Miss Anuradha Megpara

: Chiropodist / podiatrist

: CH09496

: Final Hearing

Date and Time of hearing:10:00 26/07/2017 End: 17:00 26/07/2017

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

: Conduct and Competence Committee
: Struck off

Allegation

Whilst registered as a Chiropodist/Podiatrist:

1. On 5 April 2016 at the City of London Magistrates’ Court, you were convicted of the following charge:

Between 26 April 2015 and 9 September 2015 at Wellington Hospital, St John’s Wood, London pursued a course of conduct which amounted to the harassment of [Person A] and which you knew or ought to have known amounted to harassment of him in that between the dates specified you sent a number of unwarranted greeting cards and letters confessing your love for him.
Contrary to section 2(1) and (2) of the Protection from Harassment Act 1997

2. By reason of your conviction set out at paragraph 1, your fitness to practise if 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 26 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 Committee 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 Sheridan on behalf of the HCPC, and the indication from the Registrant that she would not be attending the hearing.

4. Ms Sheridan submitted that the HCPC has taken all reasonable steps to serve the notice on the Registrant. Ms Sheridan further submitted that the Registrant was aware of the hearing and had voluntarily absented herself from the hearing as she had submitted a documentary bundle to the HCPC for the attention of the Panel. She 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 advised 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 were 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 was aware of the hearing and had voluntarily absented herself.

9. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPC 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 and implicit in her submission of her documentary bundle is an expectation that the hearing proceeds in her absence.

• the Registrant has engaged with the process and has submitted written documents for the attention of the Panel, which the Panel will take into consideration on the Registrant’s behalf.

• there is a public interest that this matter proceeds expeditiously.

11. 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. 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.

Proceeding in private

12. Ms Sheridan submitted that it was appropriate that parts of the hearing be held in private where the Registrant’s health was to be discussed. The Panel was told that the Registrant had also requested the hearing be held in private where her health condition was to be discussed.

13. The Panel accepted the Legal Assessor’s advice and it noted Rule 10(1)(a)  of the Rules whereby matters pertaining to the private life of the Registrant, the complainant, any person giving evidence or of any patient should be heard in private. The Panel agreed the parts of the hearing where reference was to be made to the Registrant’s health should be heard in private.

Background

14. The Registrant is registered with the HCPC as a Chiropodist/Podiatrist. The Registrant sent an excessive amount of correspondence to a Doctor with whom she had previously worked. The said correspondence exceeded 400 letters and cards over a three to four year period, all of which were unwarranted and in which she declared her love for him.

15. On 5 April 2016, the Registrant pleaded guilty to the above charge at the onset of the trial. She received a custodial sentence of six weeks’ imprisonment suspended for 18 months. She was also made the subject of a restraining order for an indefinite period, a Rehabilitation Activity Requirement and ordered to pay a victim surcharge of £80 and costs of £620.

16. The Registrant appealed her sentence and the appeal was heard on 25 July 2016 at the Central Criminal Court. The Court dismissed the appeal.

Decision on Facts

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

18. The Panel has before it the certificate of conviction from the City of London Magistrates’ Court in relation to the Registrant and criminal matters outlined above. It sets out clearly the offences for which the Registrant was convicted and the sentence imposed upon the Registrant. The Panel also had before it a certificate from the Central Criminal Court certifying that the Registrant’s appeal against her sentence was dismissed and the sentence confirmed.

19. Accordingly the Panel finds the fact of the conviction proved.

Decision on Impairment

20. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of the conviction.

Submissions

21. Ms Sheridan outlined the background facts of the conviction and submitted that the Registrant’s fitness to practise is currently impaired in that that the conviction was a serious matter, and the public interest requires that a finding of impairment be found so as not to undermine the public confidence in the profession and the regulatory process. Furthermore the Registrant is still subject to a suspended sentence as the operative period lasts until 4 October 2017. Ms Sheridan referred the Panel to the cases of CHRE v NMC and Grant [2011] EWHC 927 (Admin) and CHRE v GDC and Fleischmann (2005) EWHC 87. She submitted that the relevant considerations in this case are the seriousness of the charge, the nature of the sentence, the Registrant’s initial not guilty plea and her vexatious application for a Non Molestation Order against the victim. She also submitted that this was a campaign of harassment which continued even after the Registrant received a police warning.

Legal Advice

22. The Legal Assessor reminded the Panel that its role was not to go behind the conviction nor was it to seek to retry the criminal case. The Legal Assessor advised the Panel that its task was to determine whether the Registrant’s fitness to practise is impaired, based upon the nature, circumstances and gravity of the criminal offence concerned. The Panel should consider whether the Registrant’s actions had brought the Chiropodist/Podiatrist profession into disrepute or had undermined public confidence in that profession, and if so, whether any sanction needs to be imposed.

23. The Legal Assessor also advised the Panel that it should bear in mind the principle of public protection in its broadest sense.  In doing so, the Panel was entitled to adopt a 'retrospective' approach and consider the conviction as if the Registrant was applying for registration with the HCPC.

