Mazen Alkasem

Preliminary Matters

Hearing partly in private

1.          Ms Sampson, on behalf of the Health and Care Professions Council (HCPC) made an application for any matters of a personal or health nature to be discussed in private session. Mr Jolliffe on behalf of Mr Alkasem (the Registrant) agreed with this application. The Panel accepted the advice of the Legal Assessor and considered the relevant HCPTS Practice Note on “Conducting Hearings in Private”.

2.          The Panel was aware that as a starting point, all hearings should be held in public. Where there are overriding considerations, only then should that public interest in hearings held in open session be overridden. The HCPC (Conduct and Competence) (Procedure) Rules 2003 (the Rules) provide the Panel with a discretion to consider such issues of a personal or health nature in private. The right to respect for private life is protected in Human Rights legislation. The Panel gave this matter consideration and agreed the application to hear any matters of a personal or health nature in private.

Background

Academic and professional training

3.          The Registrant is an HCPC Registered Physiotherapist. The facts relevant to his fitness to practise concerns date from 16 July to 24 September 2018, when he was working for the Salford Royal NHS Foundation Trust for a probationary period. The matter was referred to the HCPC on 4 October 2018 and considered by the Investigating Committee on 4 May 2020.

4.          The Registrant had practised in Saudi Arabia, before moving to the UK to continue his extended studies.

5.          The Registrant trained as a physiotherapist in Saudi Arabia, in the Rehabilitation and Physical Therapy department, King Saud University, Riyadh, and graduated in 2001 in physical therapy and rehabilitation. As part of his internship year in 2001 he worked at the Central Riyadh Hospital for five months and the King Faisal Specialist Hospital and Research Centre in Riyadh for seven months. He was also a trainee in the physical therapy department in the Dallah Hospital, Riyadh.

6.          In October 2011 the Registrant started a PhD in sport injury rehabilitation at Salford University. His thesis title was ‘Investigation of causes and management for patients with patellofemoral pain syndrome’. He also obtained a Diploma in Community Development from Manchester Trinity College in May 2013. In 2015 and 2016 his papers on patellofemoral pain syndrome were published in the British Journal of Sports Medicine, the Physiotherapy Journal, and an international conference journal. He was employed as a physiotherapy assistant from September 2016 to January 2017 at the Alfa Physio Clinic, Manchester.

7.          The Registrant gained HCPC registration at the end of 2017. In 2018 he was granted indefinite leave to remain in the UK. He has had no patient complaints or other issues raised, other than in the current fitness to practise proceedings.

The Concerns

8.          In 2018 the Registrant obtained employment in Salford as a Band 5 Physiotherapist. He was placed on probation under supervision and was made subject to an Action Plan but was unable to meet the standards required. The Registrant had no academic barriers to progress and could maintain CPD. The issues were in relation to the Registrant’s lack of competence and that his clinical practice was not of the required standard.

9.          The concerns were summarised as being that:

between 16 July 2018 and 24 September 2018, the Registrant did not meet the standards expected of a Band 5 Physiotherapist in that he:

• Did not adequately conduct and/or record patient assessments.

• Used non-specific and / or non-clinical terminology in patient notes.

• Demonstrated a lack of knowledge regarding clinical and / or non-clinical terms and/or physiotherapy practices.

• Demonstrated poor communication with patients.

• Did not adequately prepare for patient assessments.

Other factors

10.      There were personal factors that co-existed with the concerns identified and were influential, in the Registrant’s case, in inhibiting his ability to gain and demonstrate competence in a Band 5 role.

11.      The Registrant experienced language barrier issues which also impacted on his doctoral studies. Two of his children were unable to join him in the UK as a consequence of being unable to renew their UK visas. The Registrant acknowledged that he was professionally unprepared to practice in a Band 5 role and that “…in hindsight I should have taken steps to refresh my knowledge before returning to practice”.

12.      The Registrant was dismissed from his employment in September 2018. He has not practised professionally since that time and has worked, when available, in an administrative role outside of his professional registered capacity.

13.      In this circumstance, the Registrant will be able to devote greater time and resources to addressing the conditions of practice in place and seeking an opportunity to resume work in his professional capacity.

Impairment 12 October 2022

14.      On 12 October 2022 the substantive hearing panel made the following decision in relation to the Registrant’s then current impairment.

15.      There is a lack of insight by the Registrant in respect of the matters giving rise to these proceedings. He has undertaken some Continuing Professional Development since these matters arose but this has not been sufficiently focused, to address the issues raised on the proved facts and his lack of competence. The Registrant has produced historic character evidence and a supportive testimonial from his employer who states there have been no complaints against the Registrant and he is professional. The current work being undertaken by the Registrant is of a limited nature. He has engaged with the HCPC and with this hearing but he has not focused sufficiently on the key issues raised.

