Miss Suzanne Boyce

: Hearing aid dispenser

: HAD02264

: Final Hearing

Date and Time of hearing:10:00 25/09/2017 End: 17:00 27/09/2017

: Novotel Glasgow Centre, 181 Pitt Street, Glasgow, G2 4DT

: Conduct and Competence Committee
: Suspended

Allegation

As amended at the final hearing
During the course of your employment as a Hearing Aid Dispenser with Amplifon between 12 November 2012 and 14 October 2014, you:

1. Were not registered with the HCPC whilst practising as a Hearing Aid Dispenser between 20 August 2013 and 01 June 2014.

2. Regarding your assessment of Client A for a hearing aid on 20 August 2014 you:
a) did not fully complete  Client A's paper record card;
b) did not undertake and/or record the Bone Conduction readings on:
i. the GOAL audiogram; and/or
ii. onto the paper record card;

3. Regarding your assessment of Client B for a hearing aid on 15 September 2014 you:
a) duplicated a previous Bone Conduction and Uncomfortable Loudness Level readings onto Client B's GOAL audiogram;
b) recorded the Uncomfortable Loudness Levels at greater than the acceptable level to record, namely above 110 dB HL;
c) did not apply and/or record that you had applied the Rule 2 and/or Rule 3 masking;
d) did not produce and/or complete a confidential paper record card.

4. Regarding your prescription  of a replacement hearing aid for Client C in approximately July 2014 you:
a) did not re-test and/or record a re-test of Client C's hearing for the replacement aid, and/or programmed the hearing aid using the out of date audiometric readings;
b) did not produce and/or complete a new confidential paper record card;
c) did not record a detailed account of the appointments that took place on 30 July 2014 and/or 15 September on the GOAL recording system;
d) did not create a GOAL record of the fitting appointment that took place on 28 August 2014

5. Regarding your assessment of Client D for a hearing aid on or around 17 September 2014 you:
a) did not perform an Audiometry test;
b) duplicated the audiogram from April 2014;

6. Regarding your assessment of Client E for a hearing aid on 27 August 2014 you:
a) duplicated Bone Conduction  results onto Client E's GOAL audiogram;
b) did not apply and/or record that you had applied the Rule 2 and/or Rule 3 masking;
c) did not carry out and/or record a NOAH session and/or configuration when fitting the hearing aid on 18 September 2014;
d) did not produce and/or complete a paper record card.

7. Regarding your assessment of Client F for a hearing aid on or around 14 August 2014 you:
a) did not record Bone Conduction readings:
i. on the GOAL audiogram; and/or
ii. onto the paper record card.
b) did not record the bilateral fitting that took place on 21 August 2014 onto GOAL recording system, and/or did not record any details about this bilateral fitting onto GOAL;
c) upon receipt of medical information provided by Client F, did not refer Client F to a medical practitioners as required;
d) you did not ensure that Client F signed a disclaimer confirming the client’s wish not to be referred to a medical practitioner.

8. Regarding your assessment of Client G for a hearing aid on or around 5 August 2014 you:
a) did not record your assessment of Client G onto GOAL recording system and/or onto a paper record card;
b) did not record the reason why you did not test Bone Conduction on GOAL recording system, and/or did not take Bone Conduction readings;
c) did not carry out a NOAH session or configuration  when fitting the hearing aid on 28 August 2014;
d) did not complete and/or produce a confidential paper record card for the assessment appointment on 5 August 2014.

9. The matters set out in paragraphs 1 - 8 constitute misconduct and/or lack of competence.

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

Finding

Preliminary matters
Service
1. The Registrant has neither attended the hearing nor been represented. The Panel was satisfied that the Registrant was served at her registered address with the Notice of Hearing dated 7 July 2017. In it the correct venue, date and time was set out. The notice was sent more than 28 days before today's Hearing. This amounts to notice in a reasonable time in the view of the Panel. Therefore, the Panel has determined that there has been effective service of the Notice of Hearing.

