Ms Elizabeth Israel

Preliminary Matters
Conducting the hearing partially in private
1. Ms Khan made an application for any reference to the Registrant’s health and private life to be heard in private. The Registrant supported that application.
2. The Panel had regard to the HCPTS Practice Note on “Conducting Hearings in private and accepted the advice of the Legal Assessor. The Panel granted the application on the grounds advanced by Ms Khan.
Background
3. In May 2021, the Registrant registered with PSL Recruitment Services Limited (PSL Recruitment), an agency which recruits physiotherapists for both the NHS and private providers. Mr AT, the managing director of PSL Recruitment and the Registrant had a phone conversation, and arrangements were made for the Registrant to attend for an interview. This was originally scheduled for 20 May 2021, and in the event was postponed by a day, and took place on 21 May 2021. According to Mr AT, the Registrant had said she wished to start work as soon as possible.
4. Part of the compliance process undertaken by PSL Recruitment is to obtain at least two references for candidates, covering their last three years of employment. The Registrant provided PSL Recruitment with contact details for three referees; KD at Homerton University Hospital, JP at Excellent Health Physiotherapy, and KC at TRP Physio.
5. PSL Recruitment received an ‘out of office’ from KD’s email in response to attempted contact on 21 May 2021. When PSL Recruitment were able to speak to her on 24 May, she advised that the request should be sent to the Human Resources department. No response was received to that request.
6. The second referee, Mr JP, could not be contacted on the business email provided by the Registrant. Mr AT therefore spent some time on 21 May 2021 attempting to locate him through online searches. The closest match he found was ‘Excellence Physiotherapy and Osteopathy London’. He called the practice and was informed that no-one by the name of Mr JP worked there. When Mr AT asked about the Registrant, he says he was told by the Practice Manager that the Registrant had worked at the clinic for about a month. Mr AT noted that according to the Registrant’s CV, she had worked there considerably longer.
7. Later on 21 May, PSL Recruitment received an email purporting to be from Mr JP, to say that the Registrant had informed him that PSL Recruitment were trying to get in touch with him. A reference request form was sent to the outlook email address that Mr JP had used to contact PSL Recruitment. The reference was returned on 24 May 2021.
8. The third referee was Mr KC of TRP Physio. According to Mr AT, emails sent to the address the Registrant had provided kept bouncing back. On 25 May 2021 PSL Recruitment received an email purporting to be from Mr KC, sent from a gmail address. The email said that he had been informed that PSL Recruitment were attempting to contact him for a reference in relation to the Registrant. He asked for the reference request to be sent to the gmail address. Later the same day, an email was received from Mr KC’s gmail account attaching a reference for the Registrant.
9. On 25 May 2021 Mr AT called KC in order to verify the reference. Mr KC informed Mr AP that his physiotherapy practice had closed down around a year previously, and that KC, at that time, ran a cake shop. Mr KC subsequently confirmed that he did not write the reference that PSL Recruitment had been sent in his name, for the Registrant.
10. Mr AT then suspected that the Registrant was writing the references herself. During a call later on 25 May 2021 between Mr AT and the Registrant, she admitted she had done so, after Mr AT said that he would need to report the matter to the police. There was then a discussion about notifying the HCPC, and the Registrant said she needed time to think things through. She called Mr AT back and informed him that she would self-refer to the HCPC.
11. The Registrant emailed the HCPC using the ‘registration’ email address at 5.29pm on 25 May 2021. She wrote:
I am contacting you regarding my registration as a physiotherapist. My name is Elizabeth Israel (PH105956).
As a result I created an email address and provided a reference for myself. I understand the implications and unlawfulness in doing so and I would like to offer my sincere deepest apologies. It has been brought to my attention by a previous employer and I believe that it is the best decision to contact you to let you know. I acted outside of my character and I am very remorseful.
I value my professional title as a physiotherapist which I have worked so hard to maintain and understand the implications in doing so.
Please let me know how this can be resolved. I look forward to hearing from you soon
12. On 26 May 2021 PSL Recruitment also submitted a referral to the HCPC. That referral included reference to the HCPC address to which the Registrant’s self-referral had been made, and stated that it appeared to have been sent to the incorrect place.
The substantive hearing
13. At the outset of the hearing, the Registrant admitted particulars 1 and 2 of the allegation.
14. The panel found the facts proved on the basis of the evidence of the witnesses called on behalf of the HCPC and the Registrant’s own admissions.
15. The panel found that the Registrant’s fitness to practise was impaired by reason of her misconduct in respect of both the personal and public components of impairment.
16. The panel found that the Registrant’s apology and expressions of remorse were genuine. The panel noted that, since the incident in May 2021, the Registrant had obtained and worked in three locum roles, and there had been no repetition of her misconduct.
17. The panel, however, was of the view that the Registrant had not demonstrated full insight and that much of what she had told the panel was unsupported by independent evidence. The panel stated that:
“She had not been able to give specific or concrete examples, either of courses she had undertaken, conversations she had had with her GP mentor, or the learning she had gained from the preparatory reading for her planned studies commencing in September 2023. Despite requests from the Panel, the Registrant had not provided any evidence of the development and reflection she said she had undertaken. She had not provided evidence of CPD, or extracts from the reflective diary she had referred to in her evidence. The Panel would have been assisted by such material, as well as character references. The Panel noted that the Registrant had referred to a range of people from whom she has received support, including people at her church, and in the care home where she had undertaken voluntary work. She had referred to conversations with her GP mentor and clinical educators in her professional role. Yet none of these had attested to her character”.
18. The panel concluded that there was a risk of repetition of the Registrant’s dishonest conduct, if she were under pressure to achieve a particular outcome.
19. With regard to sanction, the panel decided to impose a Suspension Order for a period of 10 months. This would give the Registrant time to reflect further on the impact of her actions on the profession and the public and give her the opportunity to address the outstanding concerns.
20. The panel advised the Registrant that a reviewing panel was likely to be assisted by:
• a reflective statement from the Registrant, dealing with the impact of her dishonesty on the public and the profession;
• evidence of CPD demonstrating learning in relation to the importance of professional standards specifically relating to Standard 9 of the HCPC Standards of Conduct, Performance and Ethics; and
• testimonials or references as to her character from paid or voluntary work.
Today’s hearing
21. The Panel was provided by the HCPC with a hearing bundle which included the decision of the panel at the substantive hearing.
22. The Registrant provided the Panel with the following documents:
• a reflective diary;
• statement of CPD demonstrating learning in relation to the importance of professional standards, specifically relating to Standard 9 of the HCPC Standards Of Conduct, Performance and Ethics; and
• statement as a Law Student.
23. The Registrant gave evidence on affirmation to the Panel. In summary, she stated the following:
• she had been studying full-time since September 2023 and had not therefore undertaken any paid or unpaid employment;
• she had attempted to obtain references and/or testimonials in respect of her employment pre-dating the substantive hearing in June 2023 but had so far been unsuccessful in doing so. She said it was difficult to obtain references because “people move on”;
• in October 2023 she had had applied for a Band 4 physiotherapy position with Kings College Hospital and had declared that she was subject to a Suspension Order;
• she had disclosed her circumstances when applying to undertake a law course at Brunel University;
• she had been unable to provide independent evidence that she had completed any CPD because she did not have a printer.
24. Ms Khan submitted:
• the Registrant had only provided her documentation for the review on the morning of today’s hearing and not engaged meaningfully with the HCPC since the substantive hearing in June 2023;
• her reflective piece was generic and did not address the issues identified by the panel at the substantive hearing;
• she had not provided any references or testimonials; and
• she had not provided any sufficient evidence of having undertaken ongoing CPD.
25. Ms Khan submitted that, in these circumstances, the Registrant had not discharged the persuasive burden on her to demonstrate that her fitness to practise was no longer impaired. It followed that her fitness to practise remained impaired in respect of both the personal and public components of impairment.
26. The Registrant submitted that she had done what was required of her in terms of complying with the recommendations of the panel at the substantive hearing and that her fitness to practise was no longer impaired.
The Panel’s decision
27. The Panel took into account the HCPTS Practice Notes “Review of Article 30 Orders” and “Fitness to Practise Impairment” and accepted the advice of the Legal Assessor.
28. The Panel first considered whether the Registrant’s fitness to practise was currently impaired by reason of her misconduct.
29. The Panel took into account the decision of the High Court in Abrahaem v GMC where it was stated that in practical terms there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that she has fully acknowledged the deficiencies which led to the original findings and has addressed her impairment sufficiently “through insight, application, education, supervision or other achievement”.
30. The Panel was not fully satisfied that the Registrant had sufficiently demonstrated that she had addressed the outstanding concerns of the panel at the substantive hearing for the following reasons:
• the Registrant’s written reflections were of a generic nature: they did not address the particular facts of her case; the lessons she had learned and why she would not repeat such dishonest conduct in the future;
• the Registrant had not yet provided any references or testimonials relating to her employment pre-dating the substantive hearing in June 2023. The Panel did not accept her explanation that she could not provide such references or testimonials because “people move on”. There was no evidence before the Panel that she had applied for such references;
• the Registrant could have provided the Panel with a copy of her application to Kings College Hospital for the Band 4 physiotherapy assistant job to demonstrate that she had disclosed that she was currently subject to a Suspension Order. That could have provided the Panel with evidence demonstrating her integrity and transparency. She did not do so;
• the Registrant could have provided the Panel with a testimonial as to her integrity and good standing from her university for the purpose of today’s review, She did not do so;
• the Registrant could have provided evidence of her completion of CPD courses but did not do so. The Panel did not accept her explanation that she could not do so because she did not have a printer;
• the Panel noted that the Registrant relied on her assertion that she had been undergoing very difficult and stressful circumstances in her personal life. She provided no independent evidence of this.

