Registrant has not engaged with this process in any meaningful way, and has not attended the substantive hearing. As such the Panel has not had the opportunity to test his level of insight nor has it been provided with any explanation for the Registrant’s misconduct that might have provided it with an understanding of the underlying issues, if any, for his attitudinal issues.

89. Taking into account all of the above, the Panel concluded that conditions could not be formulated which would adequately address the risk posed by the Registrant, nor the attitudinal issues. Neither would conditions of practice, in the current circumstances, address the public interest and the need to uphold standards and declare proper standards of conduct and behaviour.

90. The Panel went on to consider whether a period of suspension would be appropriate in this case. The Indicative Sanctions Policy sets out that a period of suspension would be appropriate in circumstances where the misconduct is of a serious nature, but would be remediable with the development of insight.

91. In this case, the Registrant has disengaged from the process, and has not provided any evidence of insight or remorse. The Panel has determined that, without evidence of insight, there is a risk of repetition of his misconduct.

92. However, the Panel reminded itself that the Indicative Sanctions Policy is merely a guideline and not a tramline. In this case, RU’s robust and uncompromising behaviour appears to have aggravated the Registrant’s behaviour, which in turn accentuated the Registrant’s shortcomings in his interpersonal skills and judgement when faced with such a situation. SP gave the Panel a clear picture of the professional relationship between RU and the Registrant. The Panel determined that to be a significant factor when considering whether a sanction suspending the Registrant’s practice was appropriate.

93. In the light of the above, the Panel determined that a Suspension Order was the appropriate and proportionate sanction, and that the Registrant is capable of gaining insight into his misconduct and shortcomings.

94. The point where a Striking Off Order was the only sanction sufficient to protect the public and the public interest has not yet been reached. The Panel determined that there was a possibility that the Registrant could re-engage with the process and demonstrate insight and therefore the sanction of last resort was not yet necessary.

95. The Panel also determined that the appropriate and proportionate duration of the Suspension Order was 12 months. The Panel had considered whether a shorter period of suspension was appropriate. However, taking into consideration the seriousness of the misconduct, the lack of evidence of insight and remorse, and the lack of engagement on the part of the Registrant, the Panel determined that a shorter period of suspension, in the current circumstances, would not suffice to maintain public confidence in the profession and the regulatory process.

96. A future panel reviewing this Order would be assisted by the following, if possible:

(a) The attendance of the Registrant at the hearing;

(b) A reflective piece by the Registrant, concentrating on: (i) what led to his misconduct; and (ii) how his actions impacted, or could have impacted, on service users and his colleagues;

(c) Information about any employment, paid or unpaid, since these events;

(d) An indication as to his future plans and whether he wishes to remain in the profession;

(e) Evidence of the Registrant keeping his practice and skills up-to-date either by attending CPD courses (which may include online courses), or being employed in any other capacity in allied and relevant roles;

(f) Up-to-date testimonials from colleagues and/or persons who are aware of these proceedings in relation to the Registrant’s communication skills, work practices, work standards, and adherence to work protocols.

Order

That the Registrar is directed to suspend the registration of Mr Peters O Aremu for a period of 12 months from the date this order comes into effect.

Notes

The order imposed today will apply from 20 July 2017 (the operative date).

This order will be reviewed again before its expiry on 20 July 2018.

Hearing history

History of Hearings for Mr Peters O Aremu

Date Panel Hearing type Outcomes / Status
15/06/2018 Conduct and Competence Committee Review Hearing Suspended
19/06/2017 Conduct and Competence Committee Final Hearing Suspended