Proceeding in the absence of the Registrant
2. Mr Paterson on behalf of the HCPC then asked the Panel to hold the hearing in the absence of the Registrant. He made references to her communications with the HCPC. He submitted that although she had not actually said she was not going to attend this hearing, there was sufficient information to infer that was her meaning. He said that therefore she has voluntarily absented herself from this hearing and it should go ahead in her absence.

3. The Registrant has engaged by email. She sent an email to the HCPC on 19 July 2017. In that email she complained of a previous hearing being postponed at short notice and also being unable to get any witnesses as they no longer worked for Amplifon. She said “I would like to ask how I go about giving a written statement? My reason for this is I have already cleared a full week in February which included paying for childcare which I then had to cancel and was still being charged for and I do not wish to take the risk and added worry of being put in this position again..” On 20 September 2017 she sent an email to the HCPC which said “please find pdf attached”. Attached to the email was a pdf document containing the Registrant’s written submissions about the Allegation.

4. There has been no communication from her since that email. She has not given any indication that she wants legal representation nor has she asked for an adjournment. The Panel accepted the Legal Assessor's advice. It also took into consideration the HCPTS's Practice Note on Proceeding in Absence of a Registrant.

5. The Panel considered that the Registrant, who has been properly served with the Notice of Hearing, had the choice to engage with this process, as she has knowledge of today's hearing and has chosen not to attend, either personally or by telephone. In the Panel's judgement, she has absented herself of her own free will. She has known of the date of the hearing since 7 July 2017. The witnesses for the HCPC are fully prepared and ready to give their evidence. The matters in the Allegation are now old and relate to dates between 2012 and 2014. Further delay may degrade the quality of witnesses’ recollections. The Panel concluded that it was in the public interest to continue with the hearing in the Registrant’s absence to ensure an expeditious and efficient disposal of the hearing.

6. The Registrant has not requested an adjournment and the Panel concluded that, if the hearing was to be adjourned today, she would be unlikely to attend on the next occasion. This is a Conduct and Competence hearing of the HCPC concerning the possible actions and behaviour of the Registrant. It is in the public interest for the matters to be resolved. The Panel determined that the protection of the public and the wider public interest outweighed the interests of the Registrant. The Panel draws no adverse inference from the Registrant’s failure to attend.

Amendments
7. Mr Paterson on behalf of the HCPC applied to amend the Allegation by amending Particulars 1, 2 and 2(a), 3, 3(a), 3(c) and 3(d), 4, 4(a), 4(c) 4(d), 4(e), 5, 5(b), 6, 6(a), 6(b), 6(d), 6(e), 7, 7(b), 7(d), 7(h), 8, 8(b), 8c) and 8(d). He also applied to discontinue Particulars 2(c), 4(b), 4(f), 5(c), 6(c), 7(a), 7(c), 7(e) and 7(g), The Registrant had been notified of the proposed amendments by letter dated 14 July 2016. There had been no objections to the proposed amendments and the Registrant had provided a written submission for this hearing which referred to the amended Particulars in the Allegation. Mr Paterson maintained that the application for amendments was made in order to ensure clarification in the way in which the Allegation was worded. The application for part discontinuance was made as the evidence proposed to be called did not support those Particulars. He said that no injustice would be caused by the proposed discontinuance of parts of the Allegation.

8. As stated above the Registrant did not oppose this application and had made no mention of it in her written submissions. The Legal Assessor advised that the Allegation could be amended provided that the Panel was satisfied that no injustice was thereby caused.  He also advised the Panel in relation to the application for discontinuance. He reminded the Panel of the HCPTS’s Practice Note ‘Discontinuance of Proceedings’ the Panel had to be satisfied that the discontinuance did not amount to an ‘under prosecution’ and as it was a case of part discontinuance the Panel had to be satisfied that the remainder of the Allegation was capable of being heard in the absence of the matters that had been discontinued.

