Mr Nahashon Ngugi Ngugi
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Whilst registered as an Occupational Therapist and employed by Sandwell and West Birmingham Hospitals NHS Trust you:
1. On or around 10 January 2014, in relation to Service User A, did not:
a) Not proved;
b) Assess whether he was fit for therapy by undertaking appropriate assessments, In that you did not: i) Speak to him to see how alert or orientated he was; ii) Speak to him to establish whether he wanted to participate in therapy; iii) Review blood results to establish whether he was fit for therapy;
c) Record clinical reasoning in relation to his lack of treatment:
2. On or around 14 January 2014, in relation to Service User B, did not take note of the entry made by the Physiotherapist before assessing him.
3. On or around 25 June 2013, in relation to Service User C:
a) Did not carry out and/or record an assessment of Service User C;
b) Recorded an inappropriate discharge plan in that Service User C required further medical intervention;
4. On or around 19 August 2013, in relation to Service User D, did not identify areas of cognitive deficit and how these may be treated further and/or managed.
5. On or around 21 October 2013 in relation to Service User E you:
a) Not proved;
b) Inappropriately arranged a discharge plan;
6. Between 2 and 8 July 2013. In relation to Service User F:
a) Not proved;
b) Demonstrated poor clinical reasoning, in that you:
(i) did not reference and/or take into account Service User F's cognitive and/or mental health issues
(ii) did not assess and/or record Service User F's capacity to live at home
(iii) did not take into account the opinions and/or assessments of the rest of the multi-disciplinary team ('MDT')
7. Your actions described in paragraphs 1 - 6 constitute misconduct and/or lack of competence.
8. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.
Notice of Hearing and Proceeding in Absence
1. The Panel was satisfied that the Registrant had been served with notice of today’s hearing in accordance with the Rules.
2. Ms Royer made an application for the Panel to proceed with the hearing in the absence of the Registrant. The Panel was informed that the Registrant had not responded to the notice of this hearing and had not been in communication with the HCPC since the review on 22 June 2017. He had not applied for an adjournment or provided any information as to why the hearing should be adjourned.
3. The Panel took into account the HCPTS Practice Note on Proceeding in the Absence of a Registrant and accepted the advice of the Legal Assessor. The Panel was satisfied that the Registrant had voluntarily absented himself from the hearing and waived his right to attend. This is a mandatory review and it should be heard in a timely manner. The case concerns public protection issues. In all the circumstances, the Panel decided that it was in the public interest to proceed with the hearing in the absence of the Registrant.
4. The Registrant is an Occupational Therapist registered with the HCPC. At the relevant time he was employed as a Band 6 Occupational Therapist by Sandwell and West Birmingham NHS Trust. In that capacity, he was responsible for assessing and treating elderly in-patient service users.
5. Concerns about the Registrant’s practice were first raised at the beginning of 2012. An action plan was drawn up with set objectives and duly implemented. By August 2012, the Registrant was deemed to have met the objectives and was signed off, on the understanding that the capability process would be initiated if further concerns were raised.
6. In March 2013, the Registrant’s colleagues raised further concerns about his practice and communication skills. The Registrant’s work was monitored and he was asked to meet with senior members of staff for his case notes to be reviewed. It was discovered that his clinical reasoning was unclear and that in some cases he had been working to plans which differed from those used by other professionals.
7. In July 2013, the Registrant was asked to participate in a new counselling process. New objectives were agreed and from July to September 2013 regular meetings were held with senior staff in which several concerns were raised in relation to the Registrant’s case notes and plans.
8. In October 2013, the capability process was again initiated because the Registrant was not making significant progress. He was absent on sick leave on a number of occasions. Capability meetings were held between October 2013 and February 2014 and further concerns about the Registrant’s practice were identified. On 27 February 2014, the Registrant again went on sick leave, from which he did not return. The capability process was never completed.
9. The concerns about the Registrant’s practice were referred by the Trust to the HCPC resulting in these proceedings.
10. At the substantive hearing held on 30 June–1 July 2016, when the Registrant was neither present nor represented, the Panel found the allegations proved to the extent referred to above and that the Registrant’s fitness to practise was impaired by reason of his lack of competence. It imposed a Suspension Order for a period of 12 months.
