UKCP’s Complaints and Conduct Process
Complaint Hearing
20 – 24 June 2016
4-6 July 2016
Resource for London
356 Holloway Road
London
N7 6PA
Name of Registrant:
Vesna Mandic-Bozic
Heard by:
Adjudication Panel
Panel Members:
Sandra Marcantonio [Lay Chair]
Jonathan Salisbury [HIPC]
Diane Cunningham [CPJA]
Legal Assessor:
John Donnelly [2 Bedford Row]
Panel Secretary:
Amy Coates, UKCP
UKCP Presenting Officer: Thomas Daniel [2 Bedford Row]
Registrant:
Registrant present. Represented by Andrew Campbell-Tiech QC
[Drystone Chambers]
Facts found proved:
1a, 1b, 2a, 2b, 2c, 2d, 2e, 3a, 3b, 3c, 4a, 4b, 5ai, 5aii, 7ai, 7aiii, 7b,
7c, 8a, 8b, 8c, 9a, 9b, 9c, 9d
Facts found not proved:
5aiii, 5aiv, 5av, 5avi, 6a, 6b, 6c, 7aii
Misconduct found proved: 1a, 1b, 3c, 8a, 8b, 8c, 9a, 9b, 9c, 9d
Panel decision:
Misconduct found proved
No current impairment found
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Detail of allegations
1. That the Registrant, whilst acting in the capacity of a registered UKCP psychotherapist between
2011-2014, engaged in the following behaviour:
a. Failed to take responsibility for respecting the best interests of Patient A, by way of allowing
her to drive her personal car in Richmond Park. This constitutes a breach of code 1.1 of
UKCP’s Ethical Principles and Code of Professional Conduct.
b. Confused the existing therapeutic relationship with Patient A, by way of allowing Patient A to
drive her personal car in Richmond Park. This constitutes a breach of code 1.5 of UKCP’s
Ethical Principals and Code of Professional Conduct.
2. That the Registrant, whilst acting in the capacity of a registered UKCP psychotherapist between
2011-2014, engaged in the following behaviour:
a. Confused the existing therapeutic relationship with Patient A, by way of giving Patient A a
bottle of her perfume. This constitutes a breach of code 1.5 of UKCP’s Ethical Principals and
Code of Professional Conduct.
b. Confused the existing therapeutic relationship with Patient A, by way of giving Patient A a
Porsche umbrella from her car. This constitutes a breach of code 1.5 of UKCP’s Ethical
Principals and Code of Professional Conduct.
c. Confused the existing therapeutic relationship with Patient A, by way of giving Patient A a
Christmas jumper. This constitutes a breach of code 1.5 of UKCP’s Ethical Principals and
Code of Professional Conduct.
d. Confused the existing therapeutic relationship with Patient A, by way of giving Patient A
home-made cakes whilst she was an inpatient at the Priory. This constitutes a breach of code
1.5 of UKCP’s Ethical Principals and Code of Professional Conduct.
e. Confused the existing therapeutic relationship with Patient A, by way of lending Patient A her
iPad whilst she was an inpatient at the Priory. This constitutes a breach of code 1.5 of
UKCP’s Ethical Principals and Code of Professional Conduct.
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3. That the Registrant, whilst acting in the capacity of a registered UKCP psychotherapist between
2011-2014, engaged in the following behaviour:
a. Confused the existing relationship with Patient A, by way of sending her a number of personal
photos, including photos of her face, her grandchildren, and her garden. This constitutes a
breach of code 1.5 of UKCP’s Ethical Principals and Code of Professional Conduct.
b. Confused the existing relationship with Patient A, by way of using inappropriate language in
text messages and e-mails to Patient A, including ‘Love Vesna’ and ‘Vx’. This constitutes a
breach of code 1.5 of UKCP’s Ethical Principals and Code of Professional Conduct.
c. Confused the existing relationship with Patient A, by way of encouraging the use of texting
and e-mail contact between sessions with Patient A. This constitutes a breach of code 1.5 of
UKCP’s Ethical Principals and Code of Professional Conduct.
4. That the Registrant, whilst acting in the capacity of a registered UKCP psychotherapist between
2011-2014, engaged in the following behaviour:
a. Confused the existing relationship with Patient A, by way of disclosing personal information,
including information regarding her interests and family life. This constitutes a breach of code
1.5 of UKCP’s Ethical Principals and Code of Professional Conduct.
b. Failed to consider the effect that her personal conduct had on the therapeutic relationship
with the client; in particular the way that disclosing personal information to Patient A may
have negatively affected the therapeutic relationship. This constitutes a breach of code 4.1 of
UKCP’s Ethical Principals and Code of Professional Conduct.