9. The Panel allowed the application for amendments in relation to all of the proposed Particulars, considering that there was no injustice caused and accepting that the amendments helped to ensure clarity in the Allegation but did not change the nature of it or make it more serious for the Registrant. The Panel also allowed the application for discontinuance. It was satisfied that the part discontinuance of the Particulars asked for did not amount to an ‘under prosecution’ of them. It was also satisfied that the discontinuance of the Particulars asked for did not make it more difficult to hear the remainder of the Particulars in the Allegation. It did not seem that the Registrant in her written submissions of 20 September 2017 had made any reference to the matters which would be discontinued and no injustice would be caused to her as a result. The Panel therefore ordered that Particulars 2(c), 4(b), 4(f), 5(c), 6(c), 7(a), 7(c), 7(e) and 7(g), should be discontinued and removed from the amended Allegation.

Background
10. The Registrant was employed at Amplifon between 12 November 2012 and 14 October 2014. When she first joined Amplifon, she was not qualified as a Hearing Aid Dispenser and was employed as a student practitioner. She completed her university course on 22 August 2013 and qualified as a Hearing Aid Dispenser. She should have registered as a Hearing Aid Dispenser with the HCPC at this time but no application was received by the HCPC.

11. In September 2013 AB conducted a clinical audit of the Registrant’s cases. This was a standard audit conducted in line with Amplifon’s policy. The Registrant failed this audit and was provided with additional training. AB carried out a second follow up audit of the Registrant’s caseload in September 2014 because of the failure of the first audit. The Registrant also failed this audit and an internal investigation meeting was held on 25 September 2014 between the Registrant and MJ the dispenser trainer.

12. In June 2014 the Human Resources department of Amplifon noted that the Registrant had failed to register with the HCPC despite being a fully qualified Hearing Aid Dispenser. VM was assigned to conduct an internal investigation into this.

Decision on facts
13. The Allegation was read out. The Panel bore in mind the burden and standard of proof and considered each Particular separately.

14. The Panel first considered the witnesses who had given evidence. The HCPC called three witnesses, AB, MJ, and VM. They all gave their evidence via video-link.

15. AB was thorough and gave clear evidence. In the Panel’s view she was credible and reliable. She was emphatic in refuting the two main planks of the Registrant’s submissions i.e. the recurrence of IT issues and that there was no requirement to maintain paper records. AB provided a clear explanation of the process she followed in undertaking the initial audit of the Registrant’s work in September 2013 and her involvement with the Registrant thereafter.

16. In the Panel’s view MJ was a credible witness who confined his answers to those issues of which he had direct knowledge. He appeared to the Panel to be knowledgeable of Amplifon’s policies and procedures and the issues with regard to when it was appropriate to refer a client to a medical practitioner with regard to a referable medical condition. He explained his limited involvement with the Registrant, which related to interviewing her following the audit in September 2014. MJ was also clear about the functionality of the company’s IT system which he said worked well. 

17. VM had a very limited involvement with the Registrant and her evidence related solely to the issues contained within Particular 1. She had limited knowledge of the process for checking and overseeing the HCPC registration of Hearing Aid Dispensers which was in force at the relevant time. She was clear and credible in giving her evidence.

18. The Panel took account of the written submissions of the Registrant. She had responded to her employer’s disciplinary investigations and made two submissions to the HCPC as part of these fitness to practise proceedings. The Panel noted that there were inconsistencies and contradictions in the Registrant’s responses to some of the Particulars and that she attributed most of the alleged problems with her record keeping to IT issues. She also maintained that she had been told that there was no requirement to keep paper records in relation to clients.

