Judith A Calvin

Preliminary matters

1. Shortly before the hearing was due to start on 15 November 2024 the Panel received:

a. a bundle of documents from the HCPC indicating that there was a new concern regarding the Registrant. This concern was that she had in two respects breached the Suspension Order imposed upon her on 15 November 2023, in ways in which the Panel has explained below.

b. a bundle of documents from the Registrant, including a report from her supervisor, evidence of CPD and a reflective piece.

2. In light of the material served by the HCPC, the Panel invited Ms Herbert, counsel representing the Registrant, to consider whether she and the Registrant wished to apply for an adjournment to deal properly with the allegations of breach of the Suspension Order. The chair indicated that the Panel would treat an application sympathetically. Ms Herbert indicated that she had already discussed the position with her client and her instructions were that the Registrant no longer wished to practise or even take part in the proceedings, and she invited the Panel to strike her off. Nevertheless, she would take the opportunity to have a further conference with her.

3. The Panel adjourned until 11:14 to allow sufficient time for a conference. At the end of that time Ms Herbert informed the Panel that her client did not want an adjournment and that she would in due course invite the Panel to find her fitness to practise still impaired and strike her off the Register.

4. The Panel was satisfied that the Registrant was represented by experienced counsel and had had legal advice and sufficient time to consider the position. The Panel concluded that there was nothing to be gained by an adjournment in those circumstances. The Panel indicated that the final outcome was a matter for the Panel but, in light of the Registrant’s decision, the Panel would continue with the hearing on 15 November 2024.

5. The Panel was unable to complete this review on 15 November 2024 because of the time it had given the Registrant to consider her position during the morning. Accordingly, the Panel adjourned until 6 December 2024 to complete its deliberations and write a determination. The Panel informed the Registrant of the date. She informed the Panel that she was unsure whether she would attend the adjourned hearing.

6. On 6 December 2024, the Panel saw documentary evidence that the HCPTS wrote to the Registrant on 25 November 2024 reminding her that the review had been adjourned to 6 December 2024 and inviting her to attend this hearing. The Panel has seen written confirmation dated 5 December 2024, from those representing the Registrant stating that, “the Registrant and counsel will not be attending tomorrow.”

7. In those circumstances, the Panel was satisfied that the Registrant had been served with notice of the adjourned hearing, knew of this adjourned hearing and had decided not to attend. The Panel was confident that she had made this decision with the benefit of legal advice.

8. In those circumstances, the Panel is satisfied that there is no realistic prospect that an adjournment would secure the Registrant’s attendance on a subsequent date, and it was right to complete the review in the absence of the Registrant. The Panel acknowledged that there is a potential disadvantage to a registrant who does not attend a hearing, but that must be set against the reasons for her non-attendance and the public interest in completing this review.

Background

9. The Registrant is a dietitian who was employed by Belfast Health and Social Care Trust (the Trust) as a Band 6 Paediatric dietitian within the Nutrition and Dietetics Paediatric Department. The Registrant was employed in this role from February 2011, within Royal Belfast Hospital for sick children (the Hospital), until December 2019. The Registrant had previously been employed in a dietitian role within the Trust since 15 June 2004.

10. Concerns regarding the Registrant’s practice were initially raised by one of the Registrant’s colleagues in December 2018. The initial concern related to the Registrant writing a letter on behalf of a friend, to her child’s GP, in which the Registrant made a product recommendation for her friend’s child. This letter was on the Trust’s letter headed paper, which was contrary to the Trust’s Referral Process. The child, the subject of the letter to the GP, is referred to within the Allegation as Person 6, had not been the subject of a referral to the Trust in accordance with the Trust’s Referral Criteria.

11. Following this, a consultant raised different and further concerns regarding the Registrant’s handling of cases during the period of February to December 2018. The Trust carried out a review of the Registrant’s cases and specific concerns were identified in respect of the Registrant’s clinical judgment and record keeping for five patients. These are identified within the Allegation as Patients 1-5. The Registrant is alleged to have provided inappropriate treatment for those patients and made retrospective amendments to the dietetic records for a number of these patients on the electronic recording system used by the Trust known as ‘PARIS’.

12. The HCPC received a referral from the Hospital in relation to the Registrant’s conduct on 8 April 2019. That referral was made in relation to the sending of the letter recommending a nutrition supplement for Person 6, and the five cases involving patients 1-5. The referral states that:

‘This information has been provided as J Calvin provides a private dietetic paediatric practice and we would have concerns that this private practice may not have supervision in place.’

