Catherine J Kirk

Profession: Physiotherapist

Registration Number: PH95870

Interim Order: Imposed on 07 Nov 2016

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 18/06/2018 End: 16:00 22/06/2018

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a Physiotherapist with The Children’s Trust, you:
1) Did not ensure the safety of Child Patients in physiotherapy sessions in that you:
a) On or around 10 April 2013, caused and / or did not take appropriate steps to prevent harm to Child A, in that you:
i. Did not ensure that the seat of a stationary bike was secure before use;
ii. Did not adequately assess the risk involved prior to the session described in Paragraph 1 (a)(i).
b) On or around 14 June 2013, caused and / or did not take appropriate steps to prevent harm to Child B, in that you:
i. did not appropriately supervise the session;
ii. did not adequately assess the risk involved prior to the session described in Paragraph 1 (b)(i).
c) On or around 06 December 2013, caused and / or did not take appropriate steps to prevent harm to Child C, in that you:
i. did not ensure the Child was supported when you changed positions;
ii. Did not adequately assess the risk involved prior to the session described in Paragraph 1 (c)(i).
d) On or around 10 June 2014, caused and / or did not take appropriate steps to prevent harm to Child D, in that you:
i. did not appropriately supervise the session;
ii. did not adequately assess the risk involved prior to the session described in Paragraph 1 (d)(i).
e) On or around 01 October 2014, caused and / or did not take appropriate steps to prevent harm to Child E, in that you:
i. did not appropriately supervise the session;
ii. did not adequately assess the risk involved prior to the session described in Paragraph 1 (e)(i).
f) On or around 13 April 2015, 28 April 2015 and 26 August 2015, caused and / or did not take appropriate steps to prevent harm to Child F, in that you:
i. did not appropriately supervise the sessions;
ii. did not adequately assess the risk involved prior to the sessions described in Paragraph 1 (f)(i).
g) On or around 18 September 2015, caused and / or did not take appropriate steps to prevent harm to Child G, in that you: (No evidence offered by the HCPC in relation to this particular)
i. did not appropriately supervise the session and/or the Child’s need to be steadied; (No evidence offered by the HCPC in relation to this particular)
ii. did not adequately assess the risk involved prior to the session described in Paragraph 1 (g)(i). (No evidence offered by the HCPC in relation to this particular)
h) On or around 18 September 2015, caused and / or did not take appropriate steps to prevent harm to Child H, in that you:
i. did not appropriately supervise the session;
ii. did not adequately assess the risk involved in the assessment described in Paragraph 1 (h)(i).
i) On or around 22 September 2015, caused and / or did not take appropriate steps to prevent Child I from falling, in that you:
i. Initiated an activity which was inappropriate for Child I’s level of ability
ii. did not adequately assess the risk involved in the assessment described in Paragraph 1 (i)(i).
j) On or around 01 March 2016, caused and / or did not take appropriate steps to prevent harm to Child J, in that you:
i. did not appropriately supervise the session and / or ensure that a physiotherapy assistant was present.
ii. did not adequately assess the risk involved prior to the session described in Paragraph 1 (j)(i).
k) On or around 08 April 2016, caused and / or did not take appropriate steps to prevent harm to Child K, in that you:
i. directed him to move from the floor to a plinth and
ii. did not adequately assess the risk involved prior to the activity.
l) On or around 27 April 2016, caused and / or did not take appropriate steps to prevent harm to Child L, in that you:
i. directed her to close her eyes whilst on a moving inclined treadmill; and
ii. did not adequately assess the risk involved prior to the session described in Paragraph 1(l)(i).
m) On or around 13 June 2016, you caused and / or did not take appropriate steps to prevent harm to Child M, in that you:
i. directed the physiotherapy assistant not to support the Child;
ii. Initiated an activity which was inappropriate for Child M’s level of ability; and
iii. did not adequately assess the risk involved prior to the session described in Paragraph 1 (m) (i) – (ii).
2) The matters described in Paragraph 1 (a) – (m) constitute misconduct and / or lack of competence.
3) By reason of your misconduct and / or lack of competence, your fitness to practise is impaired.

 

 

Finding

Preliminary matters:
Proceeding in Private

1. From time to time during the hearing the Panel raised the issue of having the hearing temporarily in Private as it noted that some of the evidence related to the Registrant’s health. The Panel reminded itself that proceedings should normally be held in public and noted Rule 10(1)(a) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules), which states:

“At any hearing—
(a) the proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the Registrant, the complainant, any person giving evidence or of any patient or client, the public should be excluded from all or part of the hearing;”

2. The Panel was mindful that, under Rule 10 (1) (a), it must be satisfied that it is in the interests of justice or for the protection of the private life of a Registrant or a witness before a decision can be made to exclude the public from any proceedings. Moreover, its decision must be consistent with Article 6(1) of the European Convention on Human Rights (ECHR), which provides limited exceptions to the need for hearings to be held in public, namely that it is “in the interests of justice or for the protection of the private life of the health professional, the complainant, any person giving evidence or of any patient or client”.
3. The Panel decided that it was appropriate to protect the private life of the Registrant and directed that the hearing was to be held in private whenever detailed consideration of her health matters was made.
Background:
4. The Registrant was appointed as a Highly Specialist Physiotherapist at The Children’s Trust (“the Trust”) from 20 May 2013.  During her initial 6 month probationary period (from May 2013 to November 2013) it was observed by her line manager, SM, that: there were aspects of her work that she was struggling with at times; her thinking was muddled; she required help from SM to identify the patient’s problems and to create effective treatment plans; she did not appear to demonstrate an ability to learn; and continually needed the same support.  However, it was also noted that the Registrant had “a fantastic attitude”; that she “tried so hard to improve” and that she “was a fantastic team member who was very positive towards change and improving her practice”.
5. On 18 November 2013 the Registrant’s probationary period was extended to 28 February 2014 as there were still some concerns about her clinical reasoning and her ability to put into practice suggestions for improvement.  There were also concerns about her time management which caused therapy sessions to overrun. 
6. At the review meeting on 28 February 2014 it was noted that there were still issues concerning her clinical reasoning so it was decided to implement a Performance Improvement Plan (“PIP”), which commenced on 24 March 2014. The Registrant was required to: improve her clinical abilities/treatment plans; submit reports on time; ensure good time management for a caseload of four children; arrive and finish work on time; work on her communication issues; and improve her hydrotherapy skills.  
7. The PIP was reviewed in June, July, and September 2014, with a final review taking place on 17 October 2014.  It was noted at that final review that, although there had been some improvements, the Registrant still required significant support considering that she had been employed as a Highly Specialist Physiotherapist.  Accordingly, after discussions, the Registrant agreed to occupy a lower graded Band 6 Specialist Physiotherapist post.
8. There were no issues with the Registrant’s practice from January 2015 to May 2016.  Her caseload returned to normal levels and she did not receive any additional support during this period. However, it came to the attention of JR that a number of children had been involved with incidents where they had fallen, or had injured themselves, during sessions with the Registrant.  These incidents had been documented by the Registrant, as required, in incident report forms, which not only detailed events where, say, a child had fallen and hurt themselves, but also near misses, where something could have gone wrong due to poor procedure and therefore the child had the potential to be harmed.
9. One such incident involved Child L (Allegation 1 (l)). The Registrant had asked the child to close her eyes whilst walking on an inclined, moving treadmill. This resulted in her overbalancing although the Registrant managed to catch the child, preventing any harm. Following this incident it was decided, on 26 May 2016 that the Registrant should be made subject to a new PIP. The principal objective of the PIP was that there should be no falls during any of the Registrant’s sessions.        
10. Following a further incident which involved Child M (Allegation 1(m) – where the child had fallen off a plinth), an investigation was commenced by the Trust into all incidents where children under the Registrant’s immediate supervision had fallen or were injured during her treatment sessions with them.  That investigation was carried out by the Nursing Manager, LK.  In the meantime, the Registrant’s work was to be supervised at all times by another physiotherapist.  The matter was also reported to the HCPC.  A disciplinary meeting was arranged following that investigation but before it took place the Registrant resigned her post on 31 August 2016.  The concerns raised as a result of that investigation are detailed in Allegations 1(a) to 1(m).
11. The HCPC maintains that the matters referred to in the particulars concern the ability of the Registrant to ensure that children in her care were safe and that the Registrant failed to take appropriate steps to adequately supervise those children and to assess risk during sessions which in turn caused, or could have caused, harm to these children.
12. The children that the Registrant had responsibility for were largely children with brain injuries which affected and limited their mobility and/or understanding and their ability to save themselves from injury should their position change.  During her employment there were 13 incidents of falls involving these children. The HCPC argues that, whilst it is accepted that accidents can always happen, the high incidence of falls during the Registrant’s sessions cause significant concern. 
13. The HCPC maintains that as the Registrant was a qualified Physiotherapist, she should have been able to anticipate, react to and provide sufficient support and supervision of her patient during physiotherapy sessions. A physiotherapist must be able to continually identify and assess risk/safety of the patient from the moment they commence their physiotherapy session with the patient until the patient leaves their care at the end of the session.  They should have the skills to assess continually and modify the tasks in the physiotherapy session to the physical and cognitive level of the patient whilst maintaining the patient’s safety at the same time. Physiotherapists must also therefore adapt the environment in such a way that tasks can be performed safely, whilst simultaneously providing sufficient challenge to the patient’s skills to ensure that improvement occurs. Accepting that adaptions needed in the environment and tasks appropriate for the patient on any day or even within a session can vary, physiotherapists should be able to assess continually and adapt by taking into account issues such as behaviour, fatigue, motivation, lack of motor skills, impaired comprehension, and unrelated co-morbidities.
14. The HCPC also submits that, physiotherapy sessions are tailored to each individual patient and this includes varying the position of patients during a session. This requires physiotherapist’s to be vigilant at all times to the dangers of falls and to position themselves in such a way that they can intervene to mitigate such risks.  It is not the patient’s responsibility to keep themselves safe within a physiotherapy session.