19. The Panel then considered the individual Particulars of the amended Allegation. 
 
Particular 1 – found proved
20. The Panel found this Particular proved. The Registrant has accepted this Particular to the extent that she has admitted that she was not registered with the HCPC during the relevant time period. The Registrant explained that she had completed the HCPC registration application form, enclosed payment, and sent the form to the HCPC. She stated that a colleague had observed her doing this. VM gave evidence regarding the investigation she undertook into this matter and explained that at the time Amplifon’s HR Department undertook an annual check of the HCPC registration of their Hearing Aid Dispensers. It was as part of this checking process that it was discovered that the Registrant was not registered with the HCPC. There was a screenshot in the evidential bundle of the search of the HCPC register undertaken by Amplifon in relation to the Registrant which showed a “no match” result which meant that she was not registered.    

Particular 2(a) – found proved
21. The Panel found this Particular proved. The Registrant was adamant in her submissions that there was no requirement to complete paper records for existing clients. There was a paper record for this client, however the mandatory questions were not completed and the Bone Conduction readings were missing on both the paper record and on GOAL.

Particular 2(b) – found proved
22. The Panel found this Particular proved in relation to both 2(b)(i) and 2(b)(ii) The Registrant has not commented upon the absence of Bone Conduction readings on both the paper and electronic records. There were no Bone Conduction readings in the evidence made available to the Panel. Both Particulars are proven on the same basis.

Particulars 3(a) – 3(d) – found proved
23. The Panel found this Particular proved in its entirety.

24. In relation to Particular 3(a) the Registrant maintains that she did complete a Bone Conduction test which was recorded on GOAL. She makes no comment as to why the results were identical to those from the previous test conducted in 2009. She denies that she performed an Uncomfortable Loudness Level (ULL) test although this is documented on her NOAH entry for the date in question.

25. In relation to Particular 3(b) as noted above the Registrant maintains that she did not conduct a ULL test at all. However the ULL test results on NOAH are documented at 115 dB HL.

26. In relation to Particular 3(c) in the Registrant’s response received 23 December 2015 she disputes the fact that masking was not carried out in accordance with Rules 2 and 3 and believed it to be an IT issue. In her response which was emailed to the HCPTS on 20 September 2017 she stated that she had not performed masking at 4kHz due to the level of masking required. This explanation for not performing masking is not recorded on the audiogram.

27. In relation to Particular 3(d) the Registrant was adamant in her submissions that there was no requirement to complete paper records for existing clients. There was no paper record for this client that had been completed by the Registrant. The most recent paper record had been completed in June 2009 prior to the Registrant’s employment with Amplifon.

Particulars 4(a) – 4(d) – found proved
28. The Panel found this Particular proved in its entirety.

29. In relation to Particular 4(a) the Registrant’s response received 23 December 2015 stated that she carried out an up to date hearing test, however in her response which was emailed to the HCPTS on 20 September 2017 she stated that she did not re-test the client as she believed that the client had been previously tested within six months and therefore there was no need to re-test her hearing. There is an audiogram dated 17 September 2014 which is identical in its readings to that dated 8 April 2014.

30. In In relation to Particular 4(b) the Registrant was adamant in her submissions that there was no requirement to complete paper records for existing clients. There was no paper record for this client that had been completed by the Registrant. The most recent paper record for this client had been completed on 27 October 2010 prior to the Registrant’s employment with Amplifon.

31. In relation to Particular 4(c) the Registrant has not specifically responded to this sub-Particular. There is a very sparse record relating to 15 September 2014 and for the fitting appointment on 30 July 2014.

32. In relation to Particular 4(d) the Registrant has not specifically responded to this sub-Particular. There is no GOAL record of the fitting appointment on 28 August 2014.

Particular 5(a) and 5(b) – found proved
33. The Panel found this Particular proved in its entirety.

34. In relation to Particulars 5(a) and 5(b) in the Registrant’s response, received 23 December 2015, she stated that she did not carry out an up to date hearing test as she believed that the client had been previously tested within six months and therefore this was not required. In her response which was emailed to the HCPTS on 20 September 2017 she stated that she did perform a re-test which was not a duplicate and that this was saved onto GOAL. She attributes this to IT issues.