13. That referral was made whilst the Registrant was on sickness absence, which started on 7 January 2019, and continued till the 15 April 2019.

14. The Trust subsequently commenced an informal capability process into those concerns on the 30 April 2019 which resulted in a Disciplinary Hearing on 28 May 2019. That Hearing concluded with the recommendation on 31 May 2019 that the Registrant continue working under supervision.

15. The Registrant [redacted] resigned from her role at the Hospital on 4 November 2019 and ceased to be employed by the Trust on 6 December 2019.

16. On 28 November 2019 the HCPC received additional information from the Trust regarding concerns that the Registrant had retrospectively amended patient records contrary to the Trust’s Record Keeping Policy. Those concerns were pursued in relation to patients 1,3, and 6.

17. At the substantive hearing the Registrant made admissions to all of the Particulars with the exception of:

• Particular 1(b) relating to Person 6;
• Particulars 2(a) and 3(a) and relating to Patient 1;
• Particular 3(c)(iii) relating to Patient 5;
• Particular 3(e)(iii) relating to Patient 3;
• Particular 8, allegation relating to dishonesty arising Particulars 1,5, 6, and 7.

18. The Panel notes that the substantive hearing panel found dishonesty in respect of Particular 1 (Person 6) alone.

19. The Substantive Panel found serious misconduct in respect of the matters proved and made the following observation:

“the errors and omissions did not stem from a lack of knowing the processes but a deviation outside of her skill and a continuing inability, despite retraining, to make accurate and complete notes. There appeared from the Registrant’s actions to be a falsely misplaced confidence in her abilities to extend her knowledge and skills into fields that were inappropriate and not authorised. The nature and variety of failings were numerous and stemmed on several occasion from the Registrant working beyond her scope of practice and skills, without seeking appropriate supervision to discuss this. There appears to be a lack of understanding of the extent and limit of her role and duties that it is behaviour that constitutes misconduct.”

20. With regard to the single finding of dishonesty, the substantive hearing panel observed that “there was only one occasion on which the Registrant had been found to be dishonest. She had however been proactive in constructing, and then executing, the act of dishonesty and so there was an element of planning which made this premeditated dishonesty. There has not been an early admission of dishonesty, and at this hearing the Registrant maintained that she had never intended to be dishonest even though she appreciated that her actions would be considered by others to be dishonest.”

21. The Panel observed that two months elapsed between the time that the substantive hearing panel found that the Registrant’s fitness to practice was impaired and the sanctions hearing. At the sanctions hearing, the Registrant produced a significant body of material that had not been available to the substantive hearing.

22. The substantive hearing panel acknowledged that the Registrant had started to develop some insight into her conduct, expressed as follows: “Despite my considerable experience, I must admit that I stepped outside of my professional boundaries and overreached my expertise, which constitutes serious misconduct. Upon reflection, I see that I did not meet the professional standards expected of a dietetic Practitioner. My work suffered because I took on tasks that exceeded my skill set without seeking appropriate support or oversight. This misstep not only put my patients at risk but also compromised the professional trust vested in me.”

23. The substantive hearing panel concluded that the Registrant’s insight was recent and incomplete. With regard to her dishonesty, the substantive hearing panel concluded that “the Registrant has not fully understood the illogicality of her actions, nor has she fully accepted the seriousness of those actions.”

24. With regard to the Registrant’s clinical failings, the substantive hearing panel concluded that, “the Registrant had not, at the time, nor until this hearing, acknowledged that her conduct, knowledge and skills had been at fault or below standard. There remains, in the Panel’s view, a lack of full insight into her level of expertise and her professional abilities… whilst she has now put in place systems to ensure that there are records of meetings and clinical observations, she has only now, after the Panel’s findings realised the need for fellow practitioner oversight of her decision making. This being the case, until there has been further reflection, study and training coupled with a change in the Registrant’s view of herself and her abilities there remains a real risk of repetition.”

25. Turning to sanction, the substantive hearing panel observed that the Registrant had not repeated her misconduct during the five years until the substantive hearing. She had also made significant admissions at the start of the hearing. Nevertheless, the substantive hearing panel observed that the Registrant’s misconduct had put patients at risk of serious harm in some cases and the risk of repetition was significant.