5. That the Registrant, whilst acting in the capacity of a registered UKCP psychotherapist between
2011-2014, engaged in the following behaviour:
a. Confused the existing relationship with Patient A, by way of initiating physical touching with
Patient A including:
i.
Holding her hand;
ii.
Wiping her nose;
iii.
Rubbing her legs;
iv. Running her hand through her hair;
v.
Giving full body hugs; and
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vi. Rubbing her forehead.
The above behaviour constitutes a breach of code 1.5 of UKCP’s Ethical Principals and Code
of Professional Conduct.
b. Failed to respect the best interests of Patient A, by way of initiating physical touching with
Patient A as outlined in 5a above. This constitutes a breach of code 1.1 of UKCP’s Ethical
Principals and Code of Professional Conduct.
c. Failed to respect Patient A, by way of initiating physical touching with Patient A as outlined in
5a above. This constitutes a breach of code 1.2 of UKCP’s Ethical Principals and Code of
Professional Conduct.
d. Failed to consider the effect that her personal conduct had on the therapeutic relationship
with the client; in particular the way that initiating physical touching with Patient A as outlined
in 5a above may have affected the way you were experienced by the client. This constitutes a
breach of code 4.1 of UKCP’s Ethical Principals and Code of Professional Conduct.
6. That the Registrant, whilst acting in the capacity of a registered UKCP psychotherapist between
2011-2014, engaged in the following behaviour:
a. Confused the existing relationship with Patient A, by way of permitting and encouraging
sexually flirtatious behaviour from Patient A. This constitutes a breach of code 1.5 of UKCP’s
Ethical Principals and Code of Professional Conduct.
b. Failed to consider the effect that her personal conduct had on the therapeutic relationship
with the client; in particular the way that encouraging sexually flirtatious behaviour from
Patient A may have affected the way you were experienced by the client. This constitutes a
breach of code 4.1 of UKCP’s Ethical Principals and Code of Professional Conduct.
c. Confused the existing relationship with Patient A, by way of sitting next to Patient A on her
bed whilst she was an in-patient at the Priory. This constitutes a breach of code 1.5 of
UKCP’s Ethical Principals and Code of Professional Conduct.
7. That the Registrant, whilst acting in the capacity of a registered UKCP psychotherapist between
2011-2014, engaged in the following behaviour:
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a. Failed to respect Patient A, by way of appearing to resent or attribute blame towards Patient
A as follows:
i.
Made comments that suggested that Patient A did not want to get better;
ii.
Told Patient A she was responsible for her ‘burn out’;
iii.
Made comments that Patient A was responsible for additional personal time you
spent attending conferences and reading about her condition.
This constitutes a breach of code 1.2 of UKCP’s Ethical Principals and Code of Professional
Conduct.
b. Failed to respect Patient A, by way of raising the issue of fees and invoicing in an
inappropriate way. This constitutes a breach of code 1.2 of UKCP’s Ethical Principals and
Code of Professional Conduct.
c. Failed to consider the effect that her personal conduct had on the therapeutic relationship
with the client; in particular the way that making the comments outlined in 7a above may have
affected the way you were experienced by the client. This constitutes a breach of code 4.1 of
UKCP’s Ethical Principals and Code of Professional Conduct.
8. That the Registrant, being aware that Patient A had lodged a complaint against you with UKCP
on 19 January 2015 that contained allegations of breach of boundaries, engaged in the following
behaviour in November 2015:
a. Confused the existing relationship with Patient A by way of viewing Patient A’s LinkedIn
profile on 18 November 2015. This constitutes a breach of code 1.5 of UKCP’s Ethical
Principals and Code of Professional Conduct.
b. Failed to treat Patient A with respect, by way of viewing Patient A’s LinkedIn profile on 18
November 2015. This constitutes a breach of code 1.2 of UKCP’s Ethical Principals and
Code of Professional Conduct.
c. Intimidated and harmed Patient A by way of viewing Patient A’s LinkedIn profile on 18
November 2015. This constitutes a breach of code 1.8 of UKCP’s Ethical Principals and
Code of Professional Conduct.
d. Failed to acknowledge the way her personal conduct negatively affected Patient A, namely
her ‘following’ Patient A on Twitter on Sunday 14 February 2016. This constitutes a breach
of code 4.1 of UKCP’s Ethical Principals and Code of Professional Conduct.
