HEARING HEARD IN PUBLIC HOUGHTON, Nicola Louise Registration No: 130502 PROFESSIONAL CONDUCT COMMITTEE FEBRUARY 2015 Outcome: Erasure (with immediate order) Nicola Louise HOUGHTON, Verified competency in Dental Nursing, was summoned to appear before the Professional Conduct Committee on 26 February 2015 for an inquiry into the following charge: Charge (as amended on 27 February 2015) "That being registered as a dental nurse; 1. On 25 October 2013, you accepted a simple caution from the Police for two offences of theft from your employer committed whilst working at Talking Teeth Dental Practice, 6 Scott Lane, Aspull, Wigan, WN2 1YX on or around 21 August 2013 and 1 October 2013. 2. Between 25 October 2013 and 27 November 2013, you failed to disclose to the General Dental Council that on 25 October 2013 you accepted a simple caution from the Police as set out at 1 above. 3. Your conduct as set out at 2 above was: a) misleading; and/or b) dishonest in that you knew you were obliged to disclose any conviction or caution and you knowingly failed to do so. 4. You failed to co-operate with a General Dental Council investigation into your fitness to practice in that: 4.1. Amended: You have not provided your current employer(s) details form having been requested to do so by the General Dental Council on 27 November 2013, 23 January 2014 and 17 April 2014; and 4.2. Amended: You have not provided details of your indemnity insurance having been requested to do so by the General Dental Council on 27 November 2013, 23 January 2014 and 17 April 2014. And by reason of the facts stated your fitness to practice as a dental nurse is impaired by your misconduct and/or caution." HOUGHTON, N L Professional Conduct Committee February 2015 Page -1/9-
On 26 February 2015 the Chairman made the following statement regarding the finding of facts: Ms Broome, Ms Houghton is not present and is not represented at this hearing. You are appearing as Counsel for the General Dental Council (GDC). The GDC s case against Ms Houghton is that she accepted a caution for theft by her as an employee, failed to inform the GDC of the caution and that her failure to inform the GDC was misleading and dishonest. Further she failed to cooperate with the GDC investigation. Preliminary matters You made an application under Rule 54 of the GDC (Fitness to Practise) Rules 2006 (the Rules) that this hearing should proceed in Ms Houghton s absence. You drew the Committee s attention to the various ways the GDC had attempted to contact Ms Houghton and their attempts to effect service. You submitted that throughout the course of the GDC s fitness to practise investigation, Ms Houghton has not engaged with the GDC, that all reasonable attempts had been made to effect service and that this matter should proceed in Ms Houghton s absence. The Committee accepted the advice of the Legal Adviser. The Committee first considered the issue of service of notice of hearing in accordance with Rules 13 and 65 of the Rules. It saw a copy of the notice of hearing letter dated 21 January 2015 sent by first class delivery and special delivery to Ms Houghton s home address and the Royal Mail Track and Trace proof of delivery document which indicated that the letter was returned to sender. The Committee notes that the home address used by the GDC for Ms Houghton was the same address used by the police on the simple caution and contained in the PCN search. You confirmed that the GDC used Ms Houghton s home address, rather than her registered address, because her registered address was her former employer s who were no longer in contact with her. You informed the Committee that Ms Houghton has not been engaging with the GDC and has not responded to communications sent to her home address. The Committee has also had sight of a diary note dated 3 February 2015 which identified that the GDC attempted to contact Ms Houghton regarding this hearing at 9:15 am and 2pm. Her mobile number was invalid and there was no answer on her home number. Further the Committee has had sight of a diary note dated 10 February 2015 indicating that the GDC again tried to contact Ms Houghton on her home number, but there was no answer. A copy of the notice of hearing letter was also sent by recorded delivery to Ms Houghton s home address on 18 February 2015. The Committee has not had sight of a track and trace receipt for this letter. You also submitted that the GDC had contacted Ms Houghton s former employer who provided an email address for Ms Houghton, but attempts to contact Ms Houghton at that email address had not produced a response. The Committee considered that the GDC had made repeated efforts to contact Ms Houghton at her home address and by email and by phone, using both her home and mobile number. The Committee was satisfied that all reasonable efforts had been made by the GDC to send Ms Houghton notification of this hearing. The Committee then considered whether to proceed with this hearing in Ms Houghton s absence in accordance with Rule 54 of the Rules. The Committee bore in mind that its discretion to proceed with a hearing in the absence of the registrant must be exercised with the utmost care and caution. The Committee considered your submission that Ms Houghton had voluntarily absented herself from today s hearing and it did not consider that Ms HOUGHTON, N L Professional Conduct Committee February 2015 Page -2/9-
