Mr Amin M Sain
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Allegation: (as found proved at the final hearing on 07 February 2014)
1) Your fitness to practise as a registered health professional is impaired by reason of your misconduct in that you have been practising the treatment of minimal invasive surgery without the full underpinning surgical knowledge necessary to perform this type of surgery safely, and in doing this you are acting beyond your scope of practice,
2) Your fitness to practise as a registered health professional is impaired by reason of your misconduct in relation to the content of the website for the General Podiatric Surgery Council.
1. The Panel was satisfied that good service had been effected.
2. On behalf of the HCPC, an application was made that the hearing proceed in the absence of the Registrant.
3. The Panel considered the HCPC Practice Notes on ‘Proceeding in the Absence of the Registrant’ and on ‘Interim Orders’. It also accepted the advice of the Legal Assessor.
4. The Panel reminded itself that its ability to proceed in the absence of a registrant was one to be used with the utmost care and caution. Its task was to balance fairness to the Registrant with the public interest.
5. The Panel considered that it could proceed in the absence of the Registrant on the following basis:
- the Registrant confirmed that he was aware of the hearing today in a telephone call on Friday 17 July, as recorded in a Note;
- he has not requested an adjournment;
- he has expressed frustration at the length of the disciplinary process and it was unlikely that he would welcome an adjournment.
6. The Panel considered that the Registrant had voluntarily absented himself today. This is a mandatory review which should take place expeditiously. An adjournment would serve no purpose as there is no reason to believe that he would attend an adjourned hearing.
7. Although the Registrant is not present, he has provided an update for the Panel as to his circumstances. This Panel decided that this information meant that the Registrant would not be unduly prejudiced by the hearing proceeding without him being present or represented.
8. Accordingly, the Panel exercised their discretion to proceed in the absence of the Registrant.
9. Given the extensive history of this case, it is important to set out the background in summary. The original allegations set out in the head of this document were found proved at the final hearing which concluded on 29 March 2009. The 2009 Panel found that Mr Sain lacked the knowledge to perform minimally invasive surgery safely. It found that Mr Sain had proceeded to undertake such surgery knowing that he was not fully qualified to do so. The Panel found that this amounted to misconduct as did Mr Sain’s association with a website which purported to be an established regulator of podiatric surgery.
10. The 2009 Panel accepted that Mr Sain had gone some way towards completing a satisfactory training programme. However it also held that in not seeking to develop his skills in relation to traditional open site surgery, and lacking the ability to prescribe antibiotic medication, he lacked the full knowledge necessary to perform surgery safely. With regard to the allegation founded on the website, the Panel found that he knowingly allowed himself to be described as “Dr Amin M Sain” and as the UK Director of the GPSC. The Panel found that the website’s inclusion of a contention that the General Podiatric Surgery Council was “much like a GMC [General Medical Council]” gave a misleading impression that the GPSC was an established regulator, whereas it was nothing of the kind. The 2009 Panel concluded that Mr Sain’s fitness to practise was impaired and imposed a Conditions of Practice Order for a period of three years.
11. The original Order was reviewed on 20 February 2012. Mr Sain did not attend that review but notified the Panel in advance that he had no new information for the review. That reviewing 2012 Panel was concerned at the content of a website print which appeared to refer to Mr Sain performing minimally invasive surgery in breach of the conditions of practice imposed in 2009. That, coupled with the failure of Mr Sain to provide any evidence that he had complied with the Conditions of Practice Order, led the Panel to revoke that order and replace it with a Suspension Order for one year.
12. On 17 January 2013 a panel carried out a review of the suspension order imposed on 20 February 2012. Mr Sain attended that review. The 2013 Panel stated that it was unable to accept that there had been any change of circumstances since the previous review of the Order. The 2013 Panel considered that Mr Sain was unclear as to the distinction between general podiatry and podiatric surgery, and had limited insight into and understanding of the implications of practising podiatric surgery without the appropriate qualifications. The 2013 Panel accepted that Mr Sain had an interest in podiatric surgery but was concerned whether he was prepared to accept that he must not undertake such surgery. Additionally, the 2013 Panel stated that Mr Sain had not demonstrated that he had taken steps to maintain and update his knowledge of general podiatric practice. The 2013 Panel ordered that the period of suspension should be extended for a further year.
13. The Suspension Order was reviewed on 07 February 2014. Mr Sain informed the 2014 Panel that he had not undertaken surgery during the Conditions of Practice Order or practised at all since the first period of suspension commencing 20 February 2012. The 2014 Panel accepted this and was of the view that the time had come to decide whether either Mr Sain should be permitted to return to practice, subject to conditions, or be removed from the register. The 2014 Panel was concerned that Mr Sain had not been practising for some time, and needed to be reminded of his on-going obligation to keep his skills and knowledge up to date in the interests of public protection and indeed of the ordinary obligations of a registrant to remain within their scope of practice, to meet the CPD standards and to comply with the Return to Practice Standards if they apply. Having considered all matters the 2014 Panel imposed a Conditions of Practice Order for a period of 18 months.
14. On 19 January 2015 there was an early review of the order carried out in accordance with Article 30(2) of the Health and Social Work Professions Order 2001 at the request of Mr Sain. He attended this hearing and gave evidence to the Panel. Mr Sain provided some certificates for the Panel to consider in addition to the Training and Refresher Course and the HCPC updating form that Mr Sain provided as required by the conditions of practice. Mr Sain told the Panel that he had learnt his lesson and that he would in future abide by the requirements of the HCPC as regulator.