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9. That the Registrant, being aware that Patient A had lodged a complaint against her with UKCP
on 19 January 2015 that contained allegations of breach of boundaries, engaged in the following
behaviour in February 2016:
a. Confused the existing relationship with Patient A, namely that of an ex-client, by way of
‘following’ Patient A on Twitter on Sunday 14 February 2016. This constitutes a breach of
code 1.5 of UKCP’s Ethical Principals and Code of Professional Conduct.
b. Failed to treat Patient A with respect, by way of ‘following’ Patient A on Twitter on Sunday 14
February 2016. This constitutes a breach of code 1.2 of UKCP’s Ethical Principals and Code
of Professional Conduct.
c. Intimidated and harmed Patient A by way of ‘following’ Patient A on Twitter on Sunday 14
February 2016. This constitutes a breach of code 1.8 of UKCP’s Ethical Principals and Code
of Professional Conduct.
d. Failed to acknowledge the way her personal conduct negatively affected Patient A, namely
her ‘following’ Patient A on Twitter on Sunday 14 February 2016. This constitutes a breach
of code 4.1 of UKCP’s Ethical Principals and Code of Professional Conduct.
Preliminary Matters
1. The complaint was heard under the UKCP Complaints and Conduct Process 2012, and the panel
considered the alleged breaches of the UKCP Code of Ethics and Professional Conduct 2009.
2. The panel considered the following preliminary matters:
a. The UKCP bundle amounted to 256 pages. The bundle will herein be referred to as Bundle
1.
b. The Registrant provided two unpaginated bundles that will be referred to as Bundle 2 (195
pages) and Bundle 3 (460 pages).
c. The panel were further provided with the following supplementary documents by the
Registrant:
i.
A collection of documents amounting to 24 pages. This will herein be referred to as
Bundle 4;
ii.
3 pages of excerpts from Patient A’s Priory records;
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iii.
An ‘Aide Memoire’ to assist the panel with the fact finding stage, amounting to 8
pages;
iv.
Submissions on misconduct, part 1 & 2, amounting to 31 and 12 pages respectively;
and
v.
A draft interim order relating to Judicial Review proceedings between the Registrant
and the British Association for Counselling and Psychotherapy.
d. The panel were further provided with the following supplementary documents by the UKCP:
i.
Witness statement of Samantha Lind, amounting to 4 pages; and
ii.
Submissions on misconduct amounting to 38 pages.
e. The panel was aware that a preliminary hearing had been held on 26 April 2016.
Determination on the facts
1. The panel considered all of the documentary evidence before it, and heard oral submissions from
Mr Daniel on behalf of UKCP and Mr Campbell-Tiech QC on behalf of the Registrant.
2. The panel also heard evidence from the following witnesses: Patient A on behalf of UKCP; Mrs
Vesna Mandic-Bozic, Mr Branko Bozic, Mr Paul Hitchings, Ms Karen Harris, and Dr Anne Kearns on
behalf of the Registrant. The panel considered the credibility of each of the witnesses it had heard
and noted the eight written and signed testimonials provided on behalf of the Registrant.
3. The panel heard and accepted the advice of the Legal Assessor, directed the panel to the
following case authorities:
a. Re B (Children) (Care Proceedings: Standard of Proof) (CAFCASS intervening) [2008] 3
WLR 1: [2009] 1 AC 11
b. Moseka v Nursing and Midwifery Council [2014] EWHC 846 (Admin)
c. Suddock v Nursing and Midwifery Council [2015] EWHC 3612 (Admin)
4. On balance, having fully considered the above, the Panel made the following findings:
a. Allegation 1a – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
b. Allegation 1b – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
c. Allegation 2a – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
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d. Allegation 2b – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
e. Allegation 2c – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
f.
Allegation 2d – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
g. Allegation 2e – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
h. Allegation 3a – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
i.
Allegation 3b – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
j.
Allegation 3c – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
k. Allegation 4a – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
l.
Allegation 4b – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
m. Allegation 5ai – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
n. Allegation 5aii – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
o. Allegation 5aiii – found not proved
Patient A’s oral evidence suggested that the touching had been through a thin sheet. The
panel noted that this was inconsistent with the entry contained within the Priory investigation
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report, dated 05/12/2014, which recorded that Patient A described the Registrant having
gently rubbed her legs through her duvet.