Decision on Facts:
15. In considering this case the Panel bore in mind that the burden of proving the facts rests upon the HCPC and that the standard of proof is the civil standard of the balance of probabilities. It has taken account of all the evidence presented to it, namely the written statements of the witnesses listed below, together with the documentary evidence provided by the HCPC and the Registrant. It has accepted the advice of the Legal Assessor.
16. The Panel particularly noted, and accepted, the Legal Assessor’s advice that, notwithstanding that the HCPC’s Procedure Rules do not have a specific provision which indicates that a Panel can find the allegations proved by simply relying upon the Registrant’s admissions of those allegations, there was likewise nothing in the Rules to prevent it from doing so if it was satisfied that the admissions were well-informed, not made for reasons of expediency or duress and had been made with the benefit of competent legal advice.  Consequently, the Panel noted that it would be entitled to treat those admissions as determinative of the factual allegations, particularly if the admissions were corroborated by the evidence presented by the HCPC.
17. This issue was raised at the commencement of the facts stage by the parties as it had become apparent that the Registrant had decided to admit all the factual particulars (with the exception of particular 1 (g), in respect of which the HCPC had decided to offer no evidence) and to indicate that she also accepted that the matters admitted by her amounted to a lack of competence.  Both parties therefore suggested that the Panel found those factual particulars proved simply by way of admission, which in turn obviated the necessity for any of the HCPC’s witnesses to give live evidence unless the Panel wanted to ask any questions of those witnesses.
18. The Panel noted that the witness statement evidence for the HCPC provided significant detail and relied primarily upon documentary evidence prepared by the Registrant (such as the incident report forms, which included her own candid summaries of the events in each case and her assessments of the risks posed) and therefore it concluded that no additional purpose would be served by having those witnesses give evidence since the factual issues were comprehensively dealt with in those statements.  It was also satisfied that the Registrant had admitted the allegations having received competent legal advice and that she was not making those admissions for reasons of duress or expediency. 
19. Accordingly, the Panel directed that it did not require any of the witnesses to give evidence and that it would determine the factual issues on the basis of the Registrant’s admissions.  Those witnesses who had attended the hearing were therefore released and those who were due to give evidence on subsequent days (one being based in Australia and who was due to give evidence by video-link) were advised that they were no longer required to give evidence.    
20. The Panel read the witness statements of the following witnesses:
• SM, a Clinical Specialist Physiotherapist and the Registrant’s Supervisor at the Trust;
• DA, a Physiotherapy Assistant at the Trust;
• JR, the Physiotherapy Professional Lead at the Trust at the time;
• LK, Nurse Manager and Investigating Officer at the Trust.
• KR, a Legal Assistant for Kingsley Napley Solicitors
21. The Panel made individual findings in relation to the following particulars, in which it has reproduced verbatim the relevant parts of the very detailed witness statement of JR dated 13 October 2017. Although the Panel did not hear any live evidence from JR, it noted that her statement comprehensively set out the factual issues in each case and the Trust’s concerns about the Registrant’s actions. The Panel appreciated that JR had not been tendered as an expert witness (notwithstanding her considerable experience in this field) and did not rely upon her as such, but it did find her analysis of each of the incidents extremely helpful in crystallising the issues the Panel had to consider.
Particular 1 (a):
During the course of your employment as a Physiotherapist with The Children’s Trust, you:
1) Did not ensure the safety of Child Patients in physiotherapy sessions in that you:
a) On or around 10 April 2013, caused and/or did not take appropriate steps to prevent harm to Child A, in that you:
i) Did not ensure that the seat of a stationary bike was secure before use;
ii) Did not adequately assess the risk involved prior to the session described in Paragraph 1 (a) (i).
Found Proved
22. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“The incident report for Child A was submitted on 10 April 2013 in respect of an incident on the same day…I assessed its contents when initially reviewing all incident reports. Child A sat on a stationary bike. As she started pedalling, the seat dropped and jarred Child A’s spine. According to the incident report, she was calmed but soon after the seat dropped again.

Did not secure seat
Catherine Kirk should have tested the bike seat for strength and stability prior to allowing the Child A to use the bike and particularly after adjusting the seat. This was not done twice in this session. A Physiotherapist should always ensure the safety of their patient at all times but twice during this session, Catherine Kirk did not check or assess whether the seat was secure before allowing Child A to sit on it. Catherine Kirk should have known to do this from her experience as a Physiotherapist and as part of her HCPC registration relating to HCPC Standards of Conduct. She needed to assess the safety of the environment and equipment she intended to use with her patient but did not appear to do this. I did not consider that this was purely an accident, because if she had assessed the bike seat to ensure it was secure on both occasions, the incident would likely not have occurred.

The incident report for Child A stated that she had “wedging on one of her lumbar vertebra, which intensified the jarring and exacerbates her underlying pain.” This is not written in medical terminology and so I am unable to interpret what this means and therefore I am unable to comment on the seriousness other than it implies that Child A’s back was hurt.

Assessment of risk
If Catherine Kirk had adequately assessed the risk to Child A during this session, she would have identified the need to test the bike seat for strength or stability before Child A sat on it and again after adjusting the seat. In order to test the bike, she could have leant on it to ensure that it did not slip down or tried to twist the seat to check if it rotated. If a bike seat is not secure it is reasonable to expect that the child could slip or fall off the bike. I considered that Catherine Kirk should have used her clinical decision-making and assessment skills to ensure the safety of Child A and to negate or minimise the risk arising from the activity.”

23. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Particular 1 (b):
b) On or around 14 June 2013, caused and/or did not take appropriate steps to prevent harm to Child B, in that you:
i) did not appropriately supervise the session;
ii) did not adequately assess the risk involved prior to the session described in Paragraph 1 (b)(i).
Found Proved
24. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“I reviewed the information in the incident report, submitted by Catherine Kirk on 14 June 2013…when initially investigating what had happened with her. The incident report stated that Child B lost their balance on a mat on the floor and bumped their head on a plinth. This happened when Catherine Kirk turned to converse with the carer during the session.

Supervision of the session
This incident was concerning because Child B was sitting on a mat which was close enough to a plinth that, if she fell, she could hit the plinth with her head. Catherine Kirk turned away visually from Child B to talk to the carer and so was not watching her. She also did not keep her hand(s) in contact with Child B when she turned visually away from her and so could not monitor or ensure her safety. Her clinical assessment of Child B’s physical and cognitive ability should have indicated the risk of losing her balance. She would have known this from her knowledge of Child B’s condition but it would always have been a risk regardless of which child was involved. I do not know the child’s condition/exact diagnosis but all of the children in the rehabilitation unit either had cerebral palsy if a patient of international status and if a child from the UK, then an acquired brain injury.

Assessment of risk
The risk of Child B being injured could have been avoided by Catherine Kirk not placing the mat in the vicinity of the plinth so that if Child B lost balance or fell their head would not come into contact with the plinth. As a tertiary qualified Physiotherapist, she should have known that children can be unpredictable and that it was important to watch the child, or to keep a hand on them if she needed to look away so that she could help her to stay upright if she suddenly lost balance. Assessing risk and safety is continuous, not an isolated thought process of clinical reasoning at the beginning of the Physiotherapy session.

I would have expected Catherine Kirk in this instance to keep her eyes on Child B and if she needed to turn away, she should have physically held Child B to monitor if she was losing her balance. It is possible for a Physiotherapist to answer a question without turning towards the person asking the question. She would have known how to handle Child B when they were sitting on the mat from her clinical experience as a Physiotherapist and she should have used her clinical decision making and assessment skills to ensure the safety of Child B and to negate or minimise the risk of them being injured.”

25. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Particular 1 (c):
c) On or around 06 December 2013, caused and/or did not take appropriate steps to prevent harm to Child C, in that you:
i) did not ensure the Child was supported when you changed positions;
ii) Did not adequately assess the risk involved prior to the session described in Paragraph 1 (c) (i).
Found Proved

26. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“Catherine Kirk submitted an incident report for Child C on the same day as the incident on 6 December 2013…It detailed that Child C was seated on the floor, wearing a spinal jacket and being supported at his trunk by Catherine Kirk. She moved to the front of Child C to correct his lower limb position when he lost balance and hit his head on the floor.

