Mr Alex Anzelmo

Profession: Physiotherapist

Registration Number: PH46837

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 26/11/2018 End: 17:00 28/11/2018

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

 

Whilst registered as a Physiotherapist and during Service User A’s appointment on 14 July 2017:

 

1. You did not stop treatment when Service User A asked you to do so.

 

2. Your actions described at particular 1 constitute misconduct.

 

3. By reason of your misconduct your fitness to practise is impaired.

 

Finding

Preliminary Matters

1. There were no preliminary matters in dispute between the parties.

2. The parties agreed however, to deal discretely with the facts and misconduct stage before the impairment and sanction stage. The Panel acceded to this request.

Background

3. The Registrant is a registered Physiotherapist, working in private practice. He graduated from Brunel University in 1993. From 1993 to 2000 he was employed in various hospitals as a senior physiotherapist and was the lead physiotherapist for the sports injury clinic at the Wellington Hospital. Since 2000 the Registrant has been a sole practitioner and runs his own clinic from his home.

4. On 10 July 2017, Service User A (SUA) made a phone call to the Registrant to make a physiotherapy appointment. SUA says that she did this because she had been suffering from lower back pain on and off for about 5 months and decided to contact the Registrant who had been highly recommend by a friend. She also said that she had received physiotherapy multiple times in the past and had treatment for her lower back from an Osteopath during the previous 5 months.

5. On 14 July 2017, SUA attended her appointment with the Registrant. Before treatment commenced she signed a consent form for the Registrant to perform physiotherapy on her.

6. During the appointment SUA alleges that the Registrant did not stop treatment after she asked the Registrant to do so.

7. The particulars of this complaint are that SUA alleges that during the course of the appointment she was asked to undertake a number of tests, one of which involved her sitting on the edge of the treatment bed. At this point she says that the Registrant held up her left leg, which was very tight, connecting to the lower back which was in a lot of pain at the time. She says that the Registrant then said “here comes the nasty part” and pushed her head down vigorously. She said this was violent and painful, and that the pain was both in the lower back, gluteal muscles and hamstring. She said that she knew it did not feel right as it felt as if it was further aggravating the area and her body braced against the pain.

8. She said that she asked the Registrant to stop but he did not. She said that whilst the Registrant pushed her head down, he was counting down from 10 to 0. She said that at 7 she asked him to stop but he continued down from 6 to 0. She said she said stop very loudly, a number of times. SUA further alleges that the Registrant’s head was only a few inches away from hers and she cannot believe that he did not hear her saying stop stop stop. She said that she pushed and pulled against the Registrant but he continued to count down from 6 to 0. SUA says that at this point she started to cry and was shocked.

9. SUA says that the Registrant did not verbally acknowledge her tears, although he did provide her with a tissue and the treatment moved on and the Registrant asked her to do some other exercises. She stated that she felt humiliated, vulnerable, upset and shocked.

10. SUA said that during the subsequent exercises the Registrant was reading out the news from his computer. She also said that the Registrant showed his awards and certificates which were displayed on his wall to her and also told her that he was in the top 0.5% of physiotherapists in the country.

11. At the end of the session, SUA said that the Registrant asked her for a score on a scale of 1-10 to assess her pain. She said she indicated that the pain was 2 on that scale.

12.When it came to payment at the end of the appointment SUA said that she discovered that the Registrant’s card machine was broken and there was an agreement to pay via bank transfer.

13. On 17 July 2017, SUA wrote to the Registrant by email, detailing her thoughts in relation to the appointment and cancelling her next appointment. SUA complained that the Registrant had been aggressive and had broken her trust. She pointed out that the Registrant had not stopped treatment when she said ‘stop stop stop’. She further stated that she was thinking of submitting an official complaint but wished to give the Registrant a chance to respond first.

14. On the same day, in response, the Registrant apologised that the SUA was unhappy and accepted her request to cancel their next session. He also stated to SUA that her pain on departure from the appointment was less than when she arrived. He went on to threaten legal action in respect of non-payment of his fees.