31. Given the matters referred to above, the Panel was not satisfied that the Registrant had discharged the persuasive burden of demonstrating that her fitness to practise was no longer impaired either in respect of the personal or public components of impairment. The Panel therefore concluded that the Registrant’s fitness to practise remained impaired.
32. With regard to sanction, the Panel took into account the HCPC’s Sanctions Policy and accepted the advice of the Legal Assessor.
33. The Panel considered the need to protect the public and gave appropriate weight to the wider public interest, which includes the reputation of the profession and public confidence in the regulatory process. The Panel applied the principle of proportionality and considered the available sanctions in ascending order of seriousness.
34. The Panel considered that the concerns about the Registrant’s fitness to practise were too serious to take no further action or for the imposition of a Caution Order.
35. The Panel considered that a Conditions of Practice Order was not relevant to a case involving dishonesty.
36. The Panel decided to impose a further period of suspension for a period of three months from the expiry of the current order. This would give the Registrant the opportunity to address the outstanding concerns.
37. The panel advised the Registrant that a reviewing panel was likely to be assisted by:
• a more focused reflective statement from the Registrant, addressing her understanding of the impact of her dishonesty on the public and the profession, together with evidence of how her practice had since changed, e.g. by providing a copy of her application to Kings College Hospital for the Band 4 position in October 2023;
• evidence of CPD completed during the last two years;
• testimonials or references in respect of her employment and character prior to and since June 2023;
• a reference or testimonial as to her character from Brunel University.

38. The Registrant should be in no doubt that if she fails to use the opportunity to address the matters referred to above, there is a risk that the next reviewing panel may consider making a Striking Off Order.

Order:
The Registrar is directed to suspend the registration of Ms Elizabeth Israel for a period of 3 months on the expiry of the current Suspension Order.

Order will take effect starting 21 May 2024

History of Hearings for Ms Elizabeth Israel