11. The Suspension Order was reviewed on 22 June 2017 and 29 June 2018 respectively. The Registrant did not attend and was not represented at either of these review hearings. He did not provide any evidence or information to show that he had attempted to remediate any of the failures in his practice which had been identified at the final hearing. At each of these reviews, the panel found that the Registrant’s fitness to practise remained impaired. The panel at the first review imposed a further Suspension Order for a period of 12 months. The panel at the second review imposed a Suspension Order for a further period of 6 months.
12. At the review hearing on 29 June 2018 the panel stated as follows: “The next reviewing Panel is likely to be assisted by the following:
• The Registrant’s attendance at the hearing or, at least, his engagement with the review by telephone.
• A reflective statement, in which the Registrant is able to show that he has reflected on:
i) the potential harm of his lack of competence, and lack of collaboration with other professionals;
ii) on the standard of care provided to service users;
iii) the negative impact of his past failings on the reputation of the profession and what steps he has taken to remediate each of the identified failings.
• Evidence as to what he has done to keep his knowledge and skills up to date, providing any recent certificates of completing relevant Continuing Professional Development Courses.
• Evidence of any work, whether paid or unpaid, that he has undertaken.
• Up to date references or testimonials from any relevant employer or organisation for which he has worked, in a paid or unpaid capacity.
The Registrant should be in no doubt that, at the next review, all options will be open to the reviewing panel by way of sanction, including a Striking Off Order. The Registrant should use the period leading up to the next review to provide evidence that he has taken to steps to address his past failures in practice and that he is committed to returning to practice as an Occupational Therapist.”
13. The Panel today was provided by the HCPC with a bundle of documents containing the decisions of the panels at the substantive hearing and at both reviews.
14. The Panel was informed that the Registrant had not been in communication with the HCPC since the first review hearing in June 2017 and had not provided any information for the purpose of today’s review.
15. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel noted that the substantive hearing on 1 July 2016 found that the Registrant’s failings included poor record keeping, inadequate collaborative working and insufficient clinical reasoning. Whilst the panel on that occasion considered such failings to be remediable, the Registrant had not provided any evidence of remediation. The panel was satisfied that there was a real risk of repetition to the detriment of service users and conequential damage to public confidence in the profession. The panel on that occasion considered that a Suspension Order for a period of 12 months was necessary to protect service users and the wider public interest.
16. The Registrant did not attend either of the two previous reviews or provide any relevant information to demonstrate that he had attempted to remediate his practice.
17. At the hearing today, there was no further information from the Registrant about any steps that he had taken to remediate his practice or about his work or personal circumstances. He had provided no evidence that he had taken any of the steps recommended to him by the last review panel in preparation for today’s hearing. The Panel therefore concluded that the Registrant’s fitness to practise remains impaired.
18. In considering what, if any, sanction to impose at the expiry of the existing order, the Panel today took into account the submissions of Ms Royer. The Panel took into account the HCPC Indicative Sanctions Policy and accepted the advice of the Legal Assessor.
19. The panel at the last review gave the Registrant a clear warning that he would be at risk of a Striking Off Order should he fail to provide evidence that he had taken steps to remediate his practice prior to today’s review.
20. The Panel today considered the available sanctions in ascending order of seriousness and applied the principle of proportionaity.
21. The Panel considered that it would not be appropriate to impose no order or a caution order because the public would not thereby be protected.
22. A Conditions of Practice Order would not be appropriate because the Panel had no information about the Registrant’s current circumstances or his willingness to comply with such an order.
23. The Panel considered whether to impose a further Suspension Order. However, given the Registrant’s failure to provide any evidence that he had used the previous periods of suspension to address any of the shortcomings in his practice, the Panel concluded that no purpose would be served by a further period of suspension.
24. In the circumstances, the only appropriate sanction was a Striking Offer Order which would come into effect at the end of the current Suspension Order on 29 January 2019.
Order: That the Registrar is directed to strike the name of Mr Nahashon Ngugi Ngugi from the Register on the date this Order comes into effect.
This Order will come into effect on 29 January 2019.