26. The substantive hearing panel considered each available sanction in turn. With regard to conditions of practice, the substantive hearing panel concluded that conditions. “would not be an effective way to address the Registrant’s clinical judgment failings. Her lack of insight into her professional abilities and boundaries are such that further reflection and professional development is required. Further, a Conditions of Practice Order is, in the Panel’s view, not sufficient to reflect the impact on the profession’s reputation that arises from the Registrant’s dishonest behaviour.”

27. The substantive hearing panel concluded that a suspension order for 12 months was the appropriate sanction because, “a lesser period would not be appropriate for the Registrant to develop her insight and to undertake the necessary steps to enable her to return to practice as an autonomous practitioner.”

28. The substantive hearing panel advised the Registrant that a review Panel was likely to be assisted by:

a. Further reflection on remediation undertaken;

b. Written evidence of systems in place for record keeping in line with HCPC standards;

c. Written evidence of supervision arrangements in place, to include a formal agreement with supervisor and a confidentiality agreement for the supervisor’s access to notes;

d. Undertake CPD on record management and data protection.

29. At the review hearing on 15 November 2024, the Panel had regard to the following documents:

a. A bundle served by the HCPC setting out the background to the case and the decision of the Substantive Panel (62 pages);

b. A further bundle from the HCPC setting out the new concerns (14 pages);

c. Registrant’s bundle (53 pages);

d. Two testimonial statements:

i. from the Registrant’s manager at a nursery, where she had worked as a dietitian; and

ii. from a colleague at the college where she has worked for nearly 5 years as an instructor teaching Anatomy and Physiology Level 3 Access Courses and teaching in Level 3 Health and Social Care BTEC National Diploma.

Both statement writers speak highly of her commitment to improving her practice.

30. Ms Sampson drew the Panel’s attention to the background set out above and also drew the Panel’s attention to the new concerns.

31. She told the Panel that the first concern was that the Registrant had continued to work as a dietitian during her period of suspension under an interim order when the substantive hearing had been adjourned from 15 September 2023 until 14 November 2023. The second concern, supported by documentary evidence, including an extract from the Registrant’s webpage, was that she had advertised herself as being registered as a Dietician on 29 October 2024.

32. Ms Sampson submitted that in view of the new concerns, the HCPC’s position was that it cannot today form an opinion on the Registrant’s current impairment and any potential sanction and that this is a matter for the Panel’s consideration. She added that the new concerns raise a risk that the Registrant may have been practising as a dietitian whilst suspended and highlighted that there is credible evidence that could potentially substantiate the new referral. She said that, if a Senior Decision Maker decides that the Threshold Test is met, it would be investigated and expedited to a panel of the Investigating Committee to determine whether there is a case to answer. Ms Sampson submitted that, in the circumstances, the HCPC could not at this stage form an opinion on the Registrant’s current state of impairment and whether she is fit to practise and was neutral in relation to any potential further sanction.

33. Ms Sampson did not oppose Counsel’s position, set out on behalf of the Registrant, that the Registrant wished to be struck off.

34. Ms Herbert again told the Panel the Registrant no longer wished to take part in proceedings and “wishes to be struck off”.

The Panel’s approach

35. The Panel received the advice of the Legal Assessor, which it accepted and followed in the decision set out below.

36. First, it reminded itself of its powers under Article 30(1) of the Health Professions Order 2001 to extend the period for which the Order has effect or to impose any order the first panel could have imposed.

37. It reminded itself of the importance of a review hearing, described by the Supreme Court in Khan v GPhC [2016] UKSC 64 as “the ‘teeth’ behind the sanctions other than erasure and should focus the doctor’s mind on the need to undertake any necessary remediation”.

38. It followed the ordered sequence of decision making set out by Blake J in Abrahaem v General Medical Council 2008 EWHC 183:

i. Address whether the fitness to practice is impaired before considering conditions.

ii. Whether all the concerns raised in the original finding of impairment have been sufficiently addressed to the Panel's satisfaction.

iii. In practical terms there is a persuasive burden on the practitioner at a review to demonstrate that he or she has fully acknowledged why past professional performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.

39. It bore in mind the guidance given to Panels by the Supreme Court in Khan (above) to focus on the Registrant’s current fitness to practise:

“The guidance therefore makes clear that the focus of a review is upon the current fitness of the Registrant to resume practice, judged in the light of what he has, or has not, achieved since the date of the suspension. The review committee will note the particular concerns articulated by the original committee and seek to discern what steps, if any, the Registrant has taken to allay them during the period of his suspension.”