24. The Panel was advised that it could take into consideration whether the Registrant pleaded guilty to the offence and if she did, at what stage in the criminal proceedings. A guilty plea entered at the first reasonable opportunity is indicative of greater insight on the part of the Registrant than one entered at the last moment. In that regard, the Panel noted that the Registrant’s appeal to the Crown Court was against the sentence imposed by the Magistrates’ Court and not against her conviction.

25. The Legal Assessor also advised the Panel to have regard to the sentence received, but also to bear in mind that the sentence imposed is not necessarily a good indicator of the seriousness of the offence when considered in a regulatory context. This is because the prime consideration of regulatory tribunals is the protection of the public and of the wider public interest. As Dame Janet Smith noted in the Fifth Shipman Inquiry Report,

“The fact that the court has imposed a very low penalty or even none at all should not lead the [regulator] to the conclusion that the case is not serious in the context of [its own] proceedings The role of the [regulator] in protecting [service users] involves different considerations from those taken into account by the criminal courts when passing sentence. What may well appear relatively trivial in the context of general criminal law may be quite serious in the context of [professional] practice.”

Panel’s consideration and decision

26. The Panel accepted the advice of the Legal Assessor. In reaching its decision, the Panel had regard to all the evidence before it. It took account of the submissions of Ms Sheridan on behalf of the HCPC.

27. The Panel also took into consideration the bundle of documents submitted on behalf of the Registrant.  It noted that it contained:

(a) Opinion on medical evidence that is not from an expert;

(b) Comment on the part of the Registrant’s family as to the Registrant’s health condition;

(c) A print out of an article from the internet regarding a medical condition.

28. The Panel accepted the advice of the Legal Assessor that it was to proceed with care when dealing with such material. The Panel determined that it would not attribute any weight to the above evidence. The first two categories amount to comment on the part of the writer, and the third is an article from the internet which cannot be certified as accurate, scientific, nor true as the source of the information cannot be verified. The Panel took into account the remainder of the bundle submitted on behalf of the Registrant.

29. In considering whether the Registrant’s fitness to practise is currently impaired by reason of her conviction, the Panel adopted the approach formulated by Dame Janet Smith in her fifth report of the Shipman inquiry by asking itself the following questions:

Does the Registrant’s conviction, and the facts relating to the conviction show that her fitness to practise is impaired in the sense that she:

a) has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b) has in the past brought and/or is liable in the future to bring the 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 profession.

30. The Panel determined that the answers to the above questions were in the affirmative. In coming to its determination, the Panel noted that the Registrant states that her offending behaviour arose from medical conditions diagnosed in late 2015 and early 2017. However, there is limited evidence from the Registrant of insight on her part as to her medical conditions, and no evidence of insight into how her behaviour would have impacted upon the victim. Furthermore, there is evidence that the medical conditions are on-going. The Panel noted that the Registrant, in her submissions, states that she does not feel she will be able to work as a podiatrist again due to the stress the job entails, which in turn was identified as the trigger for her health condition and its deterioration.

31. The Panel determined that by this conviction, the Registrant had breached a fundamental tenet of the profession, namely that it is incumbent on members of the profession not to behave in this manner and not to transgress the laws of the land. The Panel determined that the conviction of the Registrant related to a serious criminal offence. The Panel noted the aggravating features of the criminal offence:

(a) It was a course of conduct over a protracted period of time;

(b) The Registrant had been given a warning by the police but she persisted in her harassment of the victim; after only four weeks of not doing so;

(c) The Registrant had applied for a non-molestation order against the victim without any grounds; and

(d) The detrimental impact the Registrant’s behaviour may have had upon the victim’s professional and personal life.

32. The Panel reminded itself that if a registrant has been convicted of a serious criminal offence and is still serving their sentence at the time the matter comes before a panel, normally the panel should not permit the registrant to resume their practice until that sentence has been satisfactorily completed.   The Panel noted that the Registrant is still subject to the suspended sentence and will continue to be so until 05 October 2017. The Panel could not see any special reason to depart from the above mentioned principle. The Panel determined that a right-minded member of the public, in hearing all of the circumstances and evidence of the case, would consider that this case does require a finding of current impairment if public confidence in the profession and in the regulatory process were to be maintained. The Panel noted that the Court imposed a restraining order on the Registrant not to contact the victim or go to two hospitals. The restraining order does not have an end date. The Panel was of the view that this indicates that there is a risk of repetition of the Registrant’s behaviour and therefore a need to protect the public.

33. The Panel determined that the conviction was such that the need to uphold professional standards and public confidence in the professions would be undermined if a finding of impairment were not made. Therefore, the Panel determined that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction

34. Ms Sheridan, on behalf of the HCPC, reminded the Panel of the wider public interest in the imposition of a sanction. She submitted that any sanction must be proportionate and that it was important to note that the purpose of a sanction is not to punish the Registrant. She submitted that the facts of the offence were relevant to the Panel’s consideration at this stage.