16.      These matters are remediable but in the current circumstances there is a high risk of repetition. The Registrant is currently impaired under the personal component for public protection reasons. His communication problems and lack of basic clinical skills show he is lacking in relation to the necessary attributes and the fundamental tenets of the profession, for safe practice. He did not recognise the risk to patients and demonstrated a lack of insight when he gave evidence to the Panel. He referred to “mistakes which anyone could make”. This demonstrated a limited understanding of the risk to patients and the concept of harm arising from the proved facts and the extent of his lack of competence. The Registrant does not accept that his fitness to practise is currently impaired. He states that he is safe to return to practice and appears to take the view that the incidents giving rise to the proved facts are not serious. The Panel finds he has no meaningful insight into the risks posed to service users, colleagues, members of the public and the profession.

17.      The Panel has also taken into account there are important public policy issues. The Registrant is currently impaired on public policy grounds because public confidence in the profession and the regulatory process would be undermined, if a finding was made that his fitness to practice is not currently impaired. There is a high risk of harm due to the Registrant’s lack of competence and the nature of his impairment under the personal component. Despite the lapse of time there has been no significant improvement in the level of risk of harm to the public and the public interest posed by the Registrant if he returns to practice.

18.      Accordingly, the Panel finds that the Registrant’s fitness to practise is currently impaired on both the personal and public components.

19.      On 12 October 2022 the substantive hearing panel made the following decision in relation to the sanction of conditions of practice imposed.

20.      The Panel had a particular concern in relation to the issue of the insight shown by the Registrant concerning the potential risks to service users through his failings in practice. The Panel noted the HCPC submission that in respect of the Registrant’s insight “it was not as fully formed as the regulator would wish”. The lack of full insight and the consequential increased risk of repetition required the Panel to ensure that any formulated conditions of practice would satisfy the primary responsibility to protect the public and the reputation of the profession.

21.      The Panel is able to formulate workable and practicable conditions of practice that adequately address the risks and are proportionate to the proved facts and does not amount to suspension. The Registrant’s failures are capable of being remedied and allowing the Registrant to remain in practice, albeit subject to conditions, will protect the public and the wider public interest. This will also enable a future reviewing panel to determine whether sufficient remediation has been completed. Furthermore, the Panel is confident due to the Registrant’s integrity and commitment to learn he will be able to comply with the conditions set out below.

22.      In the judgement of the Panel a Suspension Order would be disproportionate and unduly punitive, in the current circumstances. Accordingly, the Panel has determined that a Conditions of Practice Order is the necessary and proportionate order to ensure the safety of the public. This Order will be reviewed before it expires. A period of 12 months is required to reflect the seriousness and extent of the Registrant’s failings.

23.      The substantive hearing panel then imposed a 12-month conditions of practice order as above.

Substantive Review

24.      Under Article 30 of the Health Professions Order 2001 (the Order), where a panel has imposed a substantive sanction order, the order must be reviewed by a panel before it expires. The Registrant’s Suspension Order is due to expire on 9 November 2023.

25.      Evidence Before the review Panel

26.      The panel was provided with:

·       the HCPC review bundle of 37 pages, and

·       the Registrant’s review bundle of 39 pages including certificates of CPD completed by him.

Submissions

HCPC

27.      Ms Sampson, on behalf of the HCPC submitted that the appropriate and proportionate order was one of conditions of practice in the same terms as are already in place. Having discussed matters with Mr Jolliffe on behalf of the Registrant, she invited the Panel to extend the current order for three years. This would allow time for the Registrant to adjust to any changes in his personal and family life, to prepare for and find employment as a physiotherapist, and to address the conditions of practice in a methodical and comprehensive manner. She reminded the panel that the current order is due to expire on 9 November 2023.

28.      Ms Sampson took the panel to the Registrant’s bundle submitted by him in advance of today’s review and also the HCPC bundle which included a reflective piece by the Registrant submitted on 9 December 2022 in response to the first conditions of practice imposed.

29.      Ms Sampson said that there had not been sufficient evidence of training, education, professional practice, or other remediation to permit the panel to find that the Registrant was no longer impaired. She invited the Panel to consider whether the Registrant’s written reflective piece had satisfied conditions of practice 1.

30.      Ms Sampson recognised that the risks to the public identified by the substantive hearing panel had not been altered in any material way. In those circumstances, the Registrant’s fitness to practise remained impaired on both the personal and the public components. Accordingly, the Panel must address those risks by imposing an appropriate and proportionate restriction on the Registrant’s practice. In her submission, that was an extension of the current conditions of practice order for a further three years.