40. The Panel had regard to the over-arching objective of protecting the public, which involves the pursuit of the following objectives:

• to protect, promote and maintain the health, safety and well-being of the public;
• to promote and maintain public confidence in the professions regulated under the Order; and
• to promote and maintain proper professional standards of conduct for members of those professions.

41. It also bore in mind that in deciding whether the Registrant’s fitness to practise is still impaired, it should follow the approach of Dame Janet Smith endorsed by the High Court in CHRE v NMC and P Grant [2011] EWHC 927 (Admin):

"Do our findings of fact in respect of the (Registrant’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

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; and/or

d. has in the past acted dishonestly and/or is liable to act dishonestly in the future”.

42. The Panel also had regard to the HCPTS Practice Note of November 2023 which directs Panels to look at both the personal and public components of impairment of fitness to practise. The “personal” component relates to the Registrant’s own practice, including any evidence of insight and remorse and efforts towards remediation. The “public” component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.

43. Accordingly, the Panel looked at the personal component first and reminded itself of the key questions which need to be answered:

i. are the acts or omissions which led to the allegation remediable?

ii. has the Registrant taken remedial action?

iii. are those acts or omissions likely to be repeated?

44. The Panel bore in mind that an important factor will be the Registrant’s insight into those acts or omissions, the extent to which the Registrant:

• understands how and why it occurred and its consequences for those affected; and
• can demonstrate they have taken action to address that failure in a manner which remedies any past harm (where that is possible) and avoids any future repetition.

45. The Panel also bore in mind the public component of impairment which encompasses the second and third limbs of the overarching objective, namely promoting and maintaining public confidence in the profession and promoting and maintaining proper professional standards of conduct for the profession.

The Panel’s decision

Impairment

46. The Panel first considered whether the Registrant’s fitness to practise remains impaired. It bore in mind that there had already been a finding of impairment and asked itself whether the Registrant had demonstrated that she had taken sufficient steps to allay the concerns of the previous Panel.

47. The Panel read the Registrant’s reflective piece in which she acknowledged that she had “let my standards slip, compromising not only the trust placed in in me by colleagues and patients but also the integrity of the dietetic profession.” She acknowledged that her misconduct had “included elements of premeditated dishonesty that undermine both my role and the trust of my colleagues and patients.”

48. The Panel saw that the Registrant had written that she was committed to practising effectively and honestly.

49. The Panel also read a report from Ms Alison Kyle who is a registered dietitian who had conducted eight sessions of online supervision. She also wrote of the Registrant’s commitment and said she had put “great effort into working to regain her HCPC registration and is extremely committed to achieving this. I truly feel she has learned from her mistakes and moving forward she should be able to practice safely and effectively as a dietitian.”

50. Against this, the Panel considered the Registrant’s decision, following a conference with her counsel, to disengage from the review process and indicate that she no longer wished to practise.

51. The Panel reminded itself that the question of impairment was a decision for its own judgement. Nonetheless, it also reminded itself that there was a persuasive burden upon the Registrant to persuade the Panel that her fitness to practise was no longer impaired.

52. In light of her refusal to engage further with the review, the Panel was satisfied that the Registrant had not discharged this burden and her fitness to practise remains impaired for the reasons set out by the substantive Panel. That is to say that her fitness to practise remains impaired on both the personal and public components because the identified risk of repetition remains and public confidence in the profession would be undermined if the Registrant were allowed to return to unrestricted practice in circumstances where she would not engage with her regulator.

Sanction

53. Having found that the Registrant’s fitness to practise remains impaired, the Panel went on to consider what sanction if any it should impose.

54. The Panel accepted the advice of the Legal Assessor and had regard to the HCPC’s Sanctions Policy (2019). The Panel was mindful that the purpose of a sanction is not to punish the Registrant but to protect the public and the wider public interest in upholding proper standards and maintaining public confidence in the profession and the regulatory process. The Panel applied the principle of proportionality, balancing the interests of the Registrant with those of the public and considered the available sanctions in ascending order.

55. The Panel noted that the substantive hearing panel had identified the following Mitigating features:

• The Registrant has demonstrated active engagement in the HCPC process throughout;
• There was no evidence of repetitions of the misconduct over the following 5 years;
• There was no personal gain from the letter to the GP;
• The Registrant voluntarily disclosed to her manager the following day that she had sent the letter;
• The letter was not delivered, and the Registrant did not attempt to re-send the letter;
• Admissions made at the start of the hearing and during it.