35. The Panel accepted the advice of the Legal Assessor. He advised the Panel that the full range of sanctions is available to the Panel as this was a case involving a criminal conviction, and he reminded the Panel that it was not to go behind the conviction. He advised the Panel that it should bear in mind its duty to protect members of the public and also the public interest which includes maintaining and declaring proper standards of conduct and behaviour, maintaining the reputation of the profession, and maintaining public confidence in the profession and the regulatory process.

36. He advised that, whilst the Panel was entitled to take into consideration the sentence that the Criminal Court imposed upon the Registrant, the sentence imposed is not necessarily a good indicator of the seriousness of the matter in the context of regulatory proceedings. That was because the prime considerations that apply in regulatory proceedings were:

a) Protection of the Public;

b) Reputational harm to the profession;

c) Public confidence in the profession and the regulatory process; and

d) Relevant professional standards of behaviour and the seriousness of any departure from those standards.

37. The Legal Assessor drew the Panel’s attention to the case of CHRE v GDC and Fleischmann (2005) EWHC 87 and the general principle, that where a practitioner had been convicted of a serious criminal offence, [he] should not be permitted to resume [his] practice until [he] has satisfactorily completed his sentence. The Legal Assessor advised the Panel that as such, it should take into consideration the facts of the offence in question and determine whether or not it was a serious criminal offence. He advised that the seriousness of a criminal offence is not necessarily determined by the type of offence, but can also be determined by the circumstances of the offending behaviour. These are factors that can affect the reputation of the profession.

38. The Legal Assessor advised the Panel that it was entitled to take into consideration factors that it considered to be aggravating and mitigating circumstances of the criminal offence when deciding what sanction would be sufficient in the public interest.

39. The Legal Assessor advised the Panel that any sanction it imposes must be the least restrictive sanction that is sufficient to protect the public and the public interest. It should take into consideration the aggravating and mitigating factors in the case. He reminded the Panel that the purpose of a sanction is not punitive, although it may have that effect. The purpose of a sanction is to protect members of the public and the wider public interest, weighing the Registrant’s interest against the public interest. 

Panel’s consideration and determination

40. The Panel had close regard to the HCPC’s Indicative Sanctions Policy document in reaching its decision on sanction. The Panel reminded itself that the purpose of a sanction is not to punish. Rather, a sanction should only be imposed to the extent that it is required to protect the public, to maintain a proper degree of confidence in the profession and the regulatory process, and to declare and maintain proper standards among fellow professionals. To ensure this approach the Panel reminded itself to first consider whether its findings require the imposition of any sanction at all. If they do, then the available sanctions must be considered in ascending order of seriousness until one that satisfies the factors already identified is reached. The Panel confirms that it has followed this approach in the present case.

41. The Panel noted that there are no issues with the Registrant’s competence and she has a previously unblemished record.

42. The Panel determined that the Registrant had been convicted of a serious criminal offence. Furthermore, the Panel could not be satisfied that there was a low risk of repetition.

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

44. The Panel first considered taking no action but concluded that, given the seriousness of the criminal offence, this would be wholly inappropriate.

45. The Panel then considered whether to make a Caution Order. The Panel determined that the circumstances of the criminal offence and the risk of repetition of the Registrant’s behaviour are such that a Caution Order is not appropriate.

46. The Panel next considered the imposition of a Conditions of Practice Order. However, the fact that there are no concerns with the Registrant’s practice or competency as a Podiatrist and the nature and seriousness of the criminal offence makes a Conditions of Practice Order inappropriate as a sanction.

47. The Panel then considered whether a period of suspension would be a sufficient and proportionate response in order to protect the public and maintain a proper degree of confidence in the profession and the regulatory process, and to declare and maintain proper standards among fellow professionals.

48. The Panel bore in mind the findings it had already made, namely that this is a serious criminal offence and that there is a risk of repetition and a need to protect the public and the public interest. The Registrant lacks insight and the evidence suggests that she may be unable to resolve or remedy her failings. Furthermore, this is a case where there appear to be continuing medical conditions that may prevent the Registrant from understanding and remedying her failings

49. The Panel therefore went on to consider striking the Registrant’s name off the HCPC Register of Chiropodist/Podiatrist. The Panel took into account the impact that such an order would have on the Registrant in terms of her finances and her reputation. It also took into account the information relating to the Registrant’s chronic medical conditions. However, it concluded that the nature and gravity of the Registrant’s conviction was such that only a striking off order would be sufficient to protect the public and maintain and declare proper standards of conduct and behaviour, to maintain the reputation of the profession, and to maintain public confidence in the profession and the regulatory process.

50. In the light of the above, the Panel is satisfied that the appropriate and proportionate sanction is a Striking-Off Order.

Order

Order: That the Registrar is directed to strike the name of Miss Anuradha Megpara from the Chiropodist/Podiatrist part of the Register with immediate effect.


The order imposed today will apply from 23 August 2017 (the operative date)

 

Notes

No notes available

Hearing history

History of Hearings for Miss Anuradha Megpara

Date Panel Hearing type Outcomes / Status
26/07/2017 Conduct and Competence Committee Final Hearing Struck off