Miss Wilma Szwajcar
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During your employment as an Occupational Therapist for NHS Lothian you:
1. Did not complete adequate Initial Assessments in that you:
a) Did not adequately explore and/or assess the mental health of the patient concerned as part of your Initial Assessment, including in relation to:
i. Patient A;
ii. Patient B;
iii. Patient D;
iv. Patient F;
v. Patient V;
vi. Patient L;
b) Did not complete all relevant sections of the Initial Assessment form, including in relation to:
i Patient J;
ii. Patient K;
iii. Patient L;
iv. Patient D;
v. Patient F;
vi. Patient A;
vii. Patient B;
viii. Patient V;
2. Did not complete adequate treatment plans in that you:
a) Did not include appropriate goals and/or interventions relating to the mental health of the patient concerned, including in relation to:
i. Patient D;
ii. Patient V;
iii. Patient F;
b) Suggested treatment for anxiety management without ascertaining whether symptoms of anxiety were present, (including) in relation to Patient M;
c) Were unable to devise appropriate treatment activities without prompting, including in relation to:
i. Patient V;
ii. Patient Q;
iii. Patient R;
iv. Patient T;
v. Patient J;
3. Delegated inappropriate tasks to an OT Clinical Support Worker in that you asked the OT Clinical Support Worker to undertake desensitisation work despite anxiety not being identified or documented in the initial assessment.
4. The matters as described in paragraphs 1 - 3 constitute misconduct and/or lack of competence.
5. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.
Service and Proceeding in Absence
1. The Panel were satisfied that appropriate notice of this hearing had been sent to the Registrant at her registered address on 5 July 2018. Ms Dudrah advised the Panel that the Registrant has not engaged with the HCPC and had emailed the HCPC on 30 July 2018 to advise that she would not be attending today’s hearing.
2. Ms Dudrah sought that the Panel proceed in the absence of the Registrant, all reasonable efforts having been made to serve notice. The Registrant was aware of the hearing and has said she would not be attending or be represented today. This was a mandatory review hearing and Ms Dudrah submitted that the Registrant had voluntarily absented herself and had not sought an adjournment.
3. The Panel heard and accepted the advice of the Legal Assessor. He advised that if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing then the Panel has the discretion to proceed in the absence of the Registrant. He reminded the Panel that it should exercise that discretion with care. The Legal Assessor referred the Panel to the HCPC Guidance Note on Proceeding in the Absence of the Registrant and to the case of GMC v Adeogba  EWCA Civ 162. This case makes clear that the first question the Panel should ask is whether all reasonable efforts have been made to serve the Registrant with notice. Thereafter, if the Panel is satisfied that proper notice has been given, the discretion whether or not to proceed must be exercised having regard to all the circumstances of which the Panel is aware with fairness to the Registrant being a prime consideration, but with fairness to the HCPC and the interests of the public also taken into account.
4. The Panel decided to proceed in the Registrant’s absence as it is satisfied that it is both in the public interest and in the Registrant’s interest to do so. In reaching this decision, the Panel has noted there has been no request for an adjournment and, indeed, the Registrant has clearly indicated that she would not be attending. It balanced fairness to the Registrant with fairness to the HCPC and the public interest. It is of the view that the Registrant has voluntarily absented herself and that no useful purpose would be served by adjourning the hearing. This is a mandatory review and the Panel weighed its responsibilities for public protection and the expeditious disposal of the case with the Registrant’s right to be present at the hearing. In these circumstances the Panel is satisfied that it is appropriate and fair to proceed in her absence.
5. The Registrant is a registered Occupational Therapist. The allegation found proved related to inadequate assessments and inadequate/inappropriate treatment plans covering numerous patients over a prolonged period of time. The panel at the Final hearing found that despite significant support, there was a pattern of the same issues being repeated and that save for a short period in 2009, the Registrant’s performance did not meet the foundation level for a Band 5 Occupational Therapist.
Submissions for the HCPC
6. Ms Dudrah reminded the Panel of its powers of review and its need to assess impairment and, if relevant, to consider sanction. She reminded the Panel that this was the second review of the 12 month Suspension Order imposed on 17 August 2016, which was reviewed and extended for a further 12 months on 16 August 2017.
