Mrs Madhu Sharma

Profession: Dietitian

Registration Number: DT06698

Hearing Type: Review Hearing

Date and Time of hearing: 08:30 07/08/2015 End: 11:30 07/08/2015

Location: Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

During the course of your employment as a Dietitian at Barts Health NHS Trust between 1999 and 23 October 2012:

 

1. The standard of your clinical practice was inadequate, including:

a. on 24 September 2010 you prescribed intravenous (IV) pabrinex on a pharmacy drug chart for a patient at risk of Refeeding Syndrome (RFS);

b. on 15 October 2010 you prescribed inappropriate Oral Nutritional

Supplements (ONS) for a patient with high output ileostomy;

c. on 05 September 2011 you documented on a patient chart an incorrect ONS product;

d. you did not calculate the nutritional requirements for Patient 106846;

e. you did not review patient RB's enteral feeding regimen before

discharge on 15 April 2012; and/or

f. on 17 May 2011 you increased patient JR's feed to 1000kcal/day, which was excessive.

 

2. You did not provide adequate clinical reasoning for:

a. on or around 24 October 2011, setting patient CNN 530002's goal rate at 4 days when the patient was at low risk of RFS;

b. on or around 24 October 2011, prescribing ONS for Patient CNN194870 when the patient was meeting their nutritional requirements by diet alone;

c. on or around 28 March 2011, continuing patient KA on ONS providing 1550kcal and 61g protein despite their being overweight and eating all meals; and/or

d. on or around 20 December 2011, continuing patient 106846's ONS as prescribed in the community without calculating nutritional requirements and/or recording intake.

 

3. You displayed poor record keeping, including:

a. on or around 31 January 2011, you did not record:

i. the biochemistry results for patient IA; and/or

ii. that patient IA was at high risk of RFS.

iii. patient KB's height, Body Mass Index (BMI) and/or indication of

percentage weight loss;

 

4. The matters described in paragraphs 1 - 3 constitute a lack of

competence.

 

5. By reason of your lack of competence your fitness to practise is

impaired.

Finding

Preliminary Matters:
1. Ms Rapu applied for the hearing to proceed in the Registrant’s absence. She informed the Panel that the Substantive Hearing on 11 August 2013 was disposed of by way of a Consent Order and that the Registrant was not present or represented at the subsequent review hearing on 11 July 2014. Ms Rapu also submitted that the Registrant was aware of this hearing as indicated in a letter from Thompsons Solicitors dated 9 July 2015 stating that Registrant would not be present nor represented. The Panel received and accepted the advice of the Legal Assessor who advised that the Panel’s discretion to proceed in a registrant’s absence should only be exercised with the utmost care and caution.
2. The Panel was satisfied that notice of this hearing was sent to the Registrant dated 7 July 2015 by first class post and had been served in accordance with the rules.  The Panel had regard to the letter from the Registrant’s solicitors dated 7 June 2015 in which it is stated that the Registrant has decided that she no longer wishes to practise as a dietitian at any stage in the future and does not propose to attend this hearing.
3. In the circumstances, the Panel concluded that the Registrant had voluntarily absented herself. The Panel noted that the purpose of this hearing was a statutory review of a suspension order which was first imposed on 11 August 2013 and extended for a further 12 months on 11 July 2014. The Panel considered that it was in the public interest and in the Registrant’s interests that the order should be reviewed expeditiously. Accordingly, the Panel decided to proceed in the Registrant’s absence.
Decision on Impairment:
4. The Panel had regard to the findings of the previous Panels that the Registrant’s fitness to practise was impaired by reason of her lack of competence.
5. The Panel was presented with no information from the Registrant or any other source of any steps she had taken to address the serious, significant failings found proved, leading to her fitness to practise being impaired and the suspension order being imposed. The matters found proved concerned basic elements of safe practice as a dietitian and serious errors of clinical judgement.
6. The Panel noted that in its determination of 11 July 2014, when extending the suspension order for a further 12 months that Panel made it clear that it may be helpful to a reviewing Panel for the Registrant to provide an indication of whether she had an intention of resuming her career, and, if she does, details of any action she has taken or plans to take or address the numerous and varied failings identified by the allegation. That Panel also made clear that the reviewing Panel would be assisted by evidence of how she has, or proposes to stay abreast of developments in her profession, together with steps taken, or to be taken, to comply with Continuing Professional Development requirements.
7. In the absence of any evidence of remediation, Continuing Professional Development or other steps demonstrating her knowledge, the Panel determined that the Registrant remains at risk of causing harm to service users and of bringing her profession into disrepute. Accordingly the Panel found that the Registrant’s fitness to practise remains impaired.

Decision on Sanction
8. The Panel considered the submissions made by Ms Rapu on behalf of the HCPC and received and accepted the advice of the Legal Assessor.
9. The Panel was mindful that the purpose of any sanction was not to punish the Registrant but to protect the public and maintain public confidence in the profession and the HCPC as its regulator, by the maintenance of proper standards of conduct and behaviour. The Panel had regard to the Indicative Sanctions Policy. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of seriousness.
10. In determining the appropriate and proportionate sanction, the Panel had regard to the serious and wide ranging matters found proved. The Panel also bore in mind that the Registrant has not provided any evidence of any steps taken by her to remedy her lack of competence.
11. The Panel first considered taking no action, however it concluded that this would be inappropriate and would not be sufficient to protect service users or the reputation of the profession. The Panel considered that this was not an appropriate case for mediation and that a caution order would be insufficient.
12. The Panel was unable to formulate any workable or practicable conditions of practice, given the Registrant’s lack of demonstrable engagement, the absence of any information as to her current employment and her stated intention not to practise as a dietitian at any time in the future.
13. The Panel carefully considered whether to confirm or extend the current Suspension Order and was mindful that the purpose of such an order includes a Registrant being able to demonstrate that her fitness to practise is no longer impaired at the time when the order is reviewed. In the circumstances of this case, where the Registrant has provided no evidence of any improvement in her ability to practise safely and has indicated an intention not to practise as a Dietitian at any time in the future, the Panel concluded that a further suspension order was not appropriate or proportionate and would serve no useful purpose.
14. The Panel was mindful that a striking off order should only be imposed where no other sanction was appropriate or proportionate. The Panel noted that it was made clear to the Registrant in the determination of the last Panel of 11 July 2014 and in the notice of hearing dated 7 July 2015 that a striking off order could be made once the Registrant had been suspended for a period of two years.
15. The Registrant will have been suspended for at least two years when the current suspension order expires on 9 September 2015. The Panel considered that it had no other option than to direct that upon the expiry of the current suspension order it is replaced with a striking off order.

Order

ORDER:   

 The Registrar is directed to strike the name of Madhu Sharma from the Register upon the expiry of the current order. 

The order imposed today will apply from 9 September 2015.

Notes

No notes available

Hearing History

History of Hearings for Mrs Madhu Sharma

Date Panel Hearing type Outcomes / Status
07/08/2015 Conduct and Competence Committee Review Hearing Struck off
07/08/2015 Conduct and Competence Committee Review Hearing Hearing has not yet been held