Mr Marin Stinca

Profession: Physiotherapist

Registration Number: PH98405

Hearing Type: Review Hearing

Date and Time of hearing: 11:30 29/05/2018 End: 16:00 29/05/2018

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

While employed as a Physiotherapist with Great Western Hospital NHS Foundation Trust:


1. Between 26 February 2016 and 16 March 2016, in respect of Patient A, you:

a) Not proved.

b) Did not complete and/or record an adequate assessment on 26 February 2016 in that you:

i. Did not record clear clinical reasoning;

ii. Not proved.

iii. Did not perform and/or record an adequate assessment of active range of movement and/or muscle strength;

iv. Not proved.

v. Not proved.

vi. Recorded that the passive range of movement for Patient A’s left hip was normal, which was factually incorrect.

c) Did not make a distinction between objective Ax and Rx.

d) Not proved.


2. Did not complete and/or record an adequate assessment on 8 March 2016 in respect of Patient B, in that:

a) You recorded that the patient’s transfer and mobility was back to baseline which was factually incorrect;

b) Not proved.


3. On 7 March 2016 in respect of Patient C, you did not complete and/or record an adequate assessment in that you did not:

a) Not proved.

b) Recommend any exercises to strengthen Patient C’s knees and/or record why no recommendation for exercises to strengthen Patient C’s knees was made;

c) Clearly record which limbs were tested during the assessment.


4. Between 26 February 2016 and 11 March 2016, in respect of Patient D, you:

a) Did not complete any or any adequate record of the assessment on 26 February 2016;

b) Did not record an adequate treatment plan or goal in your assessment recorded on 26 February 2016;

c) Did not make a distinction between objective Ax and Rx in your assessment recorded on 26 February 2016;

d) Did not use clear clinical terminology in your assessment recorded on 11 March 2016;

e) Not proved.

f) Not proved.

 

5. On 18 January 2016, in respect of Patient E, you had to be prompted to loosen the leg straps when placing Patient E in the hoist;


6. On 22 January 2016, in respect of Patient F you:

a) Used advanced instructions at points during the assessment, which were inappropriate given the patient’s presentation;

b) Did not ask adequate questions about Patient F’s pain;

c)  Not proved.

 

7. The matters set out in paragraphs 1 – 6 constitute misconduct and/or lack of competence.

 

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

 

 

 

 

 

Finding

Preliminary Matters

Service

1. The Panel is satisfied on the basis the documentation which it has been shown, that the Registrant has been served with notice of today’s hearing in accordance with the Rules.   The Panel has seen a letter dated 27 April 2018 which was sent by first class post to the Registrant at his registered address.  That letter was also emailed to him on the same date.   The Panel has also seen a further letter dated 21 May 2018 sent to the Registrant’s registered address in which the time of today’s hearing was amended from 10.00 am to 12.30 pm.

Proceeding in the absence of the Registrant

2. The Panel considered whether to proceed in the Registrant’s absence.   The Panel is satisfied that the HCPC has taken all reasonable steps to notify the Registrant of today’s hearing. In addition to the communications referred to in paragraph 1 above, the Panel also noted an email sent to the Registrant dated 15 May 2018 in which the Registrant was asked to confirm whether he was going to attend today’s hearing.   He did not respond to that email.   The Panel noted that there has been no contact with the Registrant since shortly before the substantive hearing which he did not attend.

3. The Panel has decided to proceed in the absence of the Registrant.   In reaching this decision, the Panel was mindful that it should exercise utmost care before doing so.  It took account of the matters set out in the HCPTS Practice Note on Proceeding in the Absence of the Registrant, and also received and accepted legal advice. 

4. The Panel is satisfied that the Registrant has voluntarily waived his right to be present.   There is an onus on all registrants to engage with their regulatory body and proceedings such as this.   The Panel noted that  the Registrant had not sought an adjournment.   It is satisfied that an adjournment would not result in his future attendance.   The Panel also takes the view that there is a clear public interest in mandatory review hearings being heard expeditiously and at the allotted time.  

Background

5. The Registrant is a physiotherapist registered with the HCPC.   He commenced employment with the Great Western NHS Foundation Trust (the Trust) on or around 15 November 2015 as a Band 5 physiotherapist in the Marlborough Community Team.   The first 6 months of his employment contract was a probationary period.   For the first three months of the probationary period, the Registrant worked on the rehabilitation ward of the Savernake Hospital where he was responsible for assessing and treating a wide variety of patients.   In February 2016, the Registrant was transferred to work in the community where he was responsible for assessing and treating patients in their homes.  

6. It became apparent that there were concerns in respect of the Registrant's clinical practice in the Community Team.   In an attempt to find a placement where he could be more effective, the Registrant was transferred to the Musculo Skeletal Out-Patient Department in Salisbury Hospital.   This placement lasted for two days due to concerns about the Registrant's practice.   Salisbury Hospital wanted the Registrant to return to Savernake Hospital, but the Registrant handed in his notice and left immediately.