Houghton was likely to attend a future hearing, if the Committee adjourned the hearing today. The Committee was satisfied that it was appropriate for the hearing to continue in her absence. You made submissions relating to the circumstances behind the police caution. You directed the Committee to the written simple caution which was signed by Ms Houghton and to the witness statement from MS, manager of the UK Registration s Team at the GDC which identifies that the GDC has no record of Ms Houghton contacting them to notify them that she received the caution on that date. You also directed the Committee to standard 9.3 of the GDC Standards for the Dental Team and the GDC Guidance on reporting criminal proceedings. You submitted that the Standards for the Dental Team standards were distributed to all registrants in August 2013, were promoted in the Summer 2013 Gazette and came into force on 30 September 2013, prior to Ms Houghton accepting the caution. You submitted that the only reason why Ms Houghton would not disclose the caution to her regulator was to evade the ramifications that disclosure could bring. You identified that while Ms Houghton appeared to have stopped working as a dental nurse, if she did decide that she wanted to continue to practise, failure to notify the GDC would enable her to continue to practise. You also directed the Committee to the witness statement of NK, Pre-Investigating Committee Caseworker at the GDC and the attached exhibits, relating to the GDC s requests for details of Ms Houghton s employer and indemnity insurance and the lack of a response from Ms Houghton. After you had closed your submissions, you made an application pursuant to Rule 18 to amend the charge as follows: For sub-head of charge 4.1 and 4.2; amending the date 23 January 2013 to read 23 January 2014. The Committee considered your submissions and considered that the date in sub-head of charge 4.1 and 4.2 is clearly a typographical error and that the letter which the Committee has had sight of is dated 23 January 2014. The Committee considered that the requested amendment would not prejudice or cause injustice to Ms Houghton. The Committee acceded to your request to amend the charge. The Findings of Fact The Committee has carefully considered all the documentary evidence presented to it in this case. It has taken account of your submissions on behalf of the GDC. It has accepted the advice of the Legal Adviser, including that: in respect of the word failed, which occurs in head of charge 2 and 4, the Committee should first identify whether Ms Houghton was under a duty to do what the GDC has alleged that she did not do. It should then consider whether she did not discharge the duty. That there is a two stage test for dishonesty and that the Committee should consider whether ordinary reasonable and honest people would consider the failure to be dishonest. If the Committee is satisfied on that on the balance of probabilities ordinary reasonable and honest people would consider the failure to be dishonest, then the Committee would move to the second stage of the test. The second stage is the subjective stage. The Committee then needs to consider whether, at the time Ms HOUGHTON, N L Professional Conduct Committee February 2015 Page -3/9-
Houghton did what was alleged, she knew or would have realised that what she did was dishonest by the standards of ordinary reasonable and honest people. The Committee has reminded itself that the burden of proof lies with the GDC and that Ms Houghton is not required to prove or disprove any of the charges. Further as the standard of proof is the civil standard, the Committee notes that the GDC must satisfy it, on the balance of probabilities, that each individual head and sub-head of charge is proved. The Committee has considered and reached a decision on all heads and sub-heads of charge, as amended during the hearing, separately. No adverse inference has been made against Ms Houghton by reason of her non attendance. Findings regarding each Head of Charge I will now announce the Committee s findings in relation to each head of charge: 1. Proved 2. Proved 3.(a) 3.(b) The Committee has had sight of the simple caution for theft by employee which is signed by Ms Houghton and dated 25 October 2013. The Committee considered standard 9.3 of the GDC Standards for the Dental Team which requires registrants to Inform the GDC if they are subject to criminal proceedings anywhere in the world. The Committee also considered the GDC s Guidance on reporting criminal proceedings which sets out that a registrant must immediately inform the GDC if anywhere in the world they accept a criminal caution. The Committee further considered that the Guidance came into force on 30 September 2013 and so at the time of accepting the caution, Ms Houghton had a duty to report it to the GDC. The Committee also considered the evidence from the GDC that Ms Houghton did not inform them of the caution prior to 27 