Particular 6(a) – 6(d) – found proved
35. The Panel found this Particular proved in its entirety.

36. In relation to 6(a), the Registrant denies duplicating the Bone Conduction results for this client. She attributes this issue to IT problems.

37. In relation to 6(b) the Registrant has not responded specifically to this sub-Particular. There is no record of masking being applied under Rule 2 and/or Rule 3.

38. In relation to 6(c) the Registrant has been consistent in disputing this allegation and stating that she did perform and record a NOAH session when fitting the hearing aid for this client. There is no record on NOAH of the Registrant having used the system to fit and configure the hearing aid.

39. In relation to 6(d) the Registrant was adamant in her submissions that there was no requirement to complete paper records for existing clients. There was no paper record for this client that had been completed by the Registrant.

Particular 7(a) – 7(d) – found proved
40. The Panel found this Particular proved in its entirety.  

41. In relation to 7(a)(i) & 7(a)(ii) the Registrant disputes this and states she would have completed Bone Conduction testing however there are no records of Bone Conduction tests being undertaken, either on the paper record or stored electronically.

42. In relation to 7(b) the Registrant states that she would have recorded details of the bilateral fitting however there are no notes recording this fitting.

43. In relation to 7(c) the documentation states that the client had a longstanding medical condition. The Registrant states that the client refused to be referred to a medical practitioner. There is no documentation recording this.

44. In relation to 7(d) in her submissions which were received on 23 December 2015 the Registrant accepted responsibility for not ensuring that the client signed the medical disclaimer, however in her later submission which was received on 20 September 2017 she states that she would have asked the client to sign the disclaimer, however there is no documentation to support this assertion.

Particular 8(a) – 8(d) – found proved
45. The Panel found this Particular proved in its entirety. 

46. In relation to 8(a) the Registrant maintains that she completed a paper record for this client, however none were located and there are no records on GOAL.

47. In relation to 8(b) the Registrant states that she did not undertake Bone Conduction testing of this client due to the difficulty caused by the client’s medical condition (severe dementia). No Bone Conduction readings were attached to the audiogram and there were no explanatory notes regarding the absence of Bone Conduction readings.

48. In relation to 8(c) the Registrant maintains that she did carry out a NOAH session/configuration however there were no NOAH records relating to this appointment. The Registrant attributed this to IT problems.

49. In relation to 8(d) the Registrant maintains that she completed a paper record for this client, however no such records have been located. 

Decision on grounds
50. Having found all of the facts proved, the Panel went on to consider whether they amounted to misconduct and/or lack of competence. The Panel accepted the definition given by Mr Justice Jackson in the case of R v Calhaem v GMC [2007] EWHC 2606 (Admin) para 39 for deficient professional performance and accepted that the definition was applicable to lack of competence:

"Deficient professional performance within the meaning of 35C(2)(b) is conceptually separate both from negligence and from misconduct. It connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the doctor's work.”

51. The Panel also considered whether the facts found proved amounted to misconduct. It bore in mind the misconduct was alleged to have taken place in a clinical setting and accepted the definition as given in the case of Calhaem:

Mere negligence does not constitute "misconduct" within the meaning of section 35C(2)(a) of the Medical Act 1983. Nevertheless, and depending upon the circumstances, negligent acts or omissions which are particularly serious may amount to "misconduct".

And also the case of Remedy UK Ltd V GMC [2010] EWHC 1245 (Admin) (para 37):

it may involve sufficiently serious misconduct in the exercise of professional practice such that it could properly be described as misconduct going to fitness to practise.”
 