Support when changing positions
Depending on the child’s physical and cognitive abilities, it would be standard practice for the Physiotherapist to support the child physically if the child has limited or no balance, or to have their hands ready to stabilise the child in case they lose their balance if they have some balance ability.

The incident report describes Child C as having reduced sitting balance, and mentions that he was wearing a spinal jacket.  A spinal jacket would be given to a child for various reasons but most likely in the rehabilitation setting, the spinal jacket is prescribed for a curvature in the spine (scoliosis) that is worsening or will most likely worsen.  Catherine Kirk’s clinical assessment of Child C’s physical and cognitive ability should have indicated the risk of him losing his balance. The fact that she had been supporting him at trunk level indicates that Child C had poor trunk balance and would need hands-on support when sitting.

Assessment of risk
I was concerned that, as a physiotherapist treating a child with reduced sitting balance, Catherine Kirk’s actions suggested she had not identified the risk of the child falling if he were unsupported.  The fact that Child C’s head made contact with the floor when he fell suggests that Catherine Kirk had not considered his position on the mat and where he would end up if he fell.  

A proper assessment of risk would have identified a need to use the correct level of support so that the child could perform the activities safely. Catherine Kirk should also have assessed the risk of Child C falling and positioned Child C accordingly, so that if he did fall backwards his head would land on the mat, so there would have been some protection for it, rather than on the floor. If somebody else had positioned Child C on the mat prior to Catherine Kirk arriving, she should have assessed that he was not in a safe position and moved him so that he was safe on the mat. Once Catherine Kirk became involved in the session, she had a duty of care to move the child if she assessed that the child was not in a safe position. I would have expected that Catherine Kirk would know what to do, based on her clinical decision making and assessment abilities.

The impact on the child is not documented within the incident report.”

27. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Particular 1 (d):

d) On or around 10 June 2014, caused and/or did not take appropriate steps to prevent harm to Child D, in that you:
i) did not appropriately supervise the session;
ii) did not adequately assess the risk involved prior to the session described in Paragraph 1 (d)(i).
Found Proved

28. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“An incident occurred during a session between Catherine Kirk and Child D on 10 June 2014. The incident report for this incident…states that Child D was seated with support from Catherine Kirk on a wedge on a mat, reaching for switch toys. Child D lost balance to the left (out of typical pattern) and collapsed onto the floor. The mat was not big enough and so Child D bumped the left side of his forehead of the floor.

Assessment of risk
There is no information about Child D’s balance and the risk of falling in the incident report.  Catherine Kirk’s clinical assessment of Child D’s physical and cognitive ability should have indicated the risk of him losing his balance.  This could have been mitigated by close supervision, the use of a wider mat, or the use of physiotherapy aides.

During this session, Catherine Kirk did not have an adequate sized mat and she did not provide the required physical assistance to prevent or protect Child D if they fell. She did not physically react quickly enough to prevent Child D from falling.  I do not know the reasons why but it could have been due to her position in relation to Child D; her level of physical support for Child D; or her alertness to possible loss of balance during the activities.

Catherine Kirk could have prevented Child D from losing balance by monitoring him continually and ensuring that she was physically in the correct position so that she could stabilise him or prevent a fall if he did lose his balance. She should also have ensured that the activities chosen for Child D did not over-extend him to the point that he could fall.

Catherine Kirk should have been able to assess of the level of support that Child D required from her in order for him to perform the activities safely. This would be based on the skills expected of a Physiotherapist. She should have been able to gauge the level of activities which would enhance his balance but would not lead to a fall. She should have placed the wedge on the mat in such a way that if Child D fell in any direction, he would land on the mat and not on the floor.
 
Supervision of Child D
When already supporting a child who is sitting on a wedge on a mat and practising reaching, it is expected that the Physiotherapist should be able to monitor their balance in order to react fast enough with increased physical support to prevent over-reaching or over-balancing by the child. The Physiotherapist should know at what level on the body to provide such support to ensure safety. They should have the child on a mat suitable for the activity so that safety is ensured. The activity should not demand over-reaching, which would lead to a loss of balance, but it should instead challenge increments in balance ability. It would be expected that a tertiary qualified Physiotherapist is able to assess the limit and not venture into an activity which is unsafe.  If the activity places that patient in a situation where they are going to lose balance or fall, then that is not acceptable risk.

If Catherine Kirk was not able to place the wedge on the mat in a position that would ensure Child D would only fall on the mat, she should have had aides available who would prevent a fall in the direction in which the mat could not offer protection.

I am not aware of the impact on Child D as it is not recorded in the incident report. Again, Catherine Kirk’s clinical decision making and assessment skills should have been sufficient her to ensure Child D’s safety and to negate or minimise the risks of the activity of sitting on a wedge and reaching for toys”.

29. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Tribunal, and therefore found this particular proved. 

Particular 1 (e):
e) On or around 01 October 2014, caused and/or did not take appropriate steps to prevent harm to Child E, in that you:
i) did not appropriately supervise the session;
ii) did not adequately assess the risk involved prior to the session described in Paragraph 1 (e)(i).
Found Proved

30. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“Catherine Kirk was involved in an incident with Child E on 1 October 2014.
Child E was practicing independent walking with one hand support, but then over-balanced and bumped his head on the wheelchair of another child, which was parked near the bed…
Assessment of risk
Child D’s [sic] balance and risk of falling is indicated by the documented comment that the child was walking with one hand support and close supervision.  Catherine Kirk did not plan the environment during this session to ensure that if in the case of losing balance and falling, Child E would not fall on furniture (or in this case another child’s wheelchair). She was unable to anticipate the fall and react physically quick enough to prevent the loss of balance of Child E.

Catherine Kirk should have been able to assess the level of support that Child E required from her in order for him to perform activities safely, particularly when his balance was threatened and a fall was possible. She should have found a clear area without furniture or any other objects where Child E could practice his walking. This would be standard practice before a session as a Physiotherapist is constantly assessing the child’s interaction with the activity and the environment in which the activity is being performed to ensure the child’s function and physical abilities are optimised but without any, or minimal, risk of harm for the child. Catherine Kirk, as a tertiary qualified Physiotherapist, should have had the clinical assessment skills and clinical decision-making ability to provide a safe and clear environment for her patient.

Supervision of Child E
When a Physiotherapist is providing one-handed support and close supervision, it would be expected that they would be monitoring the child's movement and balance with each step and so they would be able to react fast enough with increased physical support to ensure that the child did not fall. When assisting a child with only one-handed support, there is the danger that if the child loses balance they will rotate towards the Physiotherapist in order to attempt to regain balance and this can unbalance the Physiotherapist. The Physiotherapist should know at what level to provide such support to ensure the safety of the child and should ensure that the environment is clear of obstacles for the planned activity.”

31. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Particular 1 (f):
f) On or around 13 April 2015, 28 April 2015 and 26 August 2015, caused and/or did not take appropriate steps to prevent harm to Child F, in that you:
i) did not appropriately supervise the sessions;
ii) did not adequately assess the risk involved prior to the sessions described in Paragraph 1 (f)(i).
Found Proved

32. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“Catherine Kirk was involved in several incidents with Child F and the first occurred on 13 April 2015, as per the incident report…which states that Child F fell forward whilst sitting on the floor and hit her forehead on a plastic toy.

In the incident report, it is documented that the Physiotherapist was supporting and encouraging balance reactions.  This indicates that the child’s balance reactions were impaired and hence were being challenged.

When already supporting a child who is sitting on the floor and practicing balance activities, it would be expected that the Physiotherapist should be able to monitor the child's balance and so react fast enough with increased physical support to prevent over-reaching or over-balancing by the child. The Physiotherapist should know at what level to provide such support to ensure safety.

Supervision of Child F
Catherine Kirk does not state in the incident report where she was physically situated in relation to Child F or where her hands were located to support her.  There is no single recipe for good support but there should be constant assessment of the child and their ability at each instant in time so that the Physiotherapist is adjusting their support accordingly.

For example, a child at the beginning of a physiotherapy session may be able to sit with minimal support of the lower trunk but as they become tired, the Physiotherapist should re-assess and adjust their support, such as at a higher level of the trunk, or with their body closer to the child so that they can physically react faster if they begin to lose their balance. This assessment was within Catherine Kirk’s expected capabilities and qualification level.

Catherine Kirk should have been aware of the Child F’s physical ability and how long she was able to sustain that position. However, it is the inability to constantly re-assess and adjust her support throughout the physiotherapy session that was concerning about this incident.

A further incident occurred with Child F on 28 April 2015 and an incident report…was submitted by Catherine Kirk on the same day. Child F experienced a loss of head control and loss of standing balance and her head dropped forwards to bump onto the flat edge of the container. I do not know what container this was.