November 2013, when the GDC wrote to Ms Houghton to inform her that the GDC had received a complaint from Mr QJ, who was the owner of Talking Teeth Dental Practice. Proved The Committee considered that the standards which came into effect on 30 September 2013 required Ms Houghton to immediately inform the GDC of the caution. Dental professionals are always required to be aware of the standards and that at the time Ms Houghton received the caution they should have been at the forefront of her mind, given that the new standards were widely publicised. The Committee considered that Ms Houghton s conduct, in failing to notify the GDC of the caution, was misleading to the GDC as the regulator of the profession. Proved The Committee considered the head of charge that Ms Houghton s failure to disclose the caution to the GDC was dishonest, in that she knew she was obliged to disclose any conviction or caution and she knowingly failed to do so. The Committee first considered that ordinary honest and reasonable people would consider a dental nurse s failure to disclose the caution to the regulator as being HOUGHTON, N L Professional Conduct Committee February 2015 Page -4/9-
dishonest. 4.(4.1) Proved 4.(4.2) Proved The Committee has considered whether in the absence of information from Ms Houghton, it can satisfy itself that Ms Houghton knew of the requirement to inform the GDC. It considered that Ms Houghton had been a member of the profession for 8 years at that time, and that as a dental care professional Ms Houghton is required to uphold and comply with the standards of the profession. The Committee had regard to the self-declaration completed by Ms Houghton when she applied for registration in 2007. Ms Houghton was asked to declare whether she had any criminal convictions or cautions. The Committee considered that therefore, from that point in time, Ms Houghton would have known that this information was an important consideration by the regulator is deciding whether to register her to practice. Further the Committee considered the evidence that the new standards were advertised and sent to all registrants. The Committee was satisfied, on the balance of probabilities, Ms Houghton knew or must have known that her failure to disclose the caution to the GDC, was dishonest by the standards of ordinary, reasonable and honest people. The Committee had sight of page 1 of the letter dated 27 November 2013 which request Ms Houghton s employment details. It had sight of the letter dated 23 January 2014 and the blank details of employment and indemnity insurance form enclosed. Further it had sight of the letter dated 17 April 2014 which asked Ms Houghton to provide details of her employment. The Committee has accepted the witness statement of NK which sets out that the GDC did not receive a response from Ms Houghton regarding her employer s details. The Committee has also had sight of the royal mail receipt sticker showing the letter of 27 November 2013 was not called for. The Committee considered standard 9.4.1 of the GDC Standards for the Dental Team which requires registrants to co-operate with any relevant formal or informal enquiry and give full and truthful information. There is no evidence Ms Houghton has engaged with the GDC. The Committee considered that Ms Houghton was under a duty to provide the details of her employers when requested by the GDC, and that she failed to comply with her duty. The Committee had sight of the letter dated 23 January 2014 and the blank details of employment and indemnity insurance form enclosed. It also had sight of the letter dated 17 April 2014 which asked Ms Houghton to provide details of her indemnity cover. The Committee has seen the letter dated 27 November 2013; however, it notes that the last pages of the letter and the enclosed form have not been provided to the Committee. The page of the letter provided does not include the request for details of indemnity. However, the Committee has accepted the witness statement of NK which sets out that the GDC did request details of Ms Houghton s indemnity on 27 November 2013. Further the witness statement confirms that Ms Houghton has not provided the GDC with her indemnity details. The Committee again considered standard 9.4.1 of the GDC Standards for the Dental Team. There is no evidence Ms Houghton has engaged with the GDC. The Committee is satisfied that Ms Houghton was under a duty to provide details of her indemnity cover when requested by the GDC, and that she failed to comply with HOUGHTON, N L Professional Conduct Committee February 2015 Page -5/9-