52. The Panel took account of the evidence of AB who undertook an audit of the Registrant’s work in September 2013, one month after the Registrant had qualified. At this audit a number of deficiencies in the Registrant’s work were identified which led to the Registrant being asked to review the Amplifon Standards of Professional Practice (2012) via the Amplifon online portal ‘Amplifon Learning’. AB conducted a follow up visit in November 2013 where she observed the Registrant with a client and checked on the Registrant’s progress with the issues that arose from the audit. The Registrant attended a one day training course in May 2014 focusing upon the required clinical skills which included Audiometry (Ear and Bone Conduction) and Masking, which AB oversaw.

53. In the Panel’s view the audit report produced by AB following her audit in September 2013 was very clear in identifying the areas where the Registrant’s work was good or satisfactory and those areas which were deficient. The Panel is unable to comment about the general level of support provided to the Registrant during her first year in practice due to the lack of information in this regard.

54. Particular 1 is very different in nature to the other Particulars within the Allegation. In the Panel’s view the failure by the Registrant to register with the HCPC was not a deliberate act, but rather an error. There is evidence that a colleague observed her complete the HCPC application form shortly after qualifying and the Panel accepts that she did so and posted it to the HCPC. The Registrant’s error was in not chasing up her application with the HCPC. This fact does not meet the threshold for the statutory grounds.

55. In the Panel’s view the conduct found proved in relation to Particulars 2-8 falls well short of the standards to be expected of a registered Hearing Aid Dispenser and is serious in nature. The Allegation relates to the Registrant’s failure to fully conduct the tests required and/or document appropriately these tests. These are fundamental aspects of a clinician’s role and the failure to test and maintain accurate and/or complete records has potentially serious consequences with regard to client management, ongoing care of clients (many of whom are particularly vulnerable) and maintaining trust and confidence in the profession. The Registrant’s failure to conduct and/or document tests appropriately could led to referable medical conditions not being detected with potentially very serious impact upon a client’s health.      

56. The Panel notes that in conducting the audit of the Registrant’s work in September 2014 AB initially chose three files at random and when she found issues of concern in each of these files moved on to review another three files. This process led to a total of seven client records being reviewed, each of which contained issues of concern. These seven files relate to the seven clients detailed within the Allegation. This suggests that the Registrant’s shortcomings were pervasive and even endemic.

57. Although the Allegation contains, what in the Panel’s judgement consists of a fair sample of the Registrant’s work, the Panel is of the view that the failings in relation to Particulars 2-8 do not constitute lack of competence. Issues in relation to record keeping were clearly highlighted to her following the audit in September 2013 and in the follow up visit from AB in November 2013. There is an email from the Registrant to AB following the audit in September 2013 stating how helpful she found the associated audit report. The Panel has also noted the contradictions in the Registrant’s submissions to the HCPC regarding some of the Particulars and is of the view that the Registrant knew what was required of her to perform her role competently, but persistently failed to do so. In the Panel’s view these failures were serious. Therefore the Panel finds that the facts found proved in Particulars 2-8 constituted misconduct.    

Decision on impairment 
58. Having decided that the matters found proved amounted to misconduct, the Panel went on to consider whether if the Registrant’s fitness to practise is currently impaired. It bore in mind the statements given by the Registrant, the submissions made by Mr Paterson, the advice of the Legal Assessor and the HCPTS practice note on ‘Finding that Fitness to Practise is impaired’.

59. The Panel considers that the actions found proved against the Registrant showed that she breached the following standards of the HCPC’s Standards of Performance Conduct and Ethics:
Standard 1 You must act in the best interests of service users.
Standard 4  You must provide (to us and any other relevant regulators) any important information about your conduct and competence.
Standard 10  You must keep accurate records.