The panel also had the benefit of the Registrant’s Nursing Observation Sheet which
appeared to have been completed in considerable detail and reflected that observations
were being conducted every 60 minutes. The Registrant’s visit is recorded at 18:00 hours.
The panel considered that this document was an accurate record of the Registrant’s
behaviour and state during this time and did not serve to support the suggestion of
inappropriate touching as alleged. The panel noted that the Registrant accepted that she
had sat on Patient A’s bed. The panel further noted that there was no entry in the Patient
A’s diary which referenced this alleged behaviour. In all the circumstances the panel
considered that there was insufficient evidence to support this allegation.
p. Allegation 5aiv – found not proved
The panel noted that in the course of her evidence Patient A conceded that this did not
happen and demonstrated the nature and the action of the Registrant touching her hair. The
panel was satisfied in keeping with the evidence provided by Patient A that this was not
inappropriate, did not extend to running her hand through her hair and had been in the
nature of a soothing touch. The panel therefore was not satisfied that there had been any
evidence to support this allegation.
q. Allegation 5av – found not proved
The panel considered this allegation and noted that Patient A had suggested that the full
body hug had resulted in both Patient A and the Registrant having contact breast-to-breast.
The panel could not help but notice that there is a significant height difference between the
respective parties and that this description did not fit easily with this aspect of the evidence.
The panel therefore found there was insufficient independent evidence to support this
allegation.
r.
Allegation 5avi – found not proved
Patient A’s evidence included a demonstration of the action and did not amount to rubbing
as such. The panel was satisfied that this allegation was not sustained by the evidence and
therefore not proved.
s. Allegation 6a – found not proved
The panel considered that allegation 6a & b contained two allegations each.
One of
‘permitting’ and a second of ‘encouraging’ sexually flirtatious behaviour. The panel noted
that the Registrant accepted that some flirtatious behaviour had been permitted but had
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denied any encouragement at all.
The panel particularly noted Patient A’s comments
contained within her letter dated 06/03/2011 to the Registrant in which she described the
Registrant as “solidly unavailable”. The panel considered that this entry served to support
the Registrant’s stance that there had been no encouragement of flirtatious behaviour. In
addition to this entry the panel noted in a letter to the Registrant from Patient A dated
30/04/2011 where Patient A had stated “I know you are not interested in returning flirtatious
behaviour”.
t.
Allegation 6b – found not proved
Dealing with 6a & 6b, the panel considered that both of these statements were particularly
telling and wholly undermined the suggestion that there had been any encouragement of
sexually flirtatious behaviour by the Registrant and as such these allegations are not proved.
u. Allegation 6c – found not proved
The panel considered that the behaviour referred to in allegation 6c was not sexualised and
further noted in the entries of the Nursing Observation Sheet which records the Registrant’s
visit between 1800 and 1900 hours where Patient A is noted to be smiling during the
meeting, requesting a cup of water which was given, and that this was a time when the
Patient A was regarded as high risk and in receipt of a cocktail of medication. The panel
was satisfied that there was insufficient evidence to support this allegation.
v. Allegation 7ai – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
w. Allegation 7aii – found not proved
The panel recognised that Patient A in the course of a letter dated August 2014 to the
Registrant had included the phrase “I hear you when you say you are burnt out and for that I
apologise”. The panel is not satisfied that this necessarily reflected that the Registrant had
told Patient A that she was necessarily responsible for the burn out but more likely that
Patient A may have picked up the fact that the Registrant was exasperated in all the
circumstances and context but was not satisfied that it had been said in those terms to
Patient A.
x. Allegation 7aiii – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
y. Allegation 7b – found proved
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This allegation was found proved by way of admission, although no misconduct is admitted.
z. Allegation 7c – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
aa. Allegation 8a – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
bb. Allegation 8b – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
cc. Allegation 8c – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
dd. Allegation 9a – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
ee. Allegation 9b – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
ff. Allegation 9c – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
gg. Allegation 9d – found proved
This allegation was found proved by way of admission, although no misconduct is admitted.
5. The Panel recognised that Mr Daniel had identified a number of features within the allegations
which had been admitted and which were not consistent with the Registrant’s account. The
Panel was mindful that these may be subject to further submissions at the next stage of
proceedings.
6. In total the Panel found 25 breaches of UKCP’s Ethical Principles and Code of Professional
Conduct proved.
Determination on misconduct
1. This determination should be read in accordance with the Panel’s previous determinations.
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2. In accordance with rule 9.22.5 of UKCP’s Complaints and Conduct Process, the panel then went
on to consider the question of misconduct for those charges found proved. In addressing this
question the panel took into account of the relevant information before it.
