BEFORE THE FITNESS TO PRACTISE COMMITTEE OF THE GENERAL OPTICAL COUNCIL GENERAL OPTICAL COUNCIL F(17)04 AND KATIE MOHAN REGISTRATION NUMBER: 01-27469 DETERMINATION OF A SUBSTANTIVE HEARING 2 OCTOBER 2017 ALLEGATION (as amended) The Council alleges that Katie MOHAN, a registered optometrist: 1. On 11 April 2014 you carried out an eye examination on Patient A and: a. You failed to conduct an Amsler grid test; b. You failed to refer Patient A for further investigations; or c. You did not carry out appropriate follow up actions relating to Patient A s visual field test results. And by virtue of the facts set out above, your fitness to practise is impaired by reason of misconduct. At the outset of the hearing, Mr Day, Counsel instructed on behalf of the GOC, applied to amend the particulars of 1(b), removing the word and, so as to leave or so that 1(b) and 1(c) were in the alternative. Mr Hodivala, Counsel instructed on behalf of the Registrant, did not oppose the application. Having heard and accepted the advice of the Legal Adviser, the Committee allowed the application to amend, satisfied that it would cause no injustice to the Registrant.
DETERMINATION Admissions in relation to the particulars of the allegation The Registrant admitted particular 1(c) of the allegation, and the Chair announced that fact proved. In light of this admission, the GOC did not seek to pursue particular 1(b). Background to the allegations The Registrant qualified in 2012 and first registered with the GOC as an Optometrist on 7 August 2013. At the time of the event in question, she was employed at Specsavers, Leven (the Practice). On 11 April 2014, Patient A attended the Practice for a routine eye examination which was carried out by the Registrant. The eye examination included the taking of fundus photographs, the dilation of Patient A s pupils and visual field test for each eye. The Registrant marked in Patient A s record card that a repeat visual field test was to be carried out on the collection of her new glasses. On 18 April 2014, Patient A returned to the Practice to collect her glasses. She was seen by an Optical Assistant. The Optical Assistant did not conduct the repeat visual field test as had been requested by the Registrant on 11 April 2014. On 1 July 2014, Patient A returned to the Practice, having noticed a continued deterioration of sight. She was seen by a different optometrist and was referred for an urgent appointment at a hospital. She was subsequently diagnosed with choroidal melanoma. On 14 May 2015, the GOC received a complaint from Patient A regarding the optometric care she received at the Practice, outlining the four eye examinations which she had received at the Practice, namely 16 February 2012, 15 March 2013, 11 April 2014 (conducted by the Registrant) and 1 July 2014. Evidence adduced by the GOC The Committee had regard to the bundle of documents served by the Council, which included copies of Patient A s records in respect of the eye examinations carried out at the Practice. Professor Eperjesi, University Associated Professor and Researcher
in Optometry and registered Optometrist, provided a report to the GOC dated 1 July 2016, plus further supplementary reports, dated 17 January 2017 and 21 August 2017. The later supplementary report was prepared in response to the expert report from Ian Cameron, registered Optometrist, instructed on behalf of the Registrant. The Committee also had an agreed statement of facts. In addition, the Committee heard evidence from Professor Eperjesi. Submission of No Case to Answer At the close of the GOC case, Mr Hodivala made a submission under Rule 46(8). He submitted that there was no case to answer on the facts in respect of particular 1(a) and further, notwithstanding whether that application was successful, there was no case to answer in respect of misconduct, sufficient to support a finding of impairment on particular 1(a) and admitted particular 1(c). Mr Day contested the submission. He submitted that particular 1(a) should not be treated in the abstract, but that the full circumstances of 11 April 2014 needed to be considered. He submitted that no other test comparable to the Amsler grid test had been carried out on that day, but Patient A s visual acuity had declined and the visual field test which the Registrant conducted had raised the prospect of a macular issue or eye disease in need of further investigation. As such, an Amsler grid test or comparable test was required on that day, or a plan for such a test in the near future was required. He submitted that there was, therefore, a case to answer on the facts. In relation to misconduct and impairment, he submitted that the failure to conduct an Amsler test, together with the admitted failure to ensure appropriate follow up of a visual field test, had the potential to expose a patient to harm, such that it would fall far below the standards required of a reasonably competent Optometrist. The Committee heard and accepted the advice of the Legal Adviser. The Committee first considered whether there was a sufficiency of evidence adduced by the GOC in respect of the disputed fact, particular 1(a). The Committee had regard to the terms of the particular, which alleged a failure to carry out an Amsler grid test on 11 April 2014. In this respect it considered that the use of the word failure, alleged that there was a positive duty on the Registrant to carry out an Amsler grid test on 11 April 2014, and that she did not act in accordance with that duty.