Supervision of Child F
When already supporting a child who is standing, it is expected that the Physiotherapist should be able to monitor the child's balance and posture in order to react fast enough with increased physical support to prevent the child collapsing in such a way that they bump their head. The Physiotherapist should know through clinical assessment of the child’s ability at what level to provide such support to ensure safety. Catherine Kirk’s experience and abilities should have been adequate to make this assessment and then to monitor Child F’s balance.

Assessment of risk
Catherine Kirk should have been alert to any possibility of harm to Child F and assessed the suitability of her physical support for her. Any patient has the potential to overbalance and it is the Physiotherapist’s responsibility to ensure that if this occurs that they are able to respond quickly enough to prevent harm to the patient.

I was not present during the session and so I do not know about the impact on Child F as a consequence of her head bumping the container.

Another incident took place involving Child F on 26 August 2015 according to the incident report from Catherine Kirk on the same date…[which]…notes that Child F was practicing her standing and squatting down to the floor while not wearing her AFOs, which are ankle foot orthoses that provide support to that ankle.. She was supported by Catherine Kirk in this activity. She leaned forwards for a toy and took her feet off the floor and banged the left side of her forehead on the floor.

Supervision of Child F
For Child F to be able to lift both her feet off the floor, she would have been supported in another way, such as by Catherine Kirk or by a plinth (although it is not clear from the incident report where this support was coming from).

A Physiotherapist should be aware that any patient can be unpredictable and so should be ready to act to ensure the patient’s safety.  Catherine Kirk should have been aware of the unpredictability of Child F and also should have been vigilant to any movements of Child F which could lead to a fall.  Once the fall had started, Catherine Kirk should have been able to react quickly enough to move her own hands and body to prevent or limit the fall. As Child F’s head contacted the floor, there appears to have been a delay in reacting in this situation.

Catherine Kirk refers to the lack of ankle foot orthoses as contributing to the fall but they would not stop Child F from lifting both of her legs simultaneously. For a child to lift both legs/feet off the floor simultaneously, is not related to support at the ankles but more likely to be a behavioural incident and she must have been getting support elsewhere to be able to physically to do this.  It is not possible to lift both legs off the ground unless you jump or lean on a support or someone supports you.

Assessment of risk

When already supporting a child who is standing and squatting, it would be expected that the Physiotherapist should be able to monitor the child's balance and posture and be in a position to react quickly with increased physical support to prevent the child collapsing in such a way that they bump their head. The Physiotherapist should know at what level to provide such support to ensure safety. The incident report refers to a mat being put in place as a way of taking action to prevent an incident. A mat may provide protection but it would depend on the direction in which the child falls and what other obstacles are in the immediate vicinity of the child as to whether it could prevent an incident from occurring.”

33. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Particular 1 (g):
g) On or around 18 September 2015, caused and/or did not take appropriate steps to prevent harm to Child G, in that you:
i) did not appropriately supervise the session and/or the Child’s need to be steadied;
ii) did not adequately assess the risk involved prior to the session described in Paragraph 1 (g)(i).
Not Proved
34. The Panel noted that this allegation related to an incident when Child G was swimming backstroke in the pool, with a float belt and close supervision from the Registrant. She shielded his head from bumping the wall with her arm as he came towards the wall to finish his length of swimming but he banged the left side of his forehead against the wall after standing up.
35. No evidence was offered by the HCPC in relation to this particular on the basis that there is insufficient evidence to support any fault on the part of the Registrant.  The Panel sees no reason to doubt the HCPC’s assessment of this issue.  In addition, the Panel notes that it has to consider whether there is any under-prosecution but concludes that, as there remain 12 other similar allegations, there can be no issue of under-prosecution. Therefore, the Panel finds this particular not proved.  
Particular 1 (h):
h) On or around 18 September 2015, caused and/or did not take appropriate steps to prevent harm to Child H, in that you:
i) did not appropriately supervise the session;
ii) did not adequately assess the risk involved in the assessment described in Paragraph 1 (h)(i).
Found Proved

36. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“An incident report in respect of Child H was submitted by Catherine Kirk on 18 September 2015 in relation to an incident on the same date…Child H was supported in a sitting position and Catherine Kirk was moving backwards to stabilise herself and support Child H. He bumped into the wall, lightly making contact with the kyphotic prominence of spine against the side of the pool. I cannot state exactly what spinal level the most prominent part of the kyphosis is located for this child.  A kyphosis is a curve of the spine so that the part of the spine affected is more bent forwards.

Assessment of risk
I do not know what Child H’s specific weaknesses were as they are not documented in the incident report. Prior to the session, Catherine Kirk should have made herself aware of the pool environment and the challenges it posed for the safety of herself and Child H.

Supervision of Child H
I am unable to explain what happened on this day as I do not understand what Catherine Kirk has written in the incident report. If she had been walking backwards towards the pool wall as she has indicated in the report, she should have made contact with the wall before Child H did. Regardless of how it occurred, this incident is serious as it was her duty of care to maintain the safety of Child H at all times when under her care, and she did not appear to do this.

When supporting a child in the pool, it would be expected that the Physiotherapist would be aware of the proximity of obstacles, depth of water, the child's position and movements in the water as well as their own. It is expected that the Physiotherapist would be able to assess, analyse and integrate of all of these aspects to ensure the safety of the child. Child H banging his spine was not done deliberately.”

37. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Particular 1 (i):
i) On or around 22 September 2015, caused and/or did not take appropriate steps to prevent Child I from falling, in that you:
i) Initiated an activity which was inappropriate for Child I’s level of ability
ii) did not adequately assess the risk involved in the assessment described in Paragraph 1 (i)(i).
Found Proved

38. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“An incident took place with Catherine Kirk and Child I on 22 September 2015…Child I was using a Grillo walking frame for the first time in the posterior support set up. The Grillo walker is a mobility device to enable appropriate patients the ability to move about their environment; various adaptations can be added to the walker in order to achieve safe mobility. Child I’s head fell forwards and she bumped her nose on the padded chest support around the front of her trunk.

Assessment of risk
Catherine Kirk indicated in her report that Child I had reduced head control and so it would be expected that she would have difficulties in maintaining her head in the upright position.  This risk would increase as she became tired throughout the session. When a patient has reduced head control, trunk and pelvic control are even more reduced which makes standing very difficult or even impossible for them. Stepping would therefore be extremely difficult or impossible for them.

For Catherine Kirk to decide to have Child I to walk in the walker did not appear to me to be an appropriate clinical decision to have made as it would most likely be beyond Child I’s ability. Catherine Kirk had the knowledge and experience to clinically assess the situation for Child I’s level of ability and for safety and realise that this was not an appropriate activity for her.

Supervision of Child I

In my view, there was no way that Catherine Kirk could have appropriately supervised Child I as the walking activity should not have been attempted as this activity is beyond a child with poor head control and will always be so. Child I’s head falling forwards was not allowed to happen deliberately. Catherine Kirk could have had someone hold the child’s head to stop it falling forwards but as already stated this is not a clinically relevant activity for a child with this level of ability.”

39. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panell, and therefore found this particular proved. 

Particular 1 (j):
j) On or around 01 March 2016, caused and/or did not take appropriate steps to prevent harm to Child J, in that you:
i) did not appropriately supervise the session and / or ensure that a physiotherapy assistant was present.
ii) did not adequately assess the risk involved prior to the session described in Paragraph 1 (j)(i).
Found Proved

40. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“An incident with Child J occurred on 1 March 2016, and Catherine Kirk submitted the incident report on the same day... It detailed that Child J was practicing standing while throwing balls, with support from Catherine Kirk kneeling at his right leg. He overbalanced onto his left side and lowered to the floor onto his left bottom and then fell onto his back. Child J may have grazed his head on the base of the plinth.

Supervision of Child J
I understand that Child J was attempting to stand for the first time without parallel bars, and normally he needed the help of two people to stand if not using the bars. Providing support in a kneeling position is not adequate for support, as it places the Physiotherapist in a position in which the child is above her, and trunk/pelvic stability cannot be easily achieved unless the child is small in stature.  Catherine Kirk should have had a Physiotherapy Assistant to help her ensure truncal/pelvic support in standing if she was not using parallel bars.

During a session, the Physiotherapist should also not turn away from the child but should instead keep their vision and concentration on the child at all times.

The Registrant should have known to do this, based on her qualifications and experience.

Assessment of risk
In this case, Catherine Kirk stated in the incident report that she should not have been distracted and turned visually away from Child J.   However, it was the first time that Child J had stood without the support of parallel bars and normally he needed the help of two people to stand.  Catherine Kirk did not organise this help for the session. She did not put into place safety measures to ensure safe and successful achievement of the standing activity for Child J as well as providing inadequate supervision thereafter.

It appears that Catherine Kirk was aware of the risks when she wrote the incident report so she should have known about the risks prior to the session. She has indicated in the report that she knew that Child J needed two people to help for him to be able to stand and yet she did not arrange for a Physiotherapy Assistant to be present to assist her. If she could not enlist the help of the Physiotherapy assistant, she could have used the parallel bars instead to ensure the safety of Child J.”

41. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Particular 1 (k):
k) On or around 08 April 2016, caused and/or did not take appropriate steps to prevent harm to Child K, in that you:
i) directed him to move from the floor to a plinth and
ii) did not adequately assess the risk involved prior to the activity.
Found Proved

42. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“The incident with Child K occurred on 8 April 2016 and was reported on the same day... Catherine Kirk had encouraged Child K to pull up from standing to sitting on the large plinth. Child K lost his grip, fell backwards, and hit the back of his head on the floor.

Moving positions
There is nothing wrong with Catherine Kirk directing Child K to move from the floor to the plinth.  However, there was a lack of vigilance on her part in respect of the risk that Child K could have lost balance or fallen and it appears she had not been ready to react physically if he were to fall. Catherine Kirk should have been physically close enough to Child K to hold him if required.

Assessment of risk
When assessing a child, the Physiotherapist should not make an assumption about the ability of the child but should be able to monitor the child's balance and posture and react fast enough with increased physical support to prevent the child falling.  The Physiotherapist should know at what level to provide such support to ensure safety, and then monitor the situation through their clinical observation skills.

In this instance, Child K falling was a risk, and she was going to use activities that she had not witnessed Child K complete previously.  She needed to be physically ready to counter any over-balancing or chance of falling, and to do this she would need to place herself close enough to Child K to offer this support.

Child K falling during this session was not allowed to happen deliberately, but it was avoidable for a person with Catherine Kirk’s qualifications, expected clinical assessment skills and expected clinical decision-making ability.”

43. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 


Particular 1 (l):
l) On or around 27 April 2016, caused and / or did not take appropriate steps to prevent harm to Child L, in that you:
i) directed her to close her eyes whilst on a moving inclined treadmill; and
ii) did not adequately assess the risk involved prior to the session described in Paragraph 1(l)(i).
Found Proved

44. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“The incident with Child L occurred on 27 April 2016, and Catherine Kirk submitted an incident report in respect of this on the same day…According to the incident report, Child L was confident on the treadmill and set the speed and incline to what she had previously used in session and was comfortable with. Catherine Kirk asked her to close her eyes whilst on the moving treadmill and, consequently, her right foot came off the treadmill belt and she tumbled down to the floor.

Moving treadmill
There is no clinical reason to test walking with the child's eyes closed.  It would be expected that a Physiotherapist would know this or be able to reason this from their knowledge and experience. The documented reflection by Catherine Kirk was concerning as she thought that Child L’s poor balance led to this incident, and her practice change is noted in the incident report as “I will not get a child to walk on the treadmill with their eyes closed unless I am directly behind them and can keep them safe and prevent a fall'. However, this was not the issue. Catherine Kirk should have known that testing walking with the child’s eyes being closed is not clinically relevant and therefore there is no indication to do such a test. Such a test would be unsafe even with an able-bodied child.

Assessment of risk
There is no way that Catherine Kirk could have supervised Child L or made this activity safer as there is no valid reason to test walking with Child L’s eyes closed.  She should have realised that the test was inappropriate and dangerous.”

45. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panell, and therefore found this particular proved. 

Particular 1 (m):
m) On or around 13 June 2016, you caused and/or did not take appropriate steps to prevent harm to Child M, in that you:
i) directed the physiotherapy assistant not to support the Child;
ii) Initiated an activity which was inappropriate for Child M’s level of ability; and
iii) did not adequately assess the risk involved prior to the session described in Paragraph 1 (m) (i) – (ii).
Found Proved

46. The Panel noted the details of this particular as set out in the witness statement of JR, where it was stated:

“The incident report in respect of Child M was submitted by Catherine Kirk on 13 June 2016 relating to an incident on the same day…The incident report states that Child M had been on the bed with the Physiotherapist supporting her left side at her knee and ankle. She was pulling back on some elastic with her right arm when her trunk rocked back over to the left and she landed on the floor on her left side.

No assistance from Physiotherapy Assistant
Immediately before the fall, Catherine Kirk asked the Physiotherapy Assistant, Diane Athwal, to move and become a “human target” for Child M to aim at. However, she did not change her position or that of the other helper, Lisa Tibble, Child Support Assistant, to compensate for the absence of Diane Athwal and to prevent her falling to that side. Nor did she position Diane Athwal nearer to Child M, where she could have prevented her from falling.

Child M’s ability
In her interview with Lisa Kliem on 29 June 2016, Catherine Kirk indicates that as soon as the new game commenced, it was too challenging for Child M’s ability.  At that time, she should have stopped the game and reassigned Diane Athwal to return to the side of Child M until she had decided how to modify the game so that it was no longer too challenging and threatening her balance. Even before this, Catherine Kirk’s clinical assessment of Child M’s physical ability should have indicated the risk of her losing her balance during the game. She would have known this from the background of Child M’s condition and from previous physiotherapy sessions with her.

The game that Catherine Kirk chose with Child M would not have been acceptable even with more support, once Catherine Kirk had realised (as she indicated in her interview on 26 September 2016 with Lisa Kliem that the game was too challenging for Child M and was not achieving the purpose for which it was chosen. Once she assessed this she should have ceased the game or modified it so that Child M’s safety was ensured.

Assessment of risk and supervision
Catherine Kirk’s clinical assessment of Child M’s physical ability should have indicated the risk of her losing her balance during the game. This could be countered by monitoring the child’s balance and positioning yourself close enough to react with increased physical support to prevent over-reaching or over-balancing by the child.

The Physiotherapist should also know where to provide the necessary support to ensure safety. For example, it would not be expected for a Physiotherapist to support “through left side at the knee and ankle”, as indicated in the incident report for Child M, when a child is in a sitting position, as the danger comes from a loss of trunk or pelvic stability and so that is where the support should be directed. Support through the knee and ankle would be appropriate if the activity was a transfer from sitting to standing, provided an assistant or another Physiotherapist could ensure trunk/pelvic stability at the same time.

It would be expected that the Physiotherapist was able to assess the child's abilities and then instigate activities or games which would extend the child's abilities further but safely. If the game is too challenging, the Physiotherapist should act immediately to alter the game accordingly to achieve the aims of the activity and ensure the child's safety. It would be expected that the Physiotherapist is able to instruct the assistant as to where they are to be situated in relation to the child, how they should support the child, and how much support to give and how to help with the intervention so that the child is safe.

Allowing her to over-balance was not done deliberately. However, as a tertiary qualified Physiotherapist, Catherine Kirk should have had the clinical assessment skills and clinical decision-making ability to realise that this was not an appropriate activity for Child M and her balance was threatened. I made these assessments at the time of my initial review of the incident reports.”

47. The Panel accepted the Registrant’s admissions in respect of this particular, which are entirely consistent with the evidence before the Panel, and therefore found this particular proved. 

Decision on Grounds:
48. Having found the facts proved in this matter, the Panel went on to consider whether the facts found proved, individually or collectively, amounted to misconduct and/or lack of competence. 
49. The Panel took account of Ms O’Sullivan’s submissions that the Registrant accepted that the matters found proved amounted to a lack of competence.  However, it has made its own professional assessment about the matter.
50. The Panel also noted Ms Manning-Rees’ submissions in relation to alleged breaches of the Standards of conduct, performance and ethics (both the 2008 and the 2016 versions) and the Standards of Proficiency for Physiotherapists (the 2007 and the 2013 versions). 
51. The Panel concluded that the following Standards of conduct, performance and ethics (2008 version) had been breached:
• 1 – you must act in the best interests of service users
• 5 – you must keep your professional knowledge and skills up to date
• 6 – you must act within the limits of your knowledge, skills and experience and, if necessary, refer the matter to another practitioner
• 7 – you must communicate properly and effectively with service users and other practitioners
• 8 – you must effectively supervise tasks that you have asked other people to carry out
52. The Panel further concluded that the following Standards of conduct, performance and ethics (2016 version) had been breached:

• 2 – communicate appropriately and effectively

• 3 – work within the limits of your knowledge and skills

• 4 – delegate appropriately

• 6 – manage risk

53. The Panel next concluded that the following Standards of Proficiency for Physiotherapists (2007 version) had been breached:

• 1a.1 – be able to practise within the legal and ethical boundaries of their profession

• 1a.2 – be able to practise in a non-discriminatory manner

• 1a.3 – understand the importance of and be able to maintain confidentiality

• 1a.4 – understand the importance of and be able to obtain informed consent

• 1a.5 – be able to exercise a professional duty of care

• 1a.6 – be able to practise as an autonomous professional, exercising their own professional judgement

• 1a.8 – understand the obligation to maintain fitness to practise
 
• 1b.3 – be able to demonstrate effective and appropriate skills in communicating information, advice, instruction and professional opinion to colleagues, service users and their relatives and carers

• 1b.4 – understand the need for effective communication throughout the care of the service user

• 3a.1 – know and understand the key concepts of the bodies of knowledge which are relevant to their profession-specific practice

• 3a.2 – know how professional principles are expressed and translated into action through a number of different approaches to practice, and hot to select or modify approaches to meet the needs of an individual, groups or communities