3. The panel was provided with written submissions from Mr Daniel on behalf of UKCP, amounting
to 38 pages and from Mr Campbell-Tiech QC on behalf of the Registrant, amounting to 43 pages.
4. Mr Daniel on behalf of UKCP invited the Panel to conclude that the facts found proved constitute
misconduct. Mr Daniel reminded the panel that no ruling has been given in relation to the disputed
facts of the charges that were admitted by the Registrant. Mr Daniel summarised the disputed facts
of the charges, and invited the panel to consider each charge separately in order to determine the
disputed conduct before making a determination on misconduct.
5. Mr Campbell-Tiech QC on behalf of the Registrant invited the panel to consider each charge
separately. He invited the panel to first consider whether ‘the Registrant’s conduct in context fell far
below the standard to be expected of the reasonably competent therapist and thus constituted
misconduct’, and if so, whether ‘the Registrant’s misconduct encompassed all elements of the
allegation’. Mr Campbell-Tiech QC addressed the disputed facts of the admitted charges, and
proposed a series of questions for the panel’s consideration.
6. The Panel accepted the advice of the Legal Assessor as to the approach it should adopt in
considering the question of misconduct. The Panel recognised that the question of misconduct is a
matter of independent judgement and is not a matter of proof for the parties.
7. In addressing whether the facts proved amounted to misconduct, the Panel had regards to the
words of Lord Clyde in the case of Roylance v. General Medical Council. He stated:
“Misconduct is a word of general effect, involving some act or omission which falls short of what
would be proper in the circumstances. The standard of propriety may often be found by reference to
the rules and standards ordinarily required by…a practitioner in the particular circumstances.”
8. The Legal Assessor also directed panel to the authority of Schodlok v The General Medical
Council [2015] EWCA Civ. 769 (21 July 2015), particularly the comments of Lord Justice Beaton:
“Where there are a large number of findings of non-serious misconduct, particularly where they are
of the same or similar misconduct…it should in principle be open for a Fitness to Practise Panel to
find that, cumulatively, they are to be regarded as serious misconduct capable of impairing a
doctor's fitness to practise.” The panel were reminded that this should only be in exceptional
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circumstances, and agreed to allow both Mr Campbell-Tiech QC and Mr Daniel to make
representations if they were mindful to pursue this avenue of misconduct.
9. In light of the above, the Panel determined that:
a. Allegation 1a&b: The Panel was mindful that the facts in respect of both allegation 1a&b
were agreed between the parties. The Panel noted that this driving incident at Richmond
Park had not been particularised in that no date had been identified, albeit that there had
been evidence to suggest that it had occurred on 2 May 2014.
To allow a patient to drive a sports car in a public place (even a similar model to the one
normally driven by Patient A) was not considered by the Panel to have been appropriate.
The circumstances were aggravated by the fact that this incident had taken place when
Patient A had an extensive history of driving at speed, and had been threatening suicide. All
parties had been aware of Patient A’s vulnerability in this regard and there had been protocol
established at the Priory where Patient A had to provide her car keys prior to sessions. The
panel also noted that it was not until the Priory investigation that this incident came to light
and that the Registrant’s regret for her activities was a little slow.
The panel also noted with some concern, that the Registrant had failed to disclose this
matter to her supervisor, Mr Paul Hitchings, and whilst it might be said that this stems from
the Registrant’s embarrassment, this was not a view which the panel adopted. The panel
did consider the evidence of both Mr Hitchings and Dr Kearns who readily accepted that in
the ordinary course of events in their view, such behaviour would amount to misconduct but
not in the case of Patient A in the light of her pathology.
The panel did further consider Patient A’s evidence but again was mindful of the timing of
this event in terms of Patient A’s particularly vulnerable state and the written policy that the
Priory had produced in respect of car keys. The panel recognised that Patient A had been
particularly manipulative and Karen Harris gave evidence in this regard. The panel also
recognised that this incident may have arisen when the Registrant was out of her depth.
The suggestion that to have denied Patient A would have ruptured the relationship and that
a boundary extension of this nature was therefore justified was not a view that the panel
accepted.
The Registrant should have known better in all the circumstances, and whilst it
may be submitted that the Priory team had not been particularly supportive of the Registrant,
there were other options which the Registrant could and should have adopted. To have
permitted Patient A to drive the Registrant’s car on a road in a public park with a history of
Patient A’s erratic driving behaviour there seems no justification of this very unusual
approach. The panel is satisfied that both 1a&b amount to misconduct.