56. The Panel also noted that the substantive hearing panel had identified the following aggravating features:

• Case notes were inadequate and did not fully record on the system service users’ case histories;
• The Registrant had not made contemporaneous notes of sessions with service users;
• The Registrant returned to case notes to make significant changes to them at a distance in time. The case of Patient 1, being a case where the Registrant had returned at the end of August to make changes to previous sessions going back as far as the previous February;
• Poor clinical judgment. For instance, a non-complex case of ensuring that a child’s weight and body mass increased, produced a result at the end of the treatment programme of a negligible weight gain. In the interim this service user had been subjected to a limited food diet and had lost weight;
• Dishonest behaviour in using her employer’s facilities to make contact with a GP surgery and establish how to send a letter confirming her recommendation for treatment. This letter had been sent on NHS Trust headed paper therefore deceiving the recipient into believing that this was a referral from her place of employment;
• A continued denial of intentional wrongdoing, despite, an element of planning in that there had been some premeditation in arranging for the letter to be sent to the right email address within the GP practice;
• The potential risk of serious harm that flowed from the Registrant’s actions. Service users could, and possibly already have, suffered long term impacts as a result of the Registrant’s acts and omissions;
• In one case there could have been a fatality resulting from her advice to test nuts without there being an EpiPen available to deal with an adverse reaction.

57. The Panel had regard to the HCPC Sanctions Policy and was satisfied that neither taking no action nor imposing a caution order would be sufficient to protect the public or satisfy the wider public interest.

58. The Panel then considered whether a Conditions of Practice Order was appropriate. It reminded itself of paragraphs 106 – 109 of the Sanctions Policy:

106. A conditions of practice order is likely to be appropriate in cases where:

‘The Registrant has insight.’

‘The Registrant does not pose a risk of harm by being in restricted practice.’

107. Conditions will only be effective in cases where the Registrant is genuinely committed to resolving the concerns raised and the Panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the Registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings,

108. Conditions are less likely to be appropriate in more serious cases, for example those involving:

• Dishonesty….

109. There may be circumstances in which a Panel considers it appropriate to impose a conditions of practice order in the above cases. However, it should only do so when it is satisfied that the Registrant’s conduct was minor, out of character, capable of remediation and unlikely to be repeated. The Panel should take care to provide robust reasoning in these cases.’

59. The Panel concluded that a conditions of practice order could not be imposed in circumstances where the Registrant had made it clear that she would no longer co-operate with her regulator.

60. The Panel then considered whether a suspension order remains sufficient to protect the public and satisfy the wider public interest. The Panel had regard to paragraph 121 of the Sanctions Policy:

121. A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a condition of practice order, but which do not require the Registrant to be struck off the Register. These types of cases will typically exhibit the following factors:

• The concerns represent a serious breach of the Standards of conduct, performance and ethics;
• The Registrant has insight;
• The issues are unlikely to be repeated; and
• There is evidence to suggest the Registrant is likely to be able to resolve or remedy their failings.’

61. The Panel considered this sanction carefully in light of the material before it indicating that the Registrant may have breached the terms of the previous suspension order and her subsequent declaration, through her counsel, that she no longer intended to engage with her regulator.

62. Having regard to these matters, the Panel was unable to conclude that the Registrant was unlikely to repeat her misconduct or that she was likely to be able to resolve or remedy her failings if there were a further period of suspension.

63. The Panel also concluded that public confidence in the profession and the regulator would not be maintained if a Registrant could continue to be suspended in circumstances where she had made it clear that she no longer wished to work towards returning to practice.

64. The Panel then considered a Striking Off Order and had regard to paragraphs 130 and 131 of the Sanctions Policy.

‘130. A striking off order is a sanction of last resort for serious persistent deliberate or reckless acts involving…

…dishonesty.’

‘131. A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the Registrant;

• Lacks insight;
• Continues to repeat the misconduct…;
• Is unwilling to resolve matters.’

65. The Panel concluded that it was clear that the Registrant was now unwilling to resolve matters and that the only sanction that remained to protect the public was to make a striking off order which will come into force upon the expiry of the Suspension Order currently in force.

ORDER: The Registrar is directed strike off the name of Miss Judith A Calvin from the Register.

No notes available

History of Hearings for Judith A Calvin