Dr Donna Schelewa

: Practitioner psychologist

: PYL18736

: Final Hearing

Date and Time of hearing:10:00 10/07/2017 End: 17:00 10/07/2017

: Grand Hotel, Ivey Place, High

: Conduct and Competence Committee
: Voluntary Removal agreed

Allegation

During the course of your employment as a Practitioner Psychologist with Hywel Dda University Health Board you:

1. In relation to Patient 1:
a) Administered the Wechsler Adult Intelligence Scale IV (WAIS-IV) Test which lacked investigation of measures of current affect and/or information regarding current everyday functioning and/or background information of the patient.
b) Did not record an exploration of the patient’s educational, occupational and/or social history within your assessment report.
c) Did not record a consideration of the patient’s hospital notes within your assessment report.
d) Concluded that the patient had poor abstract reasoning, poor processing speed and poor social understanding without considering factors that are likely to have impacted on test performance, including:
I) Educational history;
II) Occupational history;
III) Emotional functioning;
IV) Patient’s approach to the assessment;
V) Consistency of the patient’s performance on the WAIS-IV subtests; and/or
VI) Current medication.
e) Did not maintain accurate patient records in that you assessed the patient on 19 March 2012 but dated your report 23 August 2013.
f) Concluded that the patient’s profile characteristics were similar to those found in individuals with an autistic spectrum without adequate psychometric testing and/or without adequate clinical justification.
g) Used the Test of Premorbid Functioning (TOPF-UK), which was not appropriate in this case.

2. In relation to Patient 2:
a) Did not record a consideration of the patient’s background, educational and medical history, past and current functioning, current symptoms of severe clinical depression and/or anxiety within your assessment report.
b) Did not consider and/or record consideration of relevant information about the patient within your assessment report, namely:
I) References to functional abdominal pain as a child; and/or
II) A CAMHS diagnosis of somatisation disorder.
c) Did not contact CAMHS for background information.
d) Did not maintain accurate patient records in that you assessed the patient in 2009 but dated your report 31 March 2010.
e) Acted outside the scope of your role as a Clinical Psychologist.

3. In relation to Patient 3:
a) Did not record a consideration of the patient’s background and/or current functioning within your assessment report.
b) Did not record a consideration of relevant information about the patient within your assessment report, namely:
I) Medication;
II) Alcohol usage
III) Drug usage
IV) Violence; and/or
V) Anger problems.
c) Did not record patient goals, patient strengths and/or meaningful recommendations for the patient within your assessment report.
d) Did not maintain accurate patient records in that you assessed the patient between May and September 2011 but dated your report 20 August 2013.
e) Did not record how the results of the assessment related to the patient’s current functioning and/or developmental history.
f) Focused on the possibility of the patient being on the autistic spectrum, which was not appropriate.

4. In relation to Patient 4:
a) Did not record background information about the patient’s previous and/or current functioning within your assessment report.
b) Provided irrelevant information about Autistic Spectrum Disorder.
c) Did not provide psychosocial interventions that were specific to the assessment results and/or adequate for the patient.
d) Did not record patient goals, patient strengths and/or advice given within your assessment report.

5. In relation to Patient 5:
a) Did not record patient goals and/or patient strengths within your assessment report.
b) Provided information about Post Traumatic Spectrum that was not specific to the patient.

6. In relation to Patient 6:
a) Did not record the patient’s educational, social and/or family history within your assessment report.
b) Concluded that the patient’s presentation was ‘consistent with vulnerabilities (cognitive and early attachment difficulties with his mother)’ without evidence to support this conclusion.
c) Did not adequately record the process followed to reach the diagnosis of Autistic Spectrum Disorder and/or record consideration of alternative explanations within your assessment report.
d) Did not provide psychosocial interventions that were adequate for the patient and/or specific to the assessment results.

7. In relation to Patient 7:
a) Did not record the timescale between the two episodes of testing for this patient within your assessment report.
b) Did not interpret and/or record the test results correctly.
c) Reached conclusions within your assessment report without sufficient evidence to support those conclusions, namely that the test results:
I) ‘demonstrate a consistent decline in cognitive functioning across two assessments. The cognitive decline is most significant for working memory and processing speed.’
II) Suggest that the patient ‘is experiencing progressive cognitive decline consistent with difficulties in Pre Frontal Cortex’.
d) Did not provide any psychosocial interventions for the patient.