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b. Allegation 2a: The panel considered the disputed facts and was satisfied that the Registrant
had given Patient A a bottle of perfume as a gift with the best intentions and as a therapeutic
tool at a specific time, when Patient A was entering hospital. In those circumstances the
panel found that there was no misconduct.
c. Allegation 2b:
The panel considered the disputed facts and noted that there was
considerable divergence of evidence as to whether the umbrella was new, in a box, and in
what circumstances in which it had been given by the Registrant. The panel did not consider
it to be a therapeutic tool but did recognise that both the Registrant and Patient A both drove
Porsche motor vehicles and the panel concluded that there had been no motive for the gift
other than it was just given. In those circumstances the panel found that there was no
misconduct.
d. Allegation 2c: The panel considered the disputed facts and is satisfied that the provision of
the jumper at Christmas in the specific circumstances was not unusual.
The panel
particularly noted the views of Dr Anne Kearns and the suggestion that these are the kind of
things you do. The panel also noted that Patient A had never brought presents for the
Registrant. In these circumstances that panel was satisfied there was no evidence of a dual
relationship and that there had been no misconduct in the provision of this gift, or indeed any
of the others.
e. Allegation 2d: The panel considered the disputed facts and was satisfied that this did not
breach any protocol and was provided with the best intention, particularly given the
diagnosis of Patient A.
In those circumstances the Panel found that there was no
misconduct.
f.
Allegation 2e: The panel considered the disputed facts and was satisfied that the iPad had
been provided to Patient A as a therapeutic tool and therefore did not amount to misconduct.
g. Allegation 3a: The panel considered the disputed facts and was satisfied that in providing
the Patient A with a range of photographs was both exceptional and ill-advised, particularly
those of the Registrants grandchildren and could not be regarded as a therapeutic tool. The
panel also noted that some of the photographs had not been provided at crisis points.
However, whilst the panel considered this behaviour to be ill-advisable it did not amount to
misconduct in the circumstances.
h. Allegation 3b: No longer an issue.
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i.
Allegation 3c: The panel considered the provision of the use of texting and email contact
between sessions to be a boundary violation which brought with it concerns for patient
safety. The panel did note that the Registrant had tried to stop communication but equally
the panel had concerns with what the patient might do next and how Patient A might
interpret, receive and understand the emails.
The panel also distinguished this
communication, as opposed to the photographs in 3a, because it involved two-way
engagement between the parties and was open to misinterpretation.
In all the
circumstances the panel did consider that this fell far below standard expected and did
amount to misconduct.
j.
Allegation 4a: The panel considered the disputed facts and was satisfied that the personal
information disclosed to Patient A was safe and the sort of information that might be
disclosed, was in effect both social and cultural and not personal. The panel considered the
same provisions applied for 4b.
The panel was satisfied that this did not amount to
misconduct.
k. Allegation 4b: The panel considered the disputed facts and was satisfied that the personal
information disclosed to Patient A was safe and the sort of information that might be
disclosed was in effect both social and cultural and not personal. The panel considered the
same provisions applied for 4a.
The panel was satisfied that this did not amount to
misconduct.
l.
Allegation 5a(i-vi): The panel considered the disputed facts and was satisfied in respect of
5a(i-vi) that these actions were therapeutic and were particularly demonstrated in evidence
to the panel and in the circumstances the touching appeared to be appropriate and did not
fall below the standard expected.
m. Allegation 5b: In light of the findings this allegation is no longer an issue
n. Allegation 5c: In light of the findings this allegation is no longer an issue
o. Allegation 5d: In light of the findings this allegation is no longer an issue
p. Allegation 6a: The panel considered the disputed facts and was satisfied that in permitting
flirtatious behaviour from Patient A there had been no element of grooming. The Registrant
15
had been described as solidly unavailable by Patient A and in the context of this allegation
the panel was satisfied that no misconduct arose.
q. Allegation 6b: In light of this the panel was equally satisfied that no misconduct arose.
r.
Allegation 6c: The panel found no issue in respect of allegation 6c from the evidence that
had been provided, the behaviour of the Registrant sitting on the bed which had possibly
been witnessed by an attending nurse, Patient A’s health at the time as the medical notes of
the attending nurse, all of which satisfied the Panel that no misconduct had arisen.
s. Allegation 7ai: The panel considered the disputed facts and particularly noted and endorsed
Mr Campbell-Tiech submissions, paragraphs 148-152, which detailed the consideration of
sabotage, addressed Patient A’s self-sabotage, and the matters discussed in supervision
with Dr Hopley. The panel found no evidence of misconduct.
t.
