Miss Marion Hazel Le Cornu

Profession: Physiotherapist

Registration Number: PH25781

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 11/04/2018 End: 11:30 11/04/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

(as found proved at Substantive Hearing):

During the course of your employment as a Physiotherapist at Jersey General Hospital, between November 2012 and May 2013 you:

1. On 23rd November 2012, in respect of Patient A;
a) You did not conduct an effective abdominal assessment in that you advised the patient to get into a brace position
b) You did not identify this patient’s main problem
c) You did not suggest relevant techniques to strengthen her abdominal muscles and function

2. On 29th November 2012, in respect of Patient B;
a) You did not establish that this patient had been on bed-rest for one week and not referred for physiotherapy input
b) You did not establish any information from the midwife in respect of the patient’s bowel movements
c) You did not identify the patient’s main problem
d) You gave the patient pelvic floor exercises, which they had been specifically asked not to do due to a risk of preterm labour at 27 weeks of pregnancy

3. On 30th November 2012, in respect of Patient C;
a) You did not position the position the patient appropriately in order to make a thorough assessment of the abdominals
b) You did not advise the patient to complete pelvic floor exercises
c) You offered the patient contradictory advice about the forms of exercise she should take after giving birth

4. On 17th January 2013, in respect of Patient D;
a) You did not look up the patient’s x-ray as part of the assessment
b) You did not establish that the patient had a lobe removed
c) [Found Not Proved]
d) You did not educate the patient on the important of self-clearing chest
e) You did not educate the patient on mobilising
f) You did not complete adequate notes in that;
i. [Found Not Proved]
ii. You did not complete adequate notes in that you did not record detail of treatment for the patient

5. On 21st January 2013, in respect of Patient E;
a) You did not establish the patient had suffered a number of falls
b) You did not establish that the patient had low blood pressure, as noted in the patient’s chart

6. On 22nd January 2013, in respect of Patient U;
a) You did not establish whether the patient had stairs at home

7. On 23rd January 2013, in respect of Patient F;
a) You did not adequately assess the height of the patient’s walking aid when assessing the patient’s mobility

8. On 31st January 2013, in respect of Patient G;
a) You continued to walk the patient despite him swaying upon standing
b) [Found Not Proved]
c) [Found Not Proved]

9. On 6th February 2013, in respect of Patient H;
a) You did not look at the latest medical notes in your assessment of the patient
b) You did not look at the x-ray report in your assessment of the patient
c) You did not ascertain the ROM or power in the patient’s hip or left leg before getting the patient to stand and walk
d) [Found Not Proved]
10. On 19th February 2013, in respect of Patient I, you were not able to carry out a neuro assessment in an appropriate manner

11. On 14th March 2013, in respect of Patient J;
a) You did not carry out an objective assessment of the patient’s mobility
b) You did not ascertain the strength of the patient when making the patient’s mobility

12. On 18th March 2013, in respect of Patient K, you;
a) Did not conduct an assessment of the patient to ascertain where her pain was located
b) Did not document your findings on a body chart
c) Did not provide advice and/or recommend treatment to the patient to alleviate her pain
d) [Found Not Proved]

13. On 18th March 2013, in respect of Patient L;
a) You did not read the precious Ax and Rx plan when making your assessment
b) You did not assess the patient in standing as part of your assessment

14. On 18th March 2013, in respect of Patient M;
a) [Found Not Proved]
b) You did not provide appropriate advice to the patient on how she could progress abdominal exercises
c) You did not provide appropriate advice against doing sit-ups

15. On 20th March 2013, in respect of Patient N:
a) [Found Not Proved]
b) You did not provide adequate and/or correct notes of the assessment in that you stated that the patient had lower back pain
c) [Found Not Proved]
d) You did not gather sufficient information from the patient in respect of cauda equine symptoms

16. You were not able to time manage your patient assessment efficiently in respect of:
a) Patient D
b) Patient E
c) Patient I
d) Patient P
e) Patient Q
f) Patient R
g) Patient U

17. The matters set out in paragraphs 1-16 constitute misconduct and/or lack of competence.

18. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary Matters


Proof of Service


1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 12 March 2018 which informed the Registrant of the date, time and venue of the hearing.

Proceeding in the absence of the Registrant

2. Ms Senior submitted that the hearing should proceed in the absence of the Registrant. She informed the Panel that the Registrant’s last engagement with the HCPC was a letter from her dated 2014, prior to the Substantive Hearing.

3. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.