The Registrant

31.      Mr Jolliffe, on behalf of the Registrant, accepted that the Registrant’s fitness to practise remained impaired today, for the reasons advanced by Ms Sampson. The Registrant remained employed in an administrative role, however, he intends to take advantage of the potential for a return to part-time professional work.

32.      Mr Jolliffe explained that the Registrant remained committed to a safe and effective return to work. He had identified that he must complete the HCPC recommended process for a Return to Practice prior to taking up a physiotherapist role, probably part-time to begin with. However, as evidenced already by the targeted CPD certificates produced, the Registrant is able to implement a plan to address and satisfy the conditions of practice order that is currently in place.

33.      Mr Jolliffe said that he agreed with Ms Sampson that an extension of the current order for three years would be a proportionate and appropriate order. The public would remain fully protected and would benefit from the gradual return to practice of an otherwise capable and committed physiotherapist.

Decision

34.      The Panel accepted the Legal Assessor’s advice and held in mind that its purpose today is to conduct a comprehensive review to determine if the Registrant is fit to return to unrestricted practice. The Panel must exercise its own independent judgement in comprehensively reviewing the case and addressing

·       whether the Registrant’s fitness to practise remains impaired today, and if so,

·       whether a sanction remained necessary and finally, if so,

·       what is the least restrictive but equally effective alternative sanction that would fully protect the public.

35.      If the evidence before the Panel is sufficient to show that there has been full remediation and full insight gained, such that there is little or no likelihood of a repetition of the misconduct, the Panel may come to the conclusion that there is no continuing impairment and, in such a situation, the Panel may allow the current order to lapse on 9 November 2023.

36.      However, if the Panel determines that the Registrant’s fitness to practise remains impaired, then the Panel must go on to consider what restriction, if any, should be imposed. The Panel must bear in mind the principles of fairness and proportionality and have regard to the Sanctions Policy document issued by the HCPC.

37.      The Panel was encouraged that the Registrant had attended today and had taken the opportunity, through Mr Jolliffe, to address the continuing concerns regarding his fitness to practise set out by Ms Sampson on behalf of the HCPC. The Registrant’s acceptance of his continuing impaired fitness to practise (although a matter ultimately for the Panel’s own professional judgement) was evidence of a realistic and creditable approach to the review.

38.      The Panel carefully considered the documentation before it and the submissions made on behalf of the HCPC by Ms Sampson and by Mr Jolliffe.

39.      The Panel observed that the Registrant has not worked in the profession since 2018. The evidence that he has supplied, within the constraints of his personal circumstances, however fell far short of addressing the conditions of practice order already in place. The Panel did not criticise the Registrant for this. The Panel was satisfied that other factors played a part in limiting the Registrant’s ability to find work in a professional capacity and to demonstrate through good practice, education, and training that he has achieved the necessary standard of professional competence. As acknowledged by him, the Panel was satisfied that the Registrant’s fitness to practise remained impaired today on both the personal and the public components.

40.      The Panel determined that the Registrant has not shown evidence of remediation or a sufficient level of insight, nor has he engaged in CPD and/or relevant training to sufficient depth. The Panel therefore concluded that there is a high risk of repetition of similar concerns in relation to the Registrant’s professional competence if he were permitted to return to practice unrestricted. There is, therefore, an ongoing risk of harm to the public, including vulnerable service users.

41.      The Panel also concluded that a finding of impairment is required to protect the public against the risk of repetition.

42.      The Panel accepted the impact that the Registrant’s personal circumstances and family life had on his ability to engage methodically and purposefully with the current conditions of practice order. He had made efforts to keep in touch with professional updates and practice. The Registrant had identified that language had acted as a practical barrier in the past and had taken steps to address current awareness of developments and skills necessary to practice in a safe and effective way. In all of these circumstances, there was no evidence of an academic or personal unwillingness or incapacity to work constructively with a conditions of practice order.

43.      In regard to the Registrant’s insight, the Panel was not persuaded that the reflective piece submitted by the Registrant in December 2022 had truly shown the depth and extent of insight necessary. In the Panel’s view, it approached the issues correctly but inadequately. There was an absence of depth and development of the core issues identified by the substantive panel. That may well be attributed to the complex personal stressors which currently are relevant in the Registrant’s life. The Panel did not consider that these matters were evidence of an entrenched superficiality in the Registrant’s response to the conditions of practice order.

44.      The absence of any real and material practical steps towards remediation identified in the current order was likewise not driven by disinterest or unwillingness by the Registrant to participate in the process.