15. Mr Sain told the Panel that he had studied the HCPC booklet entitled ‘Returning to Practice’ since this matter was last reviewed and felt that he was ready to return to unrestricted practice. Mr Sain explained that he had chosen the particular areas in his private and formal study as he thought these would best refresh his knowledge and make him a more proficient practitioner. Mr Sain listed the courses that he had attended but not all the corresponding certificates were put before the Panel.
16. Mr Sain confirmed that he had not undertaken any work as a podiatrist since the last review and was working part time in a shop. He stated that he now felt confident that he was safe to return to practice unrestricted. He confirmed that he had not attempted to undertake any shadowing work.
17. The 2014 Panel found that the early review meant that Mr Sain could not fully demonstrate through compliance with conditions that he had remediated his failings. He had not been able to evidence safe clinical practice.
18. The 2014 Panel clarified that the conditions imposed do allow Mr Sain to practise and thereby he may implement learning and development outcomes in a current clinical setting. This may assist a future reviewing panel.
19. The Panel conducted a comprehensive review of the current order in light of all the circumstances known. It has considered all of the information presented to it to including the submissions of the HCPC representative. The Panel was aware that its primary duty concerns determining whether or not Mr Sain’s fitness to practise remains impaired as of today. In deciding this the Panel has brought its own professional judgement to bear and has considered the HCPC policy document “Finding that Fitness to Practise is Impaired”.
20. While Mr Sain has engaged with this process in the past, he has not attended this review. Apart from indicating that he has not had enough time, he has provided no information to show how, if at all, he has addressed the issues identified by the previous Panel.
21. Having undertaken a comprehensive review of all the information available in this case, it is apparent to the Panel that there are two outstanding issues impairing Mr Sain’s current fitness to practise. The first is the concern that he is yet to develop sufficient insight into his original shortcomings, so as to preclude a repetition of his misconduct. The second is that he has not been working in a clinical setting for a considerable time and he needs to provide evidence that his knowledge and skills are up to date. He has provided some evidence of further training but needs to show that his CPD requirements have been fully met. He also needs to provide evidence that he has retained all his skills. On the basis of these issues, the Panel concludes that Mr Sain’s fitness to practise is still impaired and moved onto consider the appropriate and proportionate sanction.
22. The Panel then moved on to consider the appropriate and proportionate sanction. The Panel gave full consideration to the HCPC’s Indicative Sanction policy. The Panel is aware that the purpose of a sanction is not to punish, but is only to be imposed to the extent that is required to protect the public or to maintain public confidence in the profession and the regulatory process. The Panel therefore imposes a sanction which is the least restrictive but sufficient to protect the public. The Panel applied the principle of proportionality and balanced the need to protect the public and the interests of Mr Sain.
23. The Panel is aware that it can maintain, extend, vary, replace or revoke the existing order.
24. The Panel decided that taking no further action or refer the case for mediation would not be sufficient or proportionate, taking into account the seriousness of the findings made. The Panel considered a caution order, but decided that it would not be sufficient, again taking into account the seriousness of the finding and also Mr Sain’s current level of insight and the Panel’s concerns.
25. The Panel next considered a Conditions of Practice Order. Mr Sain has previously indicated and demonstrated that he is willing to attempt to comply with conditions imposed on him but does not appear to have addressed the matters directed at the last Review. The Panel find that its outstanding concerns can still be dealt with by a Conditions of Practice Order and that Mr Sain should be given one more, possibly final, chance to bring his practice up to a standard where he can resume unrestricted practice. It is the Panel’s view that this can best be achieved by varying the current conditions in order to be explicit about the evidence he must supply to assist the next panel. The varied Conditions of Practice Order is as follows:
(i) You must provide a reflective statement to evidence the insight that you have developed in relation to the shortcomings that have been identified in your practice;
(ii) You must not practice independently (that is, without supervision) until you have completed the 30 days of supervised clinical practice as detailed in condition iii below.
(iii) You must provide evidence of the practical demonstration of your clinical skills by completing 30 days of supervised clinical practice. This will require work to be done under a workplace supervisor registered with the HCPC. The identity of the supervisor, who will work at the same time and place as you, but not necessarily providing direct observation, must be notified by you to the HCPC. You must arrange for the supervisor to send a report to the HCPC, commenting on your core competencies and performance as observed from the 30 days of supervision, within 28 days of having completed the supervision. This supervised practice need not be continuous.
(iv) You must provide a copy of the evidence that demonstrates how you have complied with the HCPC’s CPD requirements.
26. The Panel finds that a further period under conditions of practice should allow Mr Sain to prove to a future panel that he has fully addressed the outstanding concerns relating to his practice. These proceedings have drawn on for many years and the Panel needs to see the evidence requested that Mr Sain is committed to his profession and can evidence his safe practice.
27. The Panel has therefore decided to confirm the current Conditions of Practice Order under section 30(4)(a) of the Order but to vary the conditions.
28. These conditions are intended to be workable and proportionate, in addressing the public interest and those of Mr Sain. Mr Sain is able to request an early review if he can demonstrate compliance with the new conditions, or indeed to contact the HCPC if these conditions are not workable for him. Mr Sain should be in no doubt that unless he is able to engage fully with this process to enable him to return to unrestricted practice, he runs a real risk of losing his registration at the next Review.
The Registrar is directed to confirm the existing order for six months but to vary the conditions as set out above.
This order comes into effect on 20 August 2015.
This order comes into effect on 20 August 2015.
History of Hearings for Mr Amin M Sain
|Date||Panel||Hearing type||Outcomes / Status|
|11/02/2016||Conduct and Competence Committee||Review Hearing||Struck off|
|20/07/2015||Conduct and Competence Committee||Review Hearing||Conditions of Practice|