• 3a.3 – understand the need to establish and maintain a safe practice environment

54. The Panel finally concluded that the following Standards of Proficiency for Physiotherapists (2013 version) had been breached:

• 1 – be able to practise safely and effectively within their scope of practice

• 2 – be able to practise within the legal and ethical boundaries of their profession

• 4 – be able to practise as an autonomous professional, exercising their own professional judgement

• 8 – be able to communicate effectively

• 9 – be able to work appropriately with others

• 11 – be able to reflect on and review practise

• 12 – be able to assure the quality of their practice

• 13 – understand the key concepts of their knowledge base relevant to their profession

• 14 – be able to draw on appropriate knowledge and skills to inform practice

• 15 – understand the need to establish and maintain a safe practice environment

55. In relation to misconduct, the Panel noted the advice of the Legal Assessor who approved the references made by the parties to the cases of Roylance v General Medical Council [2000] 1 A.C. 311, and Cheatle v General Medical Council [2009] EWHC 645 (Admin), and who also drew the Panel’s attention to the case of R v. Nursing and Midwifery Council (ex parte Johnson and Maggs) (No 2) [2013] EWHC 2140 (Admin) which is authority for the proposition that misconduct refers to actions by a registrant which fellow practitioners would find “deplorable”. The Panel accordingly concluded that misconduct must be serious and amount to a registrant’s conduct falling far below the standards expected of a registered physiotherapist.
56. In relation to lack of competence, the Panel noted the advice of the legal assessor that lack of competence connotes a standard of professional performance which is unacceptably low and which, save in exceptional circumstances, has been demonstrated by reference to a fair sample of the Registrant’s work.  Moreover, the benchmark by which to gauge impairment is the standard required of a Registered Band 7 Highly Specialist Physiotherapist (from 20 May 2013 to 20 October 2014) or a Band 6 Specialist Physiotherapist (from 21 October 2014 to 31 August 2016).  Further, the Legal Assessor referred to the case of Andrew Francis Holton v General Medical Council [2006] EWHC 2960, which is authority for the proposition that in assessing lack of competence, the standard to be applied was that applicable to the post to which the Registrant had been appointed and the work she was carrying out (as detailed above).  The public was entitled to expect that the work of a Registrant who performed in any specialty was at the standard applicable to that post in that specialty. 
57. The Panel therefore first considered whether a fair sample of the Registrant’s work had been reviewed. It finds that it has, since it covers almost the entire period of her employment, during which she was supervised and monitored and made the subject of two PIPs. 
58. The Panel has considered the individual matters found proved and notes that they indicate persistent failings in relation to 12 patients.  These failings concerned inadequate clinical assessments; inadequate risk assessments; and poor supervision of her patients 
59. The Panel considers that these are basic and fundamental errors which would not, and should not, be expected from a physiotherapist as experienced as the Registrant who had been appointed to Band 6 and 7 roles.  Moreover, the Panel notes that throughout significant periods of her employment with the Trust her line manager had concerns about the quality of her practice sufficient to make the Registrant subject to PIPs on two occasions. 
60. The Panel considers that each of the particulars found proved, both individually and collectively, amount to an unacceptably low standard of performance, knowledge and skill and therefore concludes that they amount to a lack of competence. 
61. As the Panel has found that each of the matters found proved amount to a lack of competence, then it cannot consider whether they amount to the alternative ground of Misconduct.  In any event, the Panel concluded that the Registrant’s actions in each individual case were not sufficiently serious and therefore would not be considered as “deplorable” by fellow practitioners.  Moreover, the Panel notes that the HCPC witnesses confirm that the Registrant always had a positive attitude to her work and consistently sought to improve her performance.    
Decision on Impairment:
62. In reaching its decision on impairment, the Panel has taken account of the submissions of the parties, the draft (unsigned) statement of the Registrant and the advice of the Legal Assessor. It has also taken account of the HCPC Practice Note “Finding that Fitness to Practise is Impaired”.

63. The Panel is aware that, in determining whether fitness to practise is impaired, it must take account of a range of issues which, in essence, comprise two components, namely the ‘personal’ component (the current competence and behaviour of the individual Registrant) and the ‘public’ component (the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession). It appreciates that not every finding of a lack of competence will automatically result in a Panel concluding that fitness to practice is impaired. Moreover, it cannot adopt a simplistic view and conclude that fitness to practise is not impaired simply on the basis that, since the allegation arose, a Registrant has corrected matters or “learned his/her lesson”. Although the Panel’s task is not to punish past wrongdoings, it does need to take account of past acts or omissions in determining whether a Registrant’s present fitness to practice is impaired. In addition, when assessing the likelihood of a Registrant causing similar harm in the future, the Panel should take account of both the degree of harm if any, caused by a Registrant and that Registrant’s culpability for that harm. Finally, the Panel is to consider whether a Registrant has demonstrated insight into their attitude and failings.

64. The Panel first considered the “Personal” component.  The Panel noted that in her unsigned statement, the Registrant acknowledged that she had made poor decisions and that there were areas where she should improve.  She indicated that she possibly had not selected the correct activity at times or judged the ability of a child correctly.  She stated that she needed to work on these areas.  She went on to say that since the allegations had been made she had seriously questioned her skill and suitability to be a physiotherapist, so much so that the allegations had “rocked me to the core of who I am, I love to work with children and it is a huge part of my life”.

65. The Registrant also stated that she had tried to develop her risk assessment skills and had become more risk aware.  However, she stated that she was now hesitant to try anything and that everywhere she looks she now saw risk and the potential for harm. She said that she had evolved and changed as a result of the numerous reflections upon her practice that she had carried out.  (On that point the Panel notes that the Registrant has produced a “Reflective Bundle” containing 14 reflective pieces upon her practice as a physiotherapist dated from 7 August 2016 to 22 May 2018).

66. The Registrant further stated that since leaving the Trust she had not sought work as a physiotherapist.  However, she still wanted to be a physiotherapist, albeit that she might consider different fields of practice.  She appreciated that she needed to improve areas of her practice.  She also indicated that she would be “less determined in pushing my opinion and use the better judgement and experience of my peers and supervisor until such time as my clinical reasoning is better and more reliable.  I will not assume that just because I think an activity is suitable for a child, it can be attempted”.

67. The Panel noted that in her unsigned statement the Registrant went on to reflect at great length about her failings, what areas of her practice she needed to address and what she would do differently, sufficient to persuade the Panel that the Registrant has developed insight into what she has done and how she can improve her practice.  However, it also notes that she has not practised as a physiotherapist since August 2016 and therefore has had no opportunity to put her new-found awareness into practice.  On that basis alone the Panel considers that, as her practice was clearly impaired in August 2016, she remains currently impaired by on account of her lack of competence in relation to the Personal component.

68. The Panel then moved on to consider the Public component.  The Panel notes that the Registrant’s actions had either caused harm, or had the potential to cause harm, to a particularly vulnerable group of children who had significant health issues.  Although no serious injuries resulted, the risk of harm was significant and the Panel considered that the Registrant’s lack of competence was such that the need to declare and uphold professional standards and maintain public confidence in the profession would be undermined if a finding of impairment were not made in these circumstances. A right-minded member of the public, with full knowledge of all of the circumstances would be concerned if a finding of current impairment were not made. 

69. Accordingly, the Panel concluded that the Registrant was impaired in relation to both the Personal and the Public components.

Decision on Sanction:
70. In reaching its decision on sanction the Panel took account of the Registrant’s oral evidence which she gave at the Sanction stage; the submissions of Ms Manning-Rees and Ms O’Sullivan; the Indicative Sanctions Policy (“ISP”) document; and the advice of the Legal Assessor, which it accepted. The Panel was mindful that the purpose of sanctions is not to be punitive, although they may have that effect.  It appreciated that the primary purpose of any sanction is to address public safety from the perspective of the risk which the Registrant concerned may pose to those who use or need her services. It noted, however, that in reaching its decision, panels must also give appropriate weight to the wider public interest, which includes: the deterrent effect to other registrants; the reputation of the profession concerned; and public confidence in the regulatory process. In addition, the Panel noted that it must act proportionately, which requires it to strike a balance between the interests of the public and those of the Registrant.