7. Ms Dudrah summarised the case which related to a proved lack of competence. The Registrant was referred to the HCPC after completing both an informal and a formal capability programme with her employer. The panel at the final hearing concluded that the allegation was proved and that there was a lack of competence despite substantial support given to the Registrant. At that time there was no evidence of remediation and the Registrant had shown limited insight. At the final hearing and the review in August 2017, the panels found the Registrant’s fitness to practise impaired. At both hearings, further recommendations of matters that might assist future panels were made to the Registrant.
8. The Registrant has not engaged and Ms Dudrah told the Panel that there remains no evidence of remediation and no evidence of any steps taken by the Registrant to remediate her practise. The risk of harm to patients remains and Ms Dudrah submitted that the Registrant’s fitness to practise remains impaired. The Registrant has also advised the HCPC that she has not kept her professional skills up to date.
9. Ms Dudrah submitted that there remained a real risk to the public. She said that the Registrant has had ample time to remediate her practice and to develop insight. She has not done so. Ms Dudrah sought that, in the circumstances, the Panel impose a Striking off Order from the expiry of the existing order, at which time the Registrant will have been suspended for a continuous period of 2 years. She submitted that rule 29(6) of the Health and Social Work Professions Order 2001 meant that a Striking Off Order was available to the Panel as the two years continuous period of suspension will have expired by the expiry of the current Suspension Order. She submitted that the Panel therefore had the power today to make a Striking Off Order to take effect on the expiry of the current Suspension Order. Failing that, Ms Dudrah submitted that a further 6 months Suspension Order would be appropriate.
10. The Panel accepted the advice of the Legal Assessor. He reminded the Panel that its purpose today was to conduct a comprehensive appraisal of the Registrant to determine if she is fit to return to unrestricted practice. Its role is not to conduct a rehearing of the allegations or go behind the previous findings. He advised that in carrying out this assessment, the Panel must exercise its own independent judgment.
11. The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remained impaired all the options as to sanction could be exercised by the Panel. He advised the Panel that it should bear in mind the principles of fairness and proportionality and have regard to the HCPC’s Indicative Sanctions Policy. He reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or is otherwise in the public interest. The Legal Assessor advised the Panel as to the terms of rule 29(6) regarding the calculation of the two-year continuous period.
12. The Panel considered matters carefully and the information before it. The Panel noted that the Registrant has not indicated any willingness to engage or to provide any further information on remediation, insight or on the effect of her actions on the reputation of, and public confidence in, the profession. She has indicated no willingness to meaningfully engage with the HCPC and has not provided any evidence to this Panel to assist it in the review of the substantive order.
13. In all the circumstances, the Panel has decided that the Registrant’s fitness to practice remains impaired. The Panel considered the HCPC Indicative Sanctions Policy and was mindful of the need to act proportionately and keep the public interest at the forefront of its mind. Neither a Caution Order nor a Conditions of Practice Order are appropriate in this case, particularly given the lack of engagement by the Registrant and lack of evidence of insight and remediation of her practise.
14. The Registrant has not meaningfully engaged and she has chosen to provide no meaningful information to this Panel. There is no evidence of remorse, insight or remediation and no willingness to resolve matters since the original Suspension Order was imposed on 17 August 2016. The Panel noted that the Registrant indicated in her email of 30 July 2018 that she has not worked in the profession for four years.
15. In these circumstances the Panel see nothing to be gained by the imposition of a further period of Suspension, nor would that serve the wider public interest. The Registrant has shown no interest in engaging and remediating her practice which was found not to be at foundation level. There remains a risk to the public. The Panel has carefully considered rule 29(6) and the terms of the notice of hearing sent to the Registrant which indicates that a Striking Off Order may be considered at the review hearing. It determined that it has the power to impose a Striking Off Order to take effect at the expiry of the current Suspension Order, by which time the Registrant will have been Suspended for a continuous period of two years. The Panel consider that in all the circumstances a Striking Off Order is the proportionate and appropriate sanction and it both protects the public and satisfies the wider public interest in upholding proper standards and maintaining public confidence in the profession.
ORDER: That the Registrar is directed to strike the name of Miss Wilma Szwajcar from the Register on the date this order comes into effect.
No notes available