60. The Registrant also breached the following standards of the HCPC’s Standards of Proficiency for Hearing Aid Dispensers (Aug 2014):
Standard 2.1  understand the need to act in the best interests of service users at all times
Standard 2.2   understand what is required of them by the Health and Care Professions Council
Standard 2.7   be able to exercise a professional duty of care
Standard 10.1   be able to keep accurate, comprehensive and  comprehensible records in accordance with applicable legislation, protocols and guidelines
Standard 10.2   recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines
Standard 14.2  be able to conduct appropriate diagnostic or monitoring procedures, treatment, therapy, or other actions safely and effectively
Standard 14.3   be able to safely use appropriate techniques and equipment to assess hearing loss and the physical condition of the ear
Standard 14.7   be able to safely and competently programme and physically fit hearing aids
Standard 14.11   be able to gather appropriate information
Standard 14.12  be able to undertake and record appropriate case histories
Standard 14.13  understand the need to make and keep full and accurate records of assessment results, hearing aid prescriptions and actual settings, rehabilitation plans and outcomes
Standard 14.14  be able to select and use appropriate assessment techniques
Standard 14.15  be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment
Standard 14.19  be able to interpret the data arising from case history, physical examination and hearing assessments

61. In considering the question of impairment the Panel took note of and considered the submissions of the Registrant in which she states that her fitness to practise is not impaired. The Registrant has not provided any information in relation to any employment, paid or unpaid, that she has undertaken since the period in question. Nor has she provided any information as to how she has kept her skills and knowledge up to date, including any evidence of Continuing Professional Development.

62. The Panel then considered the two component parts relating to impairment, the ‘personal component’ and the ‘public component’. It first considered the ‘personal component’ which includes whether the conduct is remediable, whether it had been remedied and whether it was likely to be repeated.

63. The Panel considered the questions raised in Cohen vs the GMC in relation to the remediation of identified shortcomings and the risk of repetition. In the Panel’s view the Registrant’s failings are in theory readily remediable, however there is no evidence that the Registrant has taken steps to address her shortcomings in relation to the testing of hearing and record keeping. Given this lack of remediation and the Registrant’s lack of insight there must be a significant risk of repetition. The Panel also notes that the Registrant has largely failed to take responsibility for her failings, to recognise the potential adverse impact upon clients or to express remorse. During the internal employer investigation process and in her submissions to the HCPC she has primarily placed responsibility for the extensive problems identified with her work on her employer’s IT system and he belief that paper records were not required for existing clients. 

64. The Panel also considered the questions raised by Dame Janet Smith in her fifth report from the Shipman enquiry in relation to impairment and fitness to practise. She identified the following as an appropriate test for panels considering the impairment of a doctor’s fitness to practise, which are equally applicable to other health professionals:

• “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 act so as 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
”.    

65. The Panel found that all three questions could be answered in the affirmative in relation to the Registrant’s past conduct and given her lack of remediation and insight; also in relation to the future.

66. The Panel found that the Registrant’s fitness to practise is impaired with regard to the ‘personal component’.

67. With regard to the ‘public component’, in the Panel’s judgement given the extensive failings of the Registrant combined with her lack of insight and remediation a reasonable and fully informed member of the public would be dismayed if a finding of impairment was not made. Consequently a failure to make such a finding would undermine public confidence in the profession and the regulatory process. The Panel was also mindful of the need to uphold and maintain standards within the profession. Consequently the Panel has also found that the Registrant’s fitness to practise is impaired on the ‘public component’.   

Decision on sanction
68. Having found that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel went on to consider the question of sanction. It heard submissions from Mr Paterson. It bore in mind all of the evidence including that given by the Registrant in her written submissions. Before reaching its decision, the Panel considered the HCPTS Indicative Sanctions Policy and accepted the advice of the Legal Assessor.

69. The Panel first considered the aggravating and mitigating factors in this case. It identified the following aggravating factors:
• The Registrant had been subject to an audit in September 2013 when she received detailed feedback setting out her deficiencies in relation to her testing and recording and she was required to undertake training. This was supplemented by a follow up meeting in November which she acknowledged was helpful. The Registrant had made positive progress at this time and was clear about what was required of her.

• The Registrant was fully aware of the HCPC standards and the Amplifon Standards of Professional Practice but failed to adhere to them.