her duty. We move to Stage Two. On 27 February 2015 the Chairman announced the determination as follows: Ms Broome, Ms Houghton is neither present nor represented at this hearing. The Committee has considered all the evidence presented to it. It has taken into account your submissions made on behalf of the General Dental Council (GDC) and it has accepted the advice of the Legal Adviser. Proven Facts On 25 October 2013, Ms Houghton accepted a simple caution from the Police for two offences of theft from her employer, committed whilst working at Talking Teeth Dental Practice in Wigan. Between 25 October 2013 and 27 November 2013, Ms Houghton failed to disclose to the GDC that she had accepted a simple caution from the Police on 25 October 2013. Her conduct in this respect was misleading and dishonest, in that she knew she was obliged to disclose any conviction or caution and she knowingly failed to do so. In addition to her failure to disclose her caution, Ms Houghton failed to co-operate with the GDC investigation into her fitness to practise. In particular, she has not provided her current employer(s) details form, having been requested to do so by the GDC on three occasions. Further, she has not provided details of her indemnity insurance, having also been requested to do so by the GDC on three occasions. Impairment At this stage of the hearing, the Committee s task has been to decide whether Ms Houghton s fitness to practise is currently impaired by reason of her caution and/or misconduct. The Committee has exercised its independent judgement and it has borne in mind that its duty is to act in the public interest. The public interest includes the protection of patients, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour. Caution The Committee considered the matter of Ms Houghton s caution, in particular the substance and seriousness of her offences of theft, both of which occurred during the course of her employment as a dental nurse. The Committee took into account the detailed planning Ms Houghton undertook in order to steal money from her employer. This included her entering the dental practice out of hours and her deactivation of the premise s burglary alarm. In the Committee s view, the grave nature of the behaviour displayed by Ms Houghton is very difficult to remedy, although not impossible. However, given her complete lack of engagement with the GDC, the Committee has received no evidence to suggest that she has even attempted to address her wrongdoing. The only relevant information before this Committee is that Ms Houghton was in debt. There is no evidence of insight, nor is there anything to indicate her understanding of the potential impact her behaviour could have had HOUGHTON, N L Professional Conduct Committee February 2015 Page -6/9-
on the reputation of the dental profession. In these circumstances, the Committee considered that the risk of repetition is high. In the absence of any evidence of remediation or insight on Ms Houghton s part, the Committee decided that public confidence in the dental profession and this regulatory process would be undermined if a finding of impairment were not made. The Committee has therefore determined that Ms Houghton s fitness to practise is currently impaired by reason of her caution. Misconduct The Committee next considered the issue of misconduct. It considered whether the facts found proved in relation to heads of charge 2, 3 and 4 amount to misconduct. It took into account that a finding of misconduct in this regulatory context should relate to a serious falling short of accepted professional standards. The Committee first considered its findings in relation to heads of charge 2 and 3, namely, Ms Houghton s misleading and dishonest conduct in failing to disclose her caution to the GDC. In doing so, it had regard to Standards for the Dental Team (September 2013), in particular, the following paragraph: 9.3 You must inform the GDC if you are subject to criminal proceedings or a regulatory finding is made against you, anywhere in the world. Further, the Committee had regard to the GDC s Guidance on reporting criminal proceedings which clearly states that a criminal caution must be disclosed. Ms Houghton failed to adhere to this key standard and Guidance. The Committee was satisfied that she was aware of her professional obligation to disclose her caution to her regulatory body. By not doing so, she misled the GDC and acted dishonestly. Honesty and integrity are fundamental tenets of the dental profession and, in the Committee s opinion, Ms Houghton s dishonest conduct in a professional context fell seriously short of what is expected of a registered dental professional. The Committee was therefore satisfied that misconduct is made out on its findings in relation to heads of charge 2 and 3. The Committee went on to consider its findings in relation to head of charge 4, this being Ms Houghton s failure to co-operate with a GDC investigation into her fitness to practise. It took into account Paragraph 9.4.1 of Standards for the Dental Team, which states: 9.4.1 If you receive a letter from the GDC in connection with concerns about your fitness to practise, you must respond fully within the time specified in the letter. You should also seek advice from your indemnity provider or professional association. Whilst the Committee considered that it was incumbent on all registrants to abide by this professional responsibility, it considered that, in different circumstances, a failure to respond to the GDC alone would not be sufficient to cross the threshold of misconduct. However, in the circumstances of this case, when taken in the context of Ms Houghton s total disregard for, and disengagement from, her regulatory body, the Committee decided that her failure to co-operate does amount to misconduct. The Committee therefore finds that the totality of the facts found proved at heads of charge 2, 3 and 4 amounts to misconduct. HOUGHTON, N L Professional Conduct Committee February 2015 Page -7/9-