The Committee had regard to the evidence of Professor Eperjesi. It noted that he described the Registrant s eye examination, overall, as a full examination which met the expected standards of a reasonably competent Optometrist. He had ultimately accepted before the Committee that there had been no clinical necessity to carry out an Amsler grid test on the day of 11 April 2014. He agreed that an Amsler grid test could have been carried out on a different day, and that included up to a week after 11 April 2014. Professor Eperjesi said that, in his opinion, there was a body of reasonably competent Optometrists who would have conducted an Amsler grid test on the day of the eye examination on 11 April 2014, and there was a body of reasonably competent Optometrists who would not have carried out an Amsler grid test on that day, but plan to do one within one to two weeks. In light of the evidence of Professor Eperjesi, the Committee was not satisfied that the GOC had adduced sufficient evidence to satisfy it that there was a clinical necessity for the Registrant to carry out an Amsler grid test on 11 April 2014. In such circumstances, the Committee concluded that the evidence taken at its highest did not establish that the Registrant had failed in any duty to carry out an Amsler grid test on 11 April 2014. Therefore, the Committee determined that there was no case to answer on the disputed fact, particular 1(a). The Committee next considered whether particular 1(c), which had been admitted and found proved, was capable of supporting a finding of impairment. It had regard to the terms of the allegation, which alleges impairment by reason of misconduct. The Committee therefore considered, whether, 1(c), taken at its highest, was capable of amounting to misconduct. The Committee took into account that this was a single eye examination, in which the failure occurred. It arose in the context of an otherwise good, conscientious, full and thorough examination, as accepted by Professor Eperjesi. The agreed position between the parties was that the Registrant had recorded in Patient A s clinical notes that the visual field test was to be repeated on collection. The Committee was of the view that the Registrant had recorded a clear plan, to the effect that a visual field test would be repeated one week later, and her failure had been one of negligence in not ensuring that the visual field test was, in fact, completed when Patient A returned on 18 April 2014, to collect her glasses. In this context, the Committee was not satisfied that, taken at its highest, this single incident of negligence on the part of the Registrant could be categorised as particularly
grave so as to amount to misconduct, as set out in the case of Calhaem, where it was said: Mere negligence does not constitute "misconduct" Nevertheless, and depending upon the circumstances, negligent acts or omissions which are particularly serious may amount to "misconduct". A single negligent act or omission is less likely to cross the threshold of "misconduct" than multiple acts or omissions. Nevertheless, and depending upon the circumstances, a single negligent act or omission, if particularly grave, could be characterised as "misconduct". The Committee noted that it was no part of the GOC s case that the Registrant had failed to detect the choroidal melanoma in her eye examination of Patient A on 11 April 2014. It had regard to Professor Eperjesi s addendum report of 21 August 2017, where he agreed with the expert instructed on behalf of the Registrant that: It would be my opinion that there were no internal physical signs of CM [choroidal melanoma] detectable by an ordinarily competent optometrist acting with ordinary care in 11/04/14 as these would have been detected by the apparently careful examination by the member. In all the circumstances, the Committee, having determined that particular 1(c) was not of such gravity that it could amount to misconduct, determined that this fact could not support a finding of misconduct. Therefore the Committee concluded that there was no case to answer in respect of impairment. Accordingly, the Committee upheld the submissions of Mr Hodivala that there was insufficient evidence to find particular 1(a) proved, and that particular 1(c) could not support a finding of impairment. Chair of the Committee: Ms Anne Johnstone Signature. Date: Registrant: Ms Katie Mohan Signature. Date:
FURTHER INFORMATION Transcript A full transcript of the hearing will be made available for purchase in due course. Professional Standards Authority This decision will be reported to the Professional Standards Authority (PSA) under the provisions of section 29 of the NHS Reform and Healthcare Professions Act 2002. PSA may refer this case to the High Court of Justice in England and Wales, the Court of Session in Scotland or the High Court of Justice in Northern Ireland as appropriate if they decide that a decision has been insufficient to protect the public and/or should not have been made, and if they consider that referral is desirable for the protection of the public. PSA is required to make its decision within 40 days of the hearing (or 40 days from the last day on which a registrant can appeal against the decision, if applicable) and will send written confirmation of a decision to refer to registrants on the first working day following a hearing. PSA will notify you promptly of a decision to refer. A letter will be sent by recorded delivery to your registered address (unless PSA has been notified by the GOC of a change of address). Further information about the PSA can be obtained from its website at www.professionalstandards.org.uk or by telephone on 020 7389 8030. Contact If you require any further information, please contact the Council s Hearings Manager at 10 Old Bailey, London, EC4M 7NG or, by telephone, on 020 7580 3898.