15. SUA responded by email indicating that she was not satisfied with the Registrant’s response. SUA considered his email was threatening rather than apologising or attempting to explain. She indicated that she would pay the fees, which she did, and that she would make a formal complaint.

16. On the same day, SUA made a complaint about the Registrant to the HCPC.

17. In a detailed statement, the Registrant denied SUA’s version of events and particularly denied that he had continued treatment when SUA had asked him to stop the treatment.

Decision on Facts

18. The Panel considered two bundles of evidence. The HCPC bundle included a notice of allegation, a case summary and the signed witness statement of SUA, with exhibits. The Registrant produced his witness statement and exhibits within his bundle.

19. The Panel heard oral evidence from Service User A and the Registrant.

20. The Panel focused on the allegation in charge 1, namely whether the Registrant did not stop treatment when Service User A asked you to do so.

21. In submissions, Ms Williams submitted that there is only one factual allegation in this case. She said that there is agreement that SUA sat on the end of the treatment bed and the Registrant placed his hands on her head and leg, and there was a countdown. She suggested that the dispute was very narrow, namely that SUA said the Registrant pushed her head down vigorously, whereas the Registrant said he applied a bit of pressure. SUA indicated that during the countdown she said stop stop stop, but the Registrant ignored her request.

22. Ms Williams submitted that SUA was a credible witness and that she gave true and accurate oral evidence for the following reasons:

• She gave a fair and reasonable account and was prepared to accept inaccuracies in her written evidence and the chronology of events

• When she was unsure of a particular proposition she said so and did not seek to elaborate her account further

• She gave a very clear and detailed account of the subject of the charge

• She clearly remembered the words “nasty” and “evil” being used. It was something which stuck in her head as she considered it odd. Her experience of other physiotherapists was to provide her with reassurance

• She remembered the Registrant sitting at his computer and informing her of news in relation to a fire

• She recalled “the moment” very clearly, namely the incident when she asked the Registrant to stop treatment. She said “everything else pales in comparison”

• The evidence she gave of the specific allegation was consistent despite a long period of questioning and that she maintained her account of events throughout.

23. Ms Williams also submitted that it was more likely than not that SUA’s account of the events were correct on the basis of the email she sent to the Registrant 3 days after the appointment, in which she made serious allegations that the Registrant’s conduct was unacceptable and unforgivable. Her complaint was raised very close to the event in question and Ms Williams submitted that particular weight should be given to this.

24. In contrast, Ms Williams submitted that the Registrant was not a credible witness and some of his explanations were not plausible and he was evasive in some of his answers. In particular she said that the Registrant’s explanation as to why he did not respond specifically to the serious allegations contained in the email sent to him by SUA on 17 July 2017, namely that he was busy and angry, was unreasonable. She said that having denied the allegation that he used the words “nasty” and “evil” he was evasive as to the exact words he did use. He referred to using ‘catchphrases’ but was unable to provide the specific words used.

25. Mr Toms on behalf of the Registrant submitted that he would only address the Panel on the issue of the facts and not misconduct, in light of his concession that, if the facts are found proved, the Registrant would accept a finding of misconduct.

26. Mr Toms submitted that it is possible that two people may have different perceptions as to what happened, which each believes to be true, and this is what happened in this case. He said that there could have been a misperception on the part of each party. In particular he said that there may have been a misperception as to the technique used for the ‘slump test’ He said that there was miscommunication between the parties as to the use of the word ‘stop’.

27. He further relied on the Registrant’s good character, his career history, his CPD record and the lack of motive to behave in the fashion alleged, and that it was more likely than not that the events as alleged by SUA did not occur.

28. He submitted that the Panel should consider the case in the round and consider the inconsistencies in SUA’s evidence, such as exactly when she says that the particular incident occurred during the appointment.

29. Mr Toms placed particular emphasis on the contemporaneous medical note of 14 July 2017. By way of example he said that it was likely to be accurate given its content when the Registrant recorded SUA’s pain scores and diagnosis of scoliosis.

30. Mr Toms said that SUA was wrong about when the incident took place, and that it was more likely to have taken place at the end of the appointment, particularly since there was evidence that SUA wanted the treatment to continue after the particular incident.