• The Registrant’s extensive failings created a real risk of harm to her clients, many of whom were very vulnerable.

• The Registrant’s failings were persistent and pervasive in relation to testing client’s hearing and record keeping and in the absence of insight there is a high risk of repetition.

• The Registrant has failed to take responsibility for her wide-ranging failings and has instead sought to attribute them to her employer’s IT system. She also maintained, contrary to the evidence of AB, that she was not required to keep paper records.

70. The Panel identified the following mitigating factor:
• The Registrant has engaged with her employer’s disciplinary process and the HCPC fitness to practise process, including making submissions to this hearing.

Sanctions
71. The Panel has found that the Registrant continues to present a risk of harm to the public and she has damaged the reputation of the profession. In view of the above the Panel has considered what sanction, if any, should be applied. It applied the principles of proportionality and considered the sanctions in ascending order of seriousness.

No Further Action
72. The safety of the public and wider public interest would not be protected if the Panel were to take no further action in a case of this seriousness.

Mediation
73. This course of action is not appropriate in this case.

Caution Order
74. Caution Orders are appropriate in cases where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence and the Registrant has shown insight and taken appropriate remedial action. In the Panel’s view none of these criteria apply in this case and a Caution Order would not provide sufficient public protection or satisfy the public interest.

Conditions of Practice Order
75. In her written submissions the Registrant provided no information with regard to any work, paid or unpaid, that she has undertaken since the time of the events that led to this hearing. Nor has she provided any information as to whether or how she has kept her skills and knowledge up to date. Whilst the Panel has found that the Registrant’s shortcomings are capable of being remedied, given her lack of insight and the absence of any indication that the Registrant would adhere to any conditions imposed this means that there are no workable conditions that could be formulated and hence a Conditions of Practice Order is not appropriate.

Suspension Order
76. The Panel has found that the Registrant’s conduct placed clients at risk of harm. Given that the Panel has found that there is a real risk of repetition any sanction imposed must provide an adequate degree of public protection and satisfy the public interest, given the serious nature of the shortcomings identified. The Panel has borne in mind the need for proportionality and balancing the interests of the Registrant with that of the public. In the Panel’s view there are no psychological or other difficulties preventing the Registrant from understanding and seeking to remedy her failings.

77. The Panel is of the view that a Suspension Order of twelve months is the appropriate sanction.  The Panel has chosen that period in order to emphasise the serious nature of the matters found proved and also to allow the Registrant adequate time to remedy her shortcomings and show she is capable of safe practice as a Hearing Aid Dispenser.

Striking Off Order
78. A Striking Off Order is a sanction of last resort. Whilst there are persistent failings in this case the Panel considers such an order is not necessary to protect the public or satisfy the public interest. Although the Panel has found that the Registrant has demonstrated a lack of insight into her failings there is no reason to believe that this insight cannot be developed or that the Registrant’s shortcomings cannot be remedied. The Panel is mindful that the issues in question arose just after the end of the Registrant’s first year as a qualified Hearing Aid Dispenser and, given her inexperience, is of the view that there is no reason why she cannot potentially return to the profession in the future. Taking all matters into consideration the imposition of a Striking Off Order would be disproportionate and punitive.

79. A future reviewing panel may be assisted by:
• The Registrant attending in person
• The Registrant providing references from any employment, paid or unpaid, that she has undertaken since the events in question
• Evidence of any CPD undertaken

Order

That the Registrar is directed to suspend the registration of Miss Suzanne Boyce for a period of 12 months from the date this order comes into effect.

Notes

The order imposed today will apply from 25 October 2017 (the operative date).

This order will be reviewed again before its expiry on 25 October 2018.

Hearing history

History of Hearings for Miss Suzanne Boyce

Date Panel Hearing type Outcomes / Status
25/09/2017 Conduct and Competence Committee Final Hearing Suspended