In deciding whether Ms Houghton s fitness to practise is currently impaired by reason of her misconduct, the Committee again considered whether it had received any evidence of remediation. It concluded that it had not. Ms Houghton has not engaged in any way and, as a result, there is nothing to explain her lack of co-operation, nor is there any information relating to any steps she has taken to remedy the situation. The Committee therefore decided that the risk of her repeating such behaviour is also high. Having taken these factors in account, the Committee decided that a finding of impairment is required to maintain public confidence in the dental profession and to declare and uphold proper standards of conduct and behaviour. The Committee has determined that Ms Houghton s fitness to practise is currently impaired by reason of her misconduct. Sanction The Committee considered what sanction, if any, to impose on Ms Houghton s registration. It reminded itself that the purpose of a sanction is not to be punitive, although it may have that effect, but to protect patients and the wider public interest. The Committee took into account the Guidance for the Professional Conduct Committee (November 2009) ( the Guidance ). It considered the range of sanctions available to it, starting with the least serious. The Committee applied the principle of proportionality, balancing the public interest with Ms Houghton s interests. Given the serious nature of its findings, the Committee decided that it would be wholly inappropriate to conclude this case without taking any action in relation to Ms Houghton s registration. It reached the same conclusion in respect of a reprimand. It considered that these courses of action would not be sufficient to address its concerns about the risk of repetition, nor would they protect the public interest. The Committee considered whether to impose conditions of practise on Ms Houghton s registration. It reminded itself that any conditions imposed must be workable, verifiable, sufficient and proportionate. In view of Ms Houghton s non-engagement, the Committee decided that conditions of practice would not be an appropriate sanction. In any event, it decided that it could not formulate any workable conditions to address the serious issue of Ms Houghton s dishonesty. The Committee went on to consider whether to suspend Ms Houghton s registration. The proven facts, which included an allegation of dishonesty, were of a serious nature. The Committee had regard to Paragraph 42e of the Guidance, which states that: Patients, employers, colleagues and others have a right to rely on registrants integrity. Important choices about treatment options and significant financial decisions can be made on the basis not only of registrants skill but also of their honesty. Dishonesty, particularly when associated with professional practice, is highly damaging to a registrant s fitness to practise and to public confidence in dental professionals. Despite being given ample opportunity, Ms Houghton has not engaged with the GDC at any stage regarding this case. Furthermore, there is no evidence of any remediation, remorse or insight on her part. Taking all this into account, the Committee concluded that a period of HOUGHTON, N L Professional Conduct Committee February 2015 Page -8/9-
suspension would not be sufficient to address the issues in this case, nor would it serve to maintain public confidence in the dental profession, or to declare and uphold proper standards of conduct and behaviour. In all the circumstances, the Committee has determined that the appropriate and proportionate sanction is one of erasure. Unless Ms Houghton exercises her right of appeal, her name will be erased from the Register for Dental Care Professionals, 28 days from the date when notice of this determination is deemed to have been served upon her. However, the Committee now invites submissions from you, as to whether her registration should be suspended immediately, pending this substantive determination for erasure taking effect. The Committee has heard submissions from Ms Broome on behalf of the GDC. It has accepted the advice of the Legal Adviser. The Committee has determined that it is otherwise in the public interest to impose an order for immediate suspension of Ms Houghton s registration. This order is made on the basis of the seriousness of the facts found proved including her lack of engagement with her professional regulator. The effect of the foregoing direction and this Order is that Ms Houghton s registration will be suspended forthwith and unless she exercises her right to appeal, the substantive direction will take effect 28 days from today. Should Ms Houghton exercise her right of appeal, this Order for immediate suspension may remain in place pending the resolution of any appeal proceedings. That concludes the case for today. HOUGHTON, N L Professional Conduct Committee February 2015 Page -9/9-