31. Further, Mr Toms said that the Registrant did not respond in detail to the email of SUA dated 17 July 2017 because it did not contain any particulars of an allegation against him. Mr Toms said that the Registrant’s perception was that SUA was trying to avoid payment but he has since apologised for this.

32. In conclusion, Mr Toms said, looking at the overall picture, this case involved two different individuals with two different takes on the events and that there are arguments on both sides. He said that those events could not, on the balance of probabilities, amount to the charges being found proved.

33. The Panel carefully considered the written and oral evidence of each of the parties. In summary, the Panel preferred the evidence of SUA over that of the Registrant in respect of allegation 1, namely that, on the balance of probabilities the Registrant did not stop treatment when SUA asked him to do so. The reasons for doing so are set out in the analysis below.

34. The Panel found that SUA provided clear and consistent evidence. In particular, the Panel gave significant weight to SUA’s recollection of what she described as “the moment.” She described the Registrant asking her to sit at the end of the bed, before saying to her “here comes the nasty part” and then performed what is referred to as the ‘slump’ test or technique. This involved the Registrant placing his hands on her head and her leg. She said that the Registrant pushed her head down vigorously and that she asked him to stop at number 7 during a countdown from 10 to 0, but he did not do so. She said that she was astonished that the Registrant denies this as she said “stop stop stop” repeatedly.

35. The Panel also considered that SUA provided important and persuasive detail in her account of the events in general. The Panel accepted SUA’s  recollection that the Registrant said that the procedure would be “nasty and evil”; that he read out news relating to a fire, and told her that he was in the top 0.5% of physiotherapists in the country.

36. Further, the Panel considered that SUA’s account was corroborated by the email she sent to the Registrant 3 days after the incident and her subsequent complaint to the HCPC, in which she set out in detail her concerns as to the events of 14 July 2017.

37. Whilst the Panel accepts that there was some inconsistency in SUA’s account, for example, as to the exact chronology of events and discrepancy in her written evidence as to which leg was elevated during the procedures, overall, the Panel considered that SUA’s account was consistent and credible, and that SUA readily accepted any inaccuracies in her evidence. The Panel was impressed by her approach to giving her evidence, during which she indicated when she could not recollect something.

38. In considering the Registrant’s credibility, the Panel is aware of his previous good character and has paid particular heed to the good character direction given by the legal assessor. The Panel has however considered the full circumstances of this case and found numerous inconsistencies in the Registrant’s evidence and account of events. It was submitted by Mr Toms that this case was one of perceptions and that each party may have differing ones. The Panel noted that SUA was familiar with receiving physiotherapy treatment and was well versed with the various procedures adopted by physiotherapists. The Panel considered it unlikely that there was misperception in this case.

39. The Panel accepted that the Registrant had provided a contemporaneous handwritten medical record of the events of 14 July 2017. However, the Panel considered it to be incomplete as it failed to record certain matters that the Registrant suggested had happened, such as SUA’s distress and providing her with a tissue, providing SUA with a video recording of further exercises, and recording that the first attempt at the slump technique had been aborted due to SUA wriggling out of the correct position. The Panel also noted that the Registrant had included additional matters in the typed record, such as including a plan to give SUA the video recording, which he did not mention in the hand-written original note.

40. The Panel further considered, in light of the email sent to the Registrant 3 days after the incident, making serious allegations against him, it was reasonable to infer that he would have provided a response beyond that which he did. The Panel did not find the Registrant’s evidence credible on this point, when he said the reason why he didn’t respond to the allegations was “I should have but thought it would maybe seem to highlight guilt that wasn’t there.”

41. The Panel rejected the Registrant’s contention, that had SUA been treated in the way that she had, she would not have continued with the treatment session. The Panel was persuaded by SUA’s explanation as to why she continued with the treatment. She said that she was in shock and felt embarrassed by her tears and that ‘she wanted to power through to the end of the session’ She said part of her wanted to ‘run away’ and part of her wanted to ‘soldier on’. The Panel considered this account to be a credible one.