8. In relation to Patient 8:
a) Reported that the patient has deficits in the prefontal and frontal lobe areas without sufficient evidence to support this conclusion.
b) Did not record a consideration of other factors that can impact on cognitive test performance within your assessment report.
c) Did not record adequate background information about the patient within your assessment report.
d) Did not record information about the patient’s current functioning within your assessment report.
e) Did not provide information on the key indicators of a brain injury within your assessment report.
f) Did not record a consideration of other relevant information about the patient within your assessment report, namely that the patient:
I) Demonstrated symptoms of body dysmorphia;
II) Demonstrated symptoms of Clinical depression;
III) Was experiencing a difficult life transition.
g) Did not record the name of the cognitive assessment administered within your assessment report.

9. In relation to Patient 9:
a) Did not record information within your assessment report to indicate when the patient’s problem began, the patient’s current functioning and/or the specific nature of the patient’s difficulties.
b) Did not use appropriate language and/or executive tests.
c) Did not screen the patient for mood and/or anxiety issues.
d) Did not obtain test results that were related the patient’s current functioning and/or other background information.
e) Inaccurately concluded that there was ‘no evidence of fronto-temporal dementia at present’.

10. In relation to Patient 10:
a) Did not record adequate background information about the patient within your assessment report.
b) Did not record a consideration of the patient’s medical history within your assessment report.
c) Did not provide an assessment of affective well-being and/or personality.
d) Concluded that the patient has executive impairments which ‘can account for impulsive and reactive behaviours’, without sufficient evidence to support this conclusion.
e) Did not make reference to the patient’s difficult life events, including his time in prison, within your assessment report.
f) Did not record a consideration of other possible explanations for the test results within your assessment report.

11. In relation to Patient 11:
a) Reached a diagnosis of Autistic Spectrum Disorder without administering sufficient psychometric testing.
b) Did not consider the patient’s current everyday functioning, background information and/or history when interpreting the WAIS-IV results.
c) Did not interpret and/or record the test results correctly within your assessment report.
d) Recorded irrelevant information about Autistic Spectrum Disorder within your assessment report.
e) Did not administer adequate psychometric testing to assess the patient’s cognition.

12. In relation to Patient 12:
a) Did not record information essential for the interpretation of psychometric tests, such as the patient’s current functioning, within your assessment report.
b) Did not interpret and/or record the test results correctly within your assessment report.
c) Concluded that the patient has ‘executive dysfunction’ despite the presence of other factors that were likely to account for the test results.
d) Did not record a consideration of essential information to reach an informed psychological formulation, including:
I) The nature and pattern of the patient’s behaviour;
II) Family History;
III) Personality Factors;
IV) Childhood issues;
V) Bi-polar Disorder.
e) Included irrelevant information about brain plasticity and childhood experiences within your assessment report.
f) Included information on executive disorders within your assessment report, which was irrelevant, unhelpful and potentially misleading.

13. In relation to Patient 13:
a) Did not record a consideration of essential information about the patient to reach an informed psychological formulation, including:
I) Background information;
II) Presenting difficulties;
III) The patient’s beliefs about what may account for her difficulties;
IV) Previous education;
V) Occupational experience;
VI) Perceived changes in function; and/or
VII) Strengths and weaknesses.
b) Did not record an assessment of affect and/or emotional functioning within your assessment report.
c) Did not maintain accurate patient records in that you assessed the Patient on 11 March 2011
but dated the report 21 August 2013.

14. In relation to Patient 14:
a) Did not undertake a comprehensive assessment which integrated information on the patient’s background and/or current functioning.
b) Did not record a consideration of relevant information within your assessment report, in reaching the conclusion that the patient had experienced a significant decline in cognitive functioning, including:
I) The presentation of severe low mood;
II) Anxiety;
III) Post-traumatic Stress Disorder;
IV) Alcohol misuse.
c) Did not maintain accurate patient records in that you assessed the patient on 29 February 2012 but dated the report 22 August 2013.
d) Required the patient to complete the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI) and the Hospital Anxiety and Depression Scale (HADS), which was excessive and/or unnecessary.
e) Did not interpret and/or record the test results accurately within your assessment report.