Oral evidence of the Registrant
71. The Registrant confirmed that, until the incidents relating to these proceedings, she had not had any concerns expressed about her practice.  She stated that whilst employed at the Trust she performed around 20 physiotherapy sessions a week which translated to about 800 per year.  She detailed how she would now go about carrying out clinical and other risk assessments.  She further indicated that during her time at the Trust she had put a lot of pressure upon herself in order to keep what she described as her “dream job”; to become as perfect a physiotherapist as she could be; and to validate the fact that she had been appointed to such a significant role.  This, she said, led her to sometimes be “too adamant” in order to demonstrate that she was right and to not adjust if she thought that she was right.  In addition, the parents of the service users she was treating sometimes expected “miracles” and the Registrant did not want to let them down. This led to her sometimes doing what they wanted even though it was not the best course to take.
72. When asked how she would now guard against this tendency, the Registrant stated that she would make sure that the “patient is most important and not me”.  She now realised that it did not matter if she was right or wrong; patient safety was the priority.
73. The Registrant further stated that she now had a clearer view of risk assessment.  Beforehand, she had “tried too hard to show I know what I am doing and that it will go right”.  Essentially, she had always considered that she was right and had neglected the safeguards.  She now appreciated that she had to consider the possibility that something would not go well.  She was also more mindful of her own impairments which beforehand she had not considered to be an issue but which clearly were. 
74. The Registrant went into some detail about her own health issues. The Registrant had reflected on this aspect and said that she now would deal with these health issues by “owning up to them and recognising them as factors” so that additional allowances could be made by others (for instance by warning them about any brusqueness she might exhibit).  In addition, she had tended to become over-emotional during sessions.  She now realised that she was just one of many factors to take into account whereas before she had a tendency to regard herself as being primarily determinative. However, the success of a treatment was “not just up to me”.
75. The Registrant confirmed that she did intend to return to practise as a physiotherapist but that she had not practised since resigning in August 2016.  This was because she had found it very difficult to contemplate being a physiotherapist at that stage.  It had been very difficult seeing “all my failings in black and white” and reading the opinions of others whom she had trusted.  Her confidence was “really low” and she thought that “if I could not do that job perhaps I should look at other options”.  She had therefore interpreted her leaving the Trust as an opportunity to pursue other career options.  It was easier to focus on something new.  However, she had undertaken reflections on her physiotherapy practice even though she had not been comfortable doing these initially.  They had in fact been “really useful”.  However, since that time she had not let herself “think hugely” about returning to practise as a physiotherapist and she was “cautious about hoping for a job I could not have”. She had therefore tried to focus on what was positive.
76. The Registrant went on to say that the reason she wanted to return to practice was because she “really” missed the profession, regarding being part of it as a privilege.  She would want to be part of a team so that she would continue to learn from others, and vice versa, but would require a team with a well-designed management structure where she would know where she could go to for help and to test her opinions.  She was still committed to professional excellence and high standards but now appreciated that the outcome of any physiotherapy session was not just down to her but that other factors were responsible as well.
77. As for the support she thought that she would require, she wanted a base to “run ideas past” and to build her confidence.  She would benefit from supervision so that someone would be available to look at her clinical judgement and her prioritising.
78. The Registrant added further details on how she would manage a return to practice during Panel questions.  She indicated that she would probably aim for Band 5 or Band 6 roles with the “end goal” being to resume working with children with neurological conditions.  She appreciated that there were very few opportunities in this specialism and that she would not be able to confine herself to such.  Ideally, she would want a “rotational” post, observing and assisting another physiotherapist, but then swapping roles under that physiotherapist’s supervision so as to achieve a gradual transition.  She confirmed that she would benefit from supervision and patience from her employer.
79. The Registrant also appreciated that there was significant competition for employment as a physiotherapist, particularly in the NHS, which was the most likely potential employer, and that jobs which catered for her need to be supervised would be difficult to find.  However, she believed that such jobs would be more likely to be available in Band 5 roles and she was willing to resume physiotherapy at that level.  Although she realised that working in the NHS would be pressurised, the Registrant considered that it could be managed by prioritising patient contact.    
80. When asked about the PIPs, the Registrant indicated that she had found the first PIP very helpful and her practice had improved.  However, although she agreed with the aims of the second PIP, the enabling support system had not been set up by the time that the incident with Child M had occurred and therefore it had not had time to become truly operative.
81. The Registrant took the Panel through her thought processes in relation to the incident involving Child L.  She had conceived a spontaneous idea to ask the child to close her eyes whilst walking on the treadmill.  Child L was used to walking on the treadmill and the Registrant believed in adding variety to her normal routines and to set challenges.  She had not realised how difficult it would be for Child L; indeed, she had tried it herself later on and would now never ask someone to do it.  She had learned that “a good idea will still be a good idea tomorrow” and that she should have stepped back at the time and fully considered the risks involved.
82. When asked what she had learned from the process, the Registrant replied “humility”.  She had learned that “being wrong is not wrong” and that “pretending you are right and not acknowledging that you are wrong” was wrong.  Moreover, she had become more cautious and would plan in advance by selecting the right activity and ask what could go wrong. 
83. The Panel also noted, from her draft statement, that, since leaving the Trust, the Registrant has worked as an au pair, tutor and babysitter, both in the UK and in Italy.  She had also done support work with an adult with a brain injury since August 2016.  In that regard the Panel notes the reference from LM confirming that the Registrant had “demonstrated highly developed clinical skills and expertise whilst working with my sister with complex care needs.  [CK] has always remained conscientious in ensuring my sister’s safety and has been an asset in supporting her independence”.  Finally, the Panel notes that the Registrant has also commenced training to become a primary school teacher in the UK and has studied Italian.
Submissions
84. Ms Manning-Rees drew the Panel’s attention to what the HCPC considered to be the aggravating features of the case, namely that the Registrant’s failings were in relation to basic and fundamental physiotherapy skills; that she had received some support from the Trust; and that she was dealing with vulnerable service users.
85. Ms O’Sullivan set out the mitigating features, which included the Registrant’s early and full admissions; the abundant evidence of her good practice; the testimonials (which were unusual in that they were from those who had worked with her at the Trust in a senior capacity); her realistic understanding of the difficulties in returning to practice; the complex personal mitigation; and the “earnest and honest” reflections which had being ongoing for some time (for almost two years) and had not been produced just for the purposes of this hearing. Ms O’Sullivan therefore submitted that the most appropriate sanction was that of a Conditions of Practice Order, perhaps based on the same conditions under which the Registrant was already subject in relation to the Interim Oder against her.
86. The Panel found the Registrant to be an intelligent, candid and honest witness who clearly had reflected significantly on her failings and who showed genuine remorse in relation to potentially endangering those children who were under her care.  However, although the Panel considered that the Registrant had developing insight, it was not satisfied that she as yet had full insight into how she would manage her return to practice.  Although it was clear to the Panel that she had engaged emotionally with these proceedings, it noted that she had, for some time, consciously felt unable to engage with the prospect of practising again as a physiotherapist.  Accordingly, although the Panel noted her evidence of what she anticipated doing in the future, it was not satisfied that she had grasped the full extent of the challenges she would face.  The Panel means no criticism of the Registrant by this. It would be difficult for anyone who had been absent from the profession for almost two years to fully predict how to manage such a return, particularly when they had left practice in the circumstances prevalent when the Registrant resigned her post at the Trust.   
Mitigating and Aggravating factors
87. The Panel took account of the various mitigating factors namely:
• The Registrant’s previous good character as a physiotherapist since her qualification in South Africa in or about 2008;
• Her full admissions in relation to almost all of the allegations against her (which mirrored the candour in the Incident Reports prepared by her at the time of the incidents);
• Her numerous and honest reflections on her failings, spread over two years;
• Her developing insight into those failings;
• The testimonials from those who worked with her and the opinions from some of the HCPC witnesses, who spoke highly of her commitment and enthusiasm;
• Her commitment to improving her practice;
• The fact that she has engaged fully with these proceedings, notwithstanding the emotional cost to her which became apparent during her evidence;
• The complicated personal mitigation, including her significant health difficulties, which to her credit she did not attempt to use as an excuse for her failings; indeed, the Panel considered that she may have tended to underestimate the effect that her health conditions had upon her practice. 
88. However, the Panel also noted the following aggravating features and in particular:
• The basic and fundamental nature of the Registrant’s failings;
• The particular vulnerability of the patients under her care;
• The potential seriousness of the consequences (although the evidence before the Panel is that no serious injuries resulted from these incidents);
• Her lack of practise as a Physiotherapist for almost two years;
• The fact that she did have some support at the Trust.  However, the evidence of the level of such support is unclear. The statements of SM and JR appear to contradict each other on this point, and BT indicated that no allowances were made for the Registrant’s hearing difficulties, so the Panel is left with the impression that the support given to the Registrant at the time was not as structured as it could have been.
Consideration of Sanction
89. Given the nature and potential seriousness of the Registrant’s failings the Panel took the view that this was not a case that could be appropriately dealt with without a sanction.  The Panel therefore went on to consider the various sanctions, beginning with the least onerous.
90. The Panel first considered the sanction of Mediation and concluded that it was not appropriate. There was no evidence before it that her previous employers would co-operate in such a process, and in any event the matter was too serious to be resolved in this way.
91. The Panel next considered a Caution Order, which is deemed to be appropriate:
“where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate remedial action. A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate. A caution order is unlikely to be appropriate in cases where the registrant lacks insight.”
92. The Panel noted that the Registrant’s lapse was not isolated, limited or relatively minor in nature.  In addition, a Caution would not address or remedy the Registrant’s lack of competence or the fact that she had been out of practice for almost two years.  Moreover, it was arguable that meaningful practice restrictions could be imposed; in addition, the Panel considered that, given that the Registrant had not practised for such a long time, there remained a risk of repetition. Consequently, the Panel concluded that, notwithstanding the Registrant’s current developing insight, such a sanction would be insufficient to address the Panel’s concerns in relation to the public interest grounds or to provide adequate protection to the public.
93. The Panel then considered the next most onerous sanction, that of a Conditions of Practice Order, and noted that this is appropriate where a failure or deficiency is capable of being remedied and where the Panel is satisfied that allowing the Registrant to remain in, or return to, practice, while subject to conditions, minimises the risk of future harm to service users. The Panel determined that, despite the seriousness of the breaches, the Registrant’s failings were capable of being remedied.
94. In addition, the Panel noted that before imposing conditions a Panel was to be satisfied that: the issues which the conditions sought to address were capable of correction; there was no persistent or general failure which would prevent the registrant from doing so; appropriate, realistic and verifiable conditions could be formulated; the Registrant could be expected to comply with them; and a reviewing Panel would be able to determine whether those conditions have or were being met. 
95. The Panel was satisfied that all these pre-conditions were met particularly since it had formed a favourable impression of the Registrant who it considered had demonstrated that she was deeply concerned about her failings and wanted to rectify them.  Consequently, the Panel felt able to draft workable, appropriate, realistic and verifiable Conditions of Practice with which the Registrant would comply.
96. Accordingly, on the information before it, the Panel was reassured that there was a sufficient level of insight and understanding to indicate that a Conditions of Practice Order would be adhered to. Moreover, it was confident that conditions could be structured in such a way as to minimise the risk of future harm to patients. Thus a Conditions of Practice order was an appropriate and proportionate response.
97. The Panel did consider imposing the next most onerous sanction, that of an order of Suspension.  It noted that the ISP indicated that a Suspension Order should be considered where a Panel believes that a Caution or Conditions of Practice would provide insufficient public protection or where the allegation is of a serious nature but unlikely to be repeated and, thus, striking off is not merited. The Panel concluded that a Suspension Order would be disproportionate in the circumstances, particularly considering that the Registrant had demonstrated that she was keen to remedy her failings.
98. Accordingly, the Panel concluded that the proportionate response is to make a Conditions of Practice Order for a period of one year.