Allegation 7aii: The panel found no evidence that the Registrant had used the word ‘burn
out’ and accordingly no issue of misconduct arose.
u. Allegation 7aiii: The panel considered the disputed facts and particularly noted in an email
from the Registrant, dated 9 March 2014, page 144 of Bundle 1, which clearly sets out her
stance on additional and extra sessions which amounted to a lot of unpaid time. The panel
particularly noted the final endorsement of the paragraph which appears to be highlighted in
yellow dealing with the subject of additional therapy session, which had apparently been
taken for granted, where the Registrant concludes “enough is enough”. The panel did
consider that these matters should not have been dealt with by email but in the session and
again this was ill-conceived but did not amount to misconduct.
v. Allegation 7b: The panel considered the disputed facts and that Patient A had been allowed
to control any invoicing and had in effect been empowered by this unusual position. The
panel had some sympathy for the Registrant that in all the circumstances Patient A had been
put into this controlling position. No misconduct arises in the circumstances.
w. Allegation 7c: In light of the findings in respect of allegation 7a, no misconduct followed in
considering allegation 7c.
x. Allegation 8a,b,c&d:
The panel considered the disputed facts in respect of allegations
8a,b,c&d and recognised that these events took place after the complaint had been raised
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and whilst Patient A was still at the Priory. Patient A detailed the distress that the LinkedIn
incident had upon her in her statement dated 19 February 2016 of Bundle 1 (page 239).
The panel considered this behaviour to be inappropriate and whilst it may well be that the
Registrant may not be particularly familiar with the LinkedIn protocols, the panel considered
it far more telling that the Registrant had engaged in this activity at all in viewing Patient A’s
profile. The panel was satisfied that an investigation of this type by the Registrant was a
serious breach of the standard expected and as such allegations 8a,b&c, served to confuse
the relationship with Patient A, failed to treat Patient A with the necessary respect and
intimidated and harmed Patient A as set out in her statement. The panel was satisfied that
this amounted to misconduct.
y. Allegation 9a,b,c&d:
The panel considered the disputed facts in respect of allegations
9a,b,c&d and that these allegations represented a breach of boundaries. The panel did note
that these events took place on the 14 February, namely Valentine’s Day, and there was a
strong inference that the date was both significant and poignant. The panel further noted
that this incident took place some nine days before the preliminary hearing of this matter.
The panel considered that this was not accidental and these actions would inevitably cause
stress to Patient A, recognising the Twitter entry on Patient A’s phone which read
“@VesnaMB is now following you!”. In all the circumstances the panel was satisfied that this
behaviour amounted to a breach of the Codes 1.2, 1.5 and 4.1 and was so serious as to
amount to misconduct.
z. The panel considered these allegations separately and regarded each individually and
considered that each amounted to misconduct and did not assess them collectively.
Determination on impairment
1. The panel then went on to consider the question of impairment. This determination should be
read in accordance with the Panel’s previous determinations.
2. The Panel applied the approach as set out in the 5th Shipman Enquiry and Dame Janet Smith’s
approach to determine the question of impairment.
“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance,
adverse health, conviction, caution or determination show that his/her fitness to practise is impaired
in the sense that s/he:
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
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b. Has in the past brought and/or is liable in the future to bring the medical 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 medical profession; and/or
d. Has in the past acted dishonestly and/or is liable to act dishonestly in the future.
(Albeit that there is no allegation of dishonesty in this case)
4. The panel further considered the wider public interest and whether confidence in the profession
and the UKCP as a regulator would be undermined if there was no finding of impairment. The panel
recognised the extreme circumstances and context of this matter, a particularly demanding and
vulnerable patient, who displayed manipulative characteristics. The panel did consider the
Registrant to have been trying to do her best, but considered that at times she had lacked the
support of the Priory and appeared out of her depth. The panel approached the question of
impairment, mindful that current impairment means as of today.
5. Thereafter the panel adopted three-step process in accordance with the authority of Cohen v
General Medical Council [2008] EWHC 581 Admin, namely:
“Is the Registrant’s behaviour capable of remediation; has it been remediated; and what is the risk
of repetition?”
a. Is the behaviour capable of remediation?