4. The Panel carefully considered the circumstances of the Registrant’s absence. She has not requested an adjournment of the hearing and she has not engaged with the HCPC for four years. The Panel considered that an adjournment would serve no useful purpose. This is a mandatory review of a Suspension Order which is due to expire and there was a strong public interest that the hearing should proceed. The Panel concluded that it was in the interests of justice to proceed with the hearing in the absence of the Registrant.

Background


5. The Registrant worked as a physiotherapist at the Jersey General Hospital from 1980 until she resigned on 17 May 2013. On 21 April 2016 a panel of the Conduct and Competence Committee found that the Registrant’s fitness to practise was impaired by reason of a lack of competence and imposed a twelve month Suspension Order. The panel’s findings related to: flawed assessments; inaccuracies in documentation; poor clinical reasoning in identifying patients’ main problems. The panel also found that the Registrant had a basic lack of knowledge and an inability to improve that knowledge, despite a structured development plan put in place by her employer. The substantive hearing panel found that the Registrant’s practice had persistently fallen below the standard expected of a physiotherapist over a considerable period of time and as judged against a fair sample of her work.

6. The original panel considered that the Registrant’s actions and omissions placed patients and service users at risk and found that there was no evidence before it to indicate that that the Registrant had subsequently reflected on her practice so as to achieve sufficient insight into it. Although the Registrant’s practice was, in theory, capable of remediation, there was no evidence of remediation and there remained a real risk of repetition. The original panel concluded that the Registrant’s fitness to practice was impaired and imposed a Suspension Order for a period of twelve months.

7. On 19 April 2017 the Suspension Order was reviewed by a panel of the Conduct and Competence Committee. The Registrant did not attend the hearing and did not submit any documentation.

8. The review panel noted that there was no information from the Registrant and therefore no evidence that she had taken steps to address the deficiencies identified by the previous panel. In the circumstances, the review panel concluded that the Registrant’s fitness to practise remained impaired. The review panel decided to extend the Suspension Order for a period of twelve months which would allow the Registrant sufficient time to reflect on her actions and to demonstrate full insight and remediation.

Decision


9. Ms Senior submitted that the Registrant’s fitness to practice remained impaired and that the appropriate order was to extend the current Suspension Order.

10. The panel accepted the advice of the Legal Assessor.

11. The task of the panel today is not to go behind the decision of the previous Panel but to determine whether or not the Registrant’s fitness to practise remains impaired. The Registrant has not engaged with the HCPC and there is no evidence that she has taken steps to address the deficiencies in her practice. Consequently, there is a risk of repetition, and this panel cannot be confident that the Registrant is safe to practise.

12. The panel therefore concluded that the Registrant’s fitness to practise remains impaired.

13. The Panel considered that to impose no further action, or to impose a Caution Order would not be sufficient to protect the public or to address the wider public interest considerations, given that there remains a risk of repetition. A Conditions of Practice Order would not be appropriate where the Registrant is not engaging with the HCPC and the Panel cannot be confident that she would comply with conditions.

14. The Panel next considered an extension of the current Suspension Order. The Panel was satisfied that this was proportionate and would secure the necessary degree of public protection. Although it is unlikely that the Registrant will now engage with the HCPC, a Suspension Order would give her a further opportunity to address the deficiencies in her practice. The more serious sanction of a Striking-Off Order is not available to the Panel today, as the Registrant has not been continuously suspended for a period of two years.

15. The Panel considered the appropriate length for the Suspension Order. The Panel decided that a period of six months was appropriate. This time period was based on the Panel’s assessment that it was unlikely that the Registrant would now engage with the HCPC, and the need to allow sufficient time for the Registrant to prepare relevant evidence if she does decide to engage.

16. The Registrant should be aware that at the next review hearing the reviewing panel will have the power to make a Striking-Off Order, if appropriate.

17.  This Order will be reviewed by another panel prior to its expiry. That panel may be assisted by the following:

• the Registrant’s engagement with the process and attendance at the hearing;
• evidence of any relevant training activities and/or professional development undertaken by her;
• evidence of reflection, such as a reflective piece, demonstrating insight into her lack of competence and the associated consequences for patients and her profession.

Order

ORDER: The Suspension Order imposed on Miss Marion Hazel Le Cornu is extended for a further period of 6 months on expiry of the current Order.

Notes

This Order will be reviewed again before its expiry on 19 November 2018.

Hearing History

History of Hearings for Miss Marion Hazel Le Cornu

Date Panel Hearing type Outcomes / Status
22/10/2018 Conduct and Competence Committee Review Hearing Struck off
11/04/2018 Conduct and Competence Committee Review Hearing Suspended
19/04/2017 Conduct and Competence Committee Review Hearing Suspended
18/04/2016 Conduct and Competence Committee Final Hearing Suspended