15. In relation to Patient 15:
a) Did not recognise the impact of paranoid schizophrenia and medication on the validity of the test results.
b) Did not record a consideration of the patient’s background, mental health history and/or physical health history, when interpreting the patient’s test results.
c) Reported that the patient had frontal deficits and required an endocrinological assessment without sufficient evidence to support these conclusions.
d) Did not record the results of the TOPF-UK and/or the WAIS-IV tests within your assessment report.
e) Acted outside the scope of your role as a Clinical Psychologist.

16. In relation to Patient 16:
a) Did not recognise the potential impact of active symptoms of conditions, such as anxiety and/or OCD, on the validity of psychometric assessment.
b) Did not recognise that stress could account for the pattern of the patient’s test results.
c) Did not record information about the patient’s current situation, previous situation, recent life events and/or strategies of coping with strong emotions within your assessment report and/or a consideration of these factors when interpreting test results.

17. In relation to Patient 17:
a) Did not record context and/or background information within your assessment report and/or a consideration of this when interpreting test results.
b) Concluded that the patient presented with deficits in complex attention, working memory and processing skills, which was not supported by the WAIS-IV scores.
c) Diagnosed the Patient with Systemic Lupus Erythematosus, which was not supported by the WAIS-IV scores.
d) Did not consider other explanations in regard to the patient’s condition.
e) Did not record that the patient was distressed and/or angry at the time of the assessment.
f) Made unhelpful and/or inappropriate recommendations for this patient, which led to the patient undergoing an unnecessary private MRI scan.
g) Did not record the name of the cognitive assessment administered within your assessment report.

18. In relation to Patient 18:
a) Concluded that the patient had an Autistic Spectrum Disorder without sufficient assessment.
b) Provided insufficient evidence to support your diagnosis of interpersonal difficulties.
c) Did not record context, the patient’s background, developmental history and/or educational history within your assessment report and/or a consideration of these factors when interpreting test results.
d) Did not interpret and/or record the test results accurately within your assessment report.

19. The assessment reports for patients 1 to 18 demonstrate:
a) An overreliance on the WAIS-IV and WAISS III tests.
b) The use of the WAIS tests as a diagnostic instrument for brain dysfunction rather than as a measure of aspects of cognitive functioning.

20. Did not maintain and/or store patient data appropriately, namely instructing Colleague A to destroy numerous patient records.

21.The matters as set out in paragraphs 1-19 amount to misconduct and/or lack of competence.

22. By reason of your misconduct and/or lack 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 her address as it appeared in the register on 2 May 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 Conduct and Competence 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 Corbett on behalf of the HCPC.

4. Ms Corbett submitted that the HCPC has taken all reasonable steps to serve the notice on the Registrant. She further submitted that the Registrant has engaged with the HCPC and, in her letter dated 5 July 2017 addressed to the Panel, she has requested the hearing to proceed in her absence. Ms Corbett submitted that an adjournment would serve no useful purpose due to the nature of the hearing and the documentary requirements for Voluntary Removal have been completed. She reminded the Panel that it was in the public interest for this matter to be 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.

6. 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 is aware of the hearing from the contents of her letter dated 5 July 2017.

7. 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.
8. The Panel was satisfied that the Registrant had voluntarily absented herself from the hearing. There is a distinction between a case where the Registrant is clearly aware of the hearing date, and one where there has been no response from the Registrant. It is clear that the Registrant recognises that this matter is likely to proceed in her absence. In the light of the nature of this hearing, the Panel determined that proceeding in the Registrant’s absence would be in the public interest and also in the interest of the Registrant herself.

Background

9. The Registrant was employed as a Practitioner Psychologist until her retirement on 21 September 2015. In September 2013, the Registrant’s employer commenced an investigation into concerns regarding the Registrant’s practice, and in early January 2014, the HCPC was informed that the Registrant’s employer was pursuing disciplinary proceedings following their investigation into those concerns.

10. In April 2014, the HCPC received a report from Dr TE, Lead Consultant Clinical Neuropsychologist at the Health Board NHS Wales, who reviewed 18 assessments undertaken by the Registrant. The report raised concerns about the quality of the assessments and stated that the assessments reviewed demonstrated that the Registrant lacked the required skills and knowledge. As a result, a further review was carried out on 77 cases over which the Registrant had responsibility.

11. The second review disclosed wide-ranging and serious failings in 49 of the 77 cases reviewed. It also disclosed ‘numerous errors in all of the cases such as lack of narrative, significant omissions of information and lack of comprehensiveness in the assessments.’