Order

The Registrar is directed to annotate the HCPC Register to show that, for a period of one year from the date that this Order takes effect (“the Operative Date”), you, Catherine J Kirk, must comply with the following conditions of practice:
1) You must place yourself and remain under the supervision of a Physiotherapist registered as such by the HCPC (at Band 7 or above), and supply full details of your supervisor to the HCPC within 7 days of taking up employment as a Physiotherapist.  You must attend upon that supervisor as required and follow their advice and recommendations.
2) Before providing any physiotherapy treatment to children and young people with neurological conditions, you must first discuss with your supervisor your assessment of the patient and your proposed treatment plan.  This discussion must include the identification and management of the potential risks to the patient.
3) You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
i) Risk Management;
ii) Clinical Reasoning;
4) Within three months of taking up any physiotherapy post you must forward a copy of your Personal Development Plan (PDP) to the HCPC.
5) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your PDP.
6) You must allow workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your PDP.
7) You must provide a detailed report from your workplace supervisor commenting on your practice as a Physiotherapist and the progress you have made in achieving the aims of your PDP, one month prior to any hearing to review this Order.
8) You must allow your supervisor to contact the HCPC to report any concerns with your practice as a Physiotherapist.
9) You must promptly inform the HCPC if you are appointed, or cease to be employed, as a Physiotherapist by any employer.
10) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
11) You must inform the following parties that your registration is subject to these conditions:
A. Any organisation or person employing or contracting with you to undertake professional work;
B. Any agency you are registered with or apply to be registered with as a Physiotherapist (at the time of application);
C. Any prospective employer, seeking to employ you as a Physiotherapist, (at the time of your application).

This order will be reviewed again before its expiry.

Notes

Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health and Social Work Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you.  The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

European alert mechanism:
In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been restricted.
You may appeal to the County Court against the HCPC’s decision to do so.  Any appeal must be made within 28 days of the date when this notice is served on you.  This right of appeal is separate from your right to appeal against the decision and order of the Panel.

Application for an Interim Order:
1. Having determined to conclude this case by imposing a Conditions of Practice Order on the Registrant, the Panel heard an application by Ms Manning-Rees for an Interim Order for 18 months (to cover any appeal period) on the same terms as the substantive Conditions of Practice Order.  She submitted that such an order was necessary on both public protection and public interest grounds on the basis that the Panel had found that the Registrant was currently impaired due to her lack of competence.  She also maintained that it was also in the Registrant’s own interests on the basis that she had expressed some concerns about returning to practice without a good support system in place.
2. Ms O’Sullivan had no objection to the imposition of an Interim Order on the same terms as the Panel’s final order.  However, she argued that the period of the order should be the same as the substantive order, namely one of 12 months.
Decision on Interim Order:
3. The Panel accepted the advice of the Legal Assessor, who referred it to paragraphs 51 to 54 of the ISP, which state:
“Interim Orders to give effect to decisions
51. If a Panel disposes of a case by making a striking-off order, suspension order or conditions of practice order, Article 31 of the Order provides the Panel with the discretionary power to impose an interim suspension or conditions of practice order which will apply during the time allowed for appealing against the final disposal order or, if such an appeal is made, whilst that appeal is in progress.
52. It is important to recognise that the power is discretionary and, consequently, Panels should not regard the imposition of an interim order as an automatic outcome of fitness to practise proceedings in which a striking-off, suspension or conditions of practice order is made.
53. If the Panel is considering imposing an interim order, before doing so it must give the parties a specific opportunity to address it on the issue of whether or not such an order should be made.
54. Whether an interim order is necessary will depend upon the circumstances in each case, but Panels should consider imposing such an order in cases where:
• there is a serious and on-going risk to service users or the public from the registrant’s lack of professional knowledge or skills; conduct or unmanaged health problems; or
• the allegation is so serious that public confidence in the profession or the regulatory process would be seriously harmed if the registrant was allowed to remain in practice on an unrestricted basis.”
4. The Panel first considered whether an interim order was necessary.  It noted that the Registrant had not practised as a Physiotherapist for almost two years and that it had found that she was currently impaired due to a lack of competence.  The Panel was therefore satisfied that there was a serious and on-going risk to service users or the public and that for the same reasons public confidence in the profession or the regulatory process would be seriously harmed if the Registrant was allowed to remain in unrestricted practice.  In addition, it agreed with Ms Manning-Rees that an order would be in the Registrant’s own interests for the reasons stated by her.
5. Having determined that an interim order was necessary, the Panel then considered the appropriate form of that order, beginning with the least restrictive. It first considered whether an Interim Conditions of Practice Order would be sufficient to protect the public, meet the wider public interest and be in the Registrant’s own interests.  It concluded that it would be perverse not to impose the same Conditions of Practice on the Registrant as it had imposed upon her in its substantive decision since the Panel considered that order to be an appropriate and sufficient sanction.
6. The Panel therefore concluded that an Interim Conditions of Practice Order was the sufficient and proportionate order.  It also determined that it should be for a period of 18 months since, if there was an appeal, the substantive order would not come into effect and therefore there would be no order to review at the end of the 12 month period.

Interim Order:
The Panel makes an Interim Conditions of Practice Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.  This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
The interim conditions of practice mirror those imposed in the substantive Order. Namely, you, Catherine J Kirk, must comply with the following interim conditions of practice:
1) You must place yourself and remain under the supervision of a Physiotherapist registered as such by the HCPC (at Band 7 or above), and supply full details of your supervisor to the HCPC within 7 days of taking up employment as a Physiotherapist.  You must attend upon that supervisor as required and follow their advice and recommendations.
2) Before providing any physiotherapy treatment to children and young people with neurological conditions, you must first discuss with your supervisor your assessment of the patient and your proposed treatment plan.  This discussion must include the identification and management of the potential risks to the patient.
3) You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
i) Risk Management;
ii) Clinical Reasoning;
4) Within three months of taking up any physiotherapy post you must forward a copy of your Personal Development Plan (PDP) to the HCPC.
5) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your PDP.
6) You must allow workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your PDP.
7) You must provide a detailed report from your workplace supervisor commenting on your practice as a Physiotherapist and the progress you have made in achieving the aims of your PDP, one month prior to any hearing to review this Order.
8) You must allow your supervisor to contact the HCPC to report any concerns with your practice as a Physiotherapist.
9) You must promptly inform the HCPC if you are appointed, or cease to be employed, as a Physiotherapist by any employer.
10) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
11) You must inform the following parties that your registration is subject to these conditions:
A. Any organisation or person employing or contracting with you to undertake professional work;
B. Any agency you are registered with or apply to be registered with as a Physiotherapist (at the time of application);
C. Any prospective employer, seeking to employ you as a Physiotherapist, (at the time of your application).

 


 

Hearing History

History of Hearings for Catherine J Kirk

Date Panel Hearing type Outcomes / Status
18/06/2018 Conduct and Competence Committee Final Hearing Conditions of Practice