Conditions of practice order extended by 18 months

45.      The Panel applied the guidance in the Sanctions Policy and its powers in respect of sanction. The Panel is aware that the primary function of any sanction is to address public safety. The Panel should also give appropriate weight to the wider public interest, which includes maintaining confidence in the profession and setting the proper professional standards.

46.      The Panel applied the principle of proportionality and balanced the Registrant’s interests against the public interest. The Panel noted that the sanction should be the least restrictive which is sufficient to provide the necessary degree of public protection.

47.      The Panel considered the sanctions in ascending order of severity. The Panel decided that the Registrant’s conduct by way of convictions is of a nature and gravity that the option of taking no action would be insufficient to protect the public and to maintain public confidence in the profession.

48.      The Panel considered imposing a Caution Order but decided that it would provide insufficient protection to the public. The Registrant has not demonstrated a sufficiency of insight into his conduct and its potential to cause harm. The Panel has found that in these circumstances there is a high risk of repetition. A Caution Order would not restrict the Registrant’s practice and would not therefore provide sufficient protection for the public.

49.      For the reasons set out by the substantive panel, which the Panel agreed with, and for the reasons set out above, the Panel determined that the appropriate and proportionate order was to extend the current conditions of practice order for a period of 18 months.

50.      The Panel was not satisfied that the first condition had truly been addressed and accordingly the Panel decided to continue that condition but extended the period for compliance by an additional four months to allow the Registrant to adapt to any changes in his personal life and also to reflect in a focused and targeted way on what the Panel has said in regard to the Registrant’s first reflective piece.

51.      The Panel was satisfied that the remaining conditions were proportionate and appropriate. Accordingly these were continued unchanged.

52.      The Panel did not agree that an extension for a period of three years would assist the Registrant. There was the risk that the time available would be inadvertently lost through a lack of urgency and focus. Accordingly, in order to assist the Registrant, the Panel decided that a period of 18 months was a more suitable and achievable period for implementation.

Order

The Registrar is directed to annotate the Register to show that for 18 months from the date that this Order comes into effect (the operative date) you Mr Mazen Alkasem must comply with the following Conditions of Practice:

1. Within four months of the operative date (9 November 2023):

You must produce a written reflective piece that explains your understanding of the potential impact of your identified practice deficiencies on service users, colleagues, and the reputation of the physiotherapy profession. This must be forwarded to the HCPC and will be made available to any subsequent panel.

2. Prior to commencing work as a physiotherapist:

You must contact the HCPC and successfully complete its recommended process for a “Return To Practice”.

3. If you undertake employment as a registered physiotherapist, you must place yourself and remain under the supervision of a workplace supervisor, who is a physiotherapist of band 6 or higher and registered by the HCPC.

4. You must supply details of your supervisor to the HCPC within one week of returning to practice as a physiotherapist, attend upon that supervisor as required and follow their advice and recommendations.

5. You must work with your nominated supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

a. Effective communication with service users and

b. Conducting comprehensive and effective patient

c. Recording comprehensive and effective patient

6. Before undertaking physiotherapy practice without direct supervision, you must complete refresher training in the following subjects:

a. Obtaining and recording service user consent for

b. Obtaining and recording service user clinical

c. Obtaining and recording service user

d. Obtaining and recording clinical

e. Obtaining and recording SMART service user

f. Obtaining and recording service user SOAP

g. Mental

h. Activities of Daily

i. Red flags and sinister

j. Deep vein

7. You must detail the areas of required refresher training within your Personal Development Plan and have them confirmed by your nominated supervisor when they are successfully completed.

8. You must meet with your nominated supervisor on a monthly basis to discuss and document your progress towards achieving the objectives set out in your Personal Development Plan and provide copies of these documents to the HCPC at least 28 days before the review hearing.

9. Once you have completed the specified refresher training you must undertake a period of directly supervised physiotherapy practice for a minimum of 3 months.

10. You must not commence physiotherapy practice without direct supervision until your nominated supervisor has confirmed your overall fitness for safe unsupervised practice and you have provided evidence of this to the HCPC.

11. Within three months of commencing practice as a physiotherapist you must forward a copy of your Personal Development Plan to the

12. You must allow your nominated supervisor to provide information to the HCPC about your progress in attaining your objectives within your Personal Development Plan.

13. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

14. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

15. You must inform the following parties that your registration is subject to these conditions:

a. any organisation or person employing or contracting with you to undertake professional work;

b. any agency you are registered with or apply to be registered with (at the time of application); and

c. any prospective employer (at the time of your application).

Any condition requiring you to provide information to the HCPC is to be met by you sending it marked for the attention of the relevant Case Manager or the FTP department.

The Order imposed today will apply from 9 November 2023.

This Order will be reviewed again before its expiry on 8 May 2025

History of Hearings for Mazen Alkasem