Decision

12. The Panel considered the submissions of Ms Corbett on behalf of the HCPC. She outlined the circumstances that led to the referral to the HCPC, and submitted that a Voluntary Removal Agreement was the appropriate method of finalising this case. In her written correspondence, the Registrant fully admitted the factual particulars and that her fitness to practice was impaired. The HCPC was satisfied that the Registrant fully understood the effect of the Voluntary Removal Agreement and that granting the application would not compromise the protection of the public or have any detrimental effect on the wider public interest.

13. The Panel had sight of the letter from the Registrant, dated 20 December 2016, from which it is clear that she admits the allegation in full. She has advised that she no longer wishes to practise as a Practitioner Psychologist and has embarked on a new career as a chef. She has also indicated that as such, she has no intention of applying for restoration to the HCPC register as a Practitioner Psychologist in the future.

14. The Panel considered all of the information and representations by Ms Corbett The Panel has applied its own judgement to the application to withdraw the allegation and to discontinue these proceedings. The Panel has also had regard to the HCPTS’s Practice Note on “Disposal of Cases by Consent” and has accepted the advice of the Legal Assessor.

15. The Panel noted that the HCPC is satisfied that it would be meeting its statutory objective of protecting the public and the public interest, if the Registrant was permitted to be removed from the Register on similar terms to those which would apply if she were subject to a striking off order under article 29(5) of the Health and Social Work Professions Order 2001. The Panel noted from the documents that the Investigating Committee had concluded that there was a case to answer. The Panel is satisfied that the Registrant has fully admitted the allegation.

16. The Panel had before it a Voluntary Removal Agreement which had been agreed between the HCPC and the Registrant. It was signed and executed by both parties in terms of which the Registrant admitted the allegations which had been made against her. She agreed that she will resign from the HCPC Register on the terms and conditions fully set out in that Agreement. The Registrant also signed a Declaration that there was no other matter of which the Registrant was aware which might give rise to any other allegation.

17. The Panel firstly considered whether there were any factors that would make it undesirable to allow the allegation to be concluded on the consensual basis set out in the Voluntary Removal Agreement. It noted that the failings were basic, and occurred over a sustained period of time involving a significant number of patients. However, these matters did not arise from patient complaints. Furthermore, the Registrant acknowledged her failings from an early stage and has demonstrated insight into her failings. She recognised that her fitness to practise was impaired and has chosen to leave the profession and to pursue another career. Taking the above into consideration, the Panel concluded that there are no overriding public interest factors that would require this matter to go to a full hearing.

18. The Panel is aware that if the Registrant seeks to return to the HCPC Register at any time in the future, her application would be treated as if she had been struck off as a result of the allegation. The Panel noted that the Registrant was assisted by an advocate in these proceedings and is therefore satisfied that the Registrant fully understands the consequences of her application today.

19. In all the circumstances, the Panel is satisfied that both the public and the public interest would be adequately protected by the terms of the agreement reached between the Registrant and the HCPC in as much as the Registrant will henceforth be prevented from practising as a Practitioner Psychologist and, should she wish to apply to return to the Register, she will be treated as though she had been struck off.

20. Furthermore, the Panel is satisfied that this method of finalising this case is appropriate and proportionate, and is jointly in the interest of the public, the HCPC and the Registrant. Accordingly, the Panel approves the Voluntary Removal Agreement and the withdrawal of the allegation and discontinuance of those proceedings.

Order

The Panel approves the Voluntary Removal Agreement.

Notes

The Registrant will not be able to apply for restoration onto the HCPC register for at least five years from the date the order takes effect.

Hearing history

History of Hearings for Dr Donna Schelewa

Date Panel Hearing type Outcomes / Status
10/07/2017 Conduct and Competence Committee Final Hearing Voluntary Removal agreed
15/06/2017 Conduct and Competence Committee Interim Order Review Interim Suspension
24/03/2017 Conduct and Competence Committee Interim Order Review Interim Suspension
10/01/2017 Investigating committee Interim Order Review Interim Suspension
14/10/2016 Investigating committee Interim Order Review Interim Suspension
19/05/2016 Investigating committee Interim Order Review Interim Suspension
01/03/2016 Investigating committee Interim Order Review Interim Suspension
25/09/2015 Investigating committee Interim Order Review Interim Suspension
02/07/2015 Investigating committee Interim Order Review Interim Suspension
15/01/2015 Investigating committee Interim Order Application Interim Suspension