7. The Registrant did not attend the previous substantive hearing and that panel referred to his “minimal” engagement with the proceedings and noted that there was no indication the Registrant had reflected on his clinical deficiencies in "any meaningful way", or that he had any sense of the potential impact these might have on patients.   As there was no evidence before the panel that the Registrant had taken steps to remedy the clinical deficiencies, or brought his knowledge and skills up to date, it concluded there was a serious and ongoing risk of repetition.   That panel was also satisfied that where a registrant was unable to work as an autonomous practitioner with vulnerable patients, a finding of impairment was in the public interest to uphold professional standards, and to safeguard public confidence in the profession and in its regulatory body.    

Decision

8. In reaching its decision, the Panel has taken account of the HCPTS Practice Note “Finding that Fitness to Practise is Impaired”.    It has had regard to the submissions made by Ms Dudrah for the HCPC.  It has received and accepted legal advice.

9. The Panel has considered with care all the information put before it, in particular the determination of the previous substantive hearing panel.   In that determination, the Registrant was advised that this Panel might be assisted by the following information:

(i) Evidence of up to date physiotherapy specific skills and knowledge, such as:
• Short course (online or otherwise)
• Seminars
• Reading journals
• Volunteering or work shadowing
• Testimonials from individuals able to comment on the Registrant’s skills and knowledge relevant to a physiotherapy role
• A reflective statement on skills and knowledge that the Registrant has acquired.

10. The Panel noted that the Registrant has not provided any of the information referred to above.   He has not engaged with the HCPC since his early, “minimal” contact.  

11. The Panel has born in mind that the purpose of a review hearing is to assess current fitness to practise.   As there is no evidence that there has been any change since the substantive hearing, the Panel is unable to conclude that the Registrant has developed any insight or has taken any steps to remedy his lack of competence.  The Panel noted that the Registrant resigned from his employment in early 2016 and has not worked as a Physiotherapist since then.    It appreciates that it is more difficult to demonstrate remediation when subject to a Suspension Order, particularly where the competency concerns raised cover a broad range of failings relating to the adequacy of assessments, treatment plans, clinical reasoning, and recording of information.    However, the Registrant’s continuing lack of engagement leaves the Panel in no doubt that the risk of repetition is high and so there remains a real risk of harm to patients.  

12. The Panel has also considered the wider public interest.   It is in no doubt that a reasonable person aware of all the circumstances of this case, would be very concerned if a finding of impairment was not made where, as here, there are serious clinical concerns which have yet to be remedied.   A finding of impairment is required in this case to maintain public confidence in the Physiotherapist profession and in its regulator, and so that proper professional standards in the profession are upheld. 

13. In these circumstances, the Panel has determined that the Registrant’s fitness to practise remains impaired.

14. The Panel considered its powers under Article 30 (1) of the Health and Social Work Professions Order 2001 and the available sanctions in ascending order of seriousness in order to determine the appropriate and proportionate sanction in this case.   It received and accepted legal advice.  

15. The Panel has in mind that the purpose of a sanction is not to punish the Registrant but to protect the public.    It has decided that to take no action or to impose a Caution Order would not be appropriate or proportionate, as neither course would manage the serious competency risks identified in this case.   The Panel is satisfied that there is a real risk of repetition and so to ensure the public is properly protected, it must impose a sanction.   

16. The Panel next considered a Conditions of Practice Order.   Although it takes the view that the Registrant’s lack of competence is potentially capable of being remedied, it has concluded that a Conditions of Practice Order is not appropriate in this case.   There is no information as to the Registrant’s current employment, and the Panel has no basis for concluding, given his lack of engagement and failure to provide the information recommended by the substantive panel, that the Registrant would comply with such an Order.  The Registrant has not worked as a Physiotherapist since early 2016 and the Panel has no information as to how he had been maintaining his skills and knowledge since that time.  In the circumstances, it has concluded that there are no conditions which it could devise which would be appropriate, workable and measurable.

17. The Panel has therefore concluded that the appropriate and proportionate order is a Suspension Order for 12 months.   The Panel considers that if the Registrant decides now to engage with these proceedings, a 12-month Suspension Order will give him sufficient time to demonstrate that he has developed insight and has properly reflected on his clinical deficiencies, and that he has taken appropriate steps to remedy them.  

18. The Panel cannot bind the next reviewing panel but considers that it might be broadly assisted by the same information as suggested at the substantive hearing :
Evidence of up to date physiotherapy specific skills and knowledge, such as: 

• Short course (onlineor otherwise)
• Seminars
• Reading journals
• Volunteering or work shadowing or substantive employment as a healthcare assistant
• Testimonials from individuals able to comment on the Registrant’s skills and knowledge relevant to a physiotherapy role
• A reflective statement on skills and knowledge that the Registrant has acquired.

Order

The Registrar is directed to suspend the registration of Mr Marin Stinca for a further period of 12 months on the expiry of the existing order. 

Notes

The order imposed today will apply from 28 June 2018.
This order will be reviewed again before its expiry on 28 June 2019.

Hearing History

History of Hearings for Mr Marin Stinca

Date Panel Hearing type Outcomes / Status
29/05/2018 Conduct and Competence Committee Review Hearing Suspended
27/11/2017 Conduct and Competence Committee Final Hearing Suspended