The panel was satisfied that the nature of the Registrant’s misconduct was capable of
remediation. The panel considered the nature of the respective breaches and considered
that they were all capable of remediation.
b. Has it been remediated?
During the course of the hearing the panel had received evidence from Karen Harris,
Practice
Manager
at
Putneymead
Medical
Practice,
who
gave
firsthand
and
contemporaneous evidence of the Registrant’s current working regime, which was most
supportive.
The panel also particularly considered the testimonial from Dr McKenzie,
Partner at Putneymead Medical Practice, who again spoke of the Registrant, and the
quarterly reports provided. Whilst the most recent report was December 2015, the panel
benefited from a witness who has regular contact with the Registrant and equally remains
supportive. The panel also considered the other testimonials which had been submitted
including her supervisors and colleagues. In light of this material and that of the Registrant
in her evidence, the panel was satisfied that these breaches had been remediated.
c. What is the risk of repetition?
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The panel recognised that some of the allegations occurred as recently as November 2015
and February 2016 nevertheless. The panel noted the Registrant’s regret as to some
aspects of her behaviour, notably surrounding the Porsche allegations. The Registrant has
embraced the due-process of this hearing, being the subject of investigation at the Priory
and given evidence before the panel. This process has inevitably taken a considerable
time and equally will have a salutary impact.
The panel is satisfied that any risk of
repetition in those circumstances is relatively low. The panel felt sure that the Registrant
as a result of this salutary experience would be taking steps to maintain the frequency of
her supervision and benefiting from therapeutic support.
8. In addressing the issues of current impairment, the panel also had regard to issues of insight.
The panel considered that the Registrant had shown some insight, had engaged with the process,
made some admissions and in the course of her evidence had again shown some insight.
9. The panel then went on to consider the wider public interest and whether an onlooker, fully aware
of all the facts, would consider that confidence in the profession and the UKCP as regulators has
been undermined.
The panel was satisfied that a well-informed onlooker in these particular
circumstances and the context of this matter would not lose confidence in the profession or the
UKCP as a regulator.
10. In light of the above, the panel concluded that there is no current impairment and therefore this
matter is concluded.
Publication of decision
1. The Panel has been invited to consider the appropriate publication or otherwise, by Mr CampbellTiech QC on behalf of the Registrant.
2. In considering this application, the panel was directed to the following documents:
a. The UKCP Publication of Decisions Policy, Version 5, dated 5 January 2016, paragraphs
13-16; and
b. The UKCP Complaint and Conduct Process 2015, clause 9.33.
3. The Panel hear oral submissions from Mr Campbell-Tiech QC and Mr Daniel on behalf of the
UKCP.
4. Mr Campbell-Tiech took the panel to the ‘obvious conflict’ in the wording of the policy, notably
that of paragraph 15 which specifically refers to ‘public hearings’. Mr Campbell-Tiech QC reminded
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the panel that this hearing had been conducted in private, and therefore invited the panel to
conclude that these proceedings were not covered by this paragraph.
5. Mr Daniel on behalf of the UKCP reminded the Panel of the wording of clause 9.33 of the
Complaints and Conduct Process, which states that the panel ‘must state in writing the reasons for
its decisions and its statements of reasons must be published according to the relevant UKCP
policy’.
6. The panel had been reminded by both parties of the status of Patient A as a vulnerable witness
who had given evidence whilst accompanied by a mental health nurse.
7. The panel was also addressed in respect of the Human Rights Act, more specifically Articles 8; 6;
and 2 by Mr Campbell-Tiech QC.
8. The panel heard and accepted the legal advice of the Legal Assessor. The panel determined that
a rule must override a policy, namely that clause 9.33 of the Complaints and Conduct Process
overrides any conflict in the Publication of Decisions Policy. However, it was mindful of the spirit of
paragraph 15 of the UKCP’s Publication of Decisions Policy which states that ‘in all cases where a
determination is redacted by the Professional Conduct Officer, the Chair of the AP should review
and agree the proposed redactions, before publication’.
9. The panel therefore agreed that the decision should be published but took comfort from the fact
that the Chair on behalf of the panel would be able to review and agree the proposed redactions,
thereby ensuring the redactions would be robust enough to ensure that Patient A could not be
identified.
Right of Appeal
1. Both the Registrant and UKCP have 28 days from when the written decision is served in which to
exercise their right of appeal.
2. The decision will not be published until the deadline for appeal has passed.
Signed,
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Sandra Marcantonio, Lay Chair
10 July 2016
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