42. The Panel also considered that there were further issues of credibility in relation to the Registrant. He told the Panel that he had informed SUA, during their telephone conversation on 10 July 2017, that his card reader was broken and that she would need to provide him with cash at the appointment. This appears wholly inconsistent with SUA signing a form dated 14 July 2017 that her method of payment was to be by card. SUA maintained throughout that she had not been told that there had been any issue with the card reader prior to the date of the appointment. Further, SUA responded to the Registrant’s email on 17 July 2017, making it clear that the reason she did not pay for the session was because the Registrant’s card machine was broken.

43. Another issue as to the Registrant’s credibility related to his assertion that he had agreed to reduce his assessment fee. When the Registrant was questioned about this he accepted that his fee was £80 and that SUA paid him £80.

44. Further, the Registrant was specifically asked by the Panel as to the allegation that he had said “nasty” and “evil”. He said that he used a catchphrase but, despite being pressed on this issue, was unwilling to indicate the words he used.

45. The Registrant, relying on CCTV footage surveying the front of his house, asserted that SUA could not have been in as much pain as she alleged. The Panel disagreed with this analysis of the CCTV as it was almost impossible to discern this from the footage of SUA entering and leaving the Registrant’s private clinic, given the poor quality of the CCTV and the inability to see the facial expressions of SUA.

46. The Panel further noted that the Registrant was upset and angry with SUA for the email she sent him dated 17 July 2017 containing her complaints. He said he had gone ‘out of his way’ to help her, including extending the appointment.

47. In light of all of these factors the Panel finds allegation 1 proved.

Decision on Misconduct

48. Ms Williams submitted that the facts, if found proved, amount to misconduct.

She submitted that the actions of the Registrant would be in breach of the following standards: HCPC Standards of Conduct, Performance and Ethics 2016, paras 1.1, 1.2, 1.4 and 2.3 and Standards of Proficiency for Physiotherapists 2013 paras 1, 3, 4, 8, 11, 12 and 15.

49. The Panel considered the following matters to be relevant from each of the codes:

HCPC Standards of Conduct, Performance and Ethics 2016

Promote and protect the interests of service users and carers

Treat service users and carers with respect

1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.

1.2 You must work in partnership with service users and carers, involving them, where appropriate, in decisions about the care, treatment or other services to be provided.

Make sure you have consent

1.4 You must make sure that you have consent from service users or other appropriate authority before you provide care, treatment or other services.

Communicate appropriately and effectively

Communicate with service users and carers

2.2 You must listen to service users and carers and take account of their needs and wishes.

Standards of Proficiency for Physiotherapists 2013.

3 be able to maintain fitness to practise

3.1 understand the need to maintain high standards of personal and professional conduct

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

4.2 be able to make reasoned decisions to initiate, continue, modify or cease techniques or procedures, and record the decisions and reasoning appropriately

8 be able to communicate effectively

8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues and others

8.6 understand the need to provide service users or people acting on their behalf with the information necessary to enable them to make informed decisions

50. At the outset, Mr Toms indicated that if the facts were found proved, the Registrant conceded that they would amount to misconduct.

51. The Panel accepted the advice of the legal assessor.

52. The Panel considered that, based on the facts found proved, the Registrant’s conduct amounted to misconduct. The Registrant’s actions were equivalent to treating a patient without consent. Although this was a one-off incident, it was of a sufficiently serious nature so as to amount to misconduct.

Decision on Impairment

53. The Registrant gave further oral evidence at this stage, following which submissions were heard from Ms Williams for the HCPC and Mr Toms on behalf of the Registrant.

54. Ms Williams submitted that since the matter involved a single event, it would be remediable if, the Registrant acknowledged his wrongdoing in respect of SUA, if he apologised to her and applied his CPD learning to his practice, but she submits this did not happen in this case.

55. Ms Williams suggested that it was of some concern that the Registrant had read relevant documents on consent and attended courses, yet still concluded that he had stayed within his parameters of professional conduct.

56. Ms Williams also said there was a lack of insight in that the Registrant failed to demonstrate this in response to SUA’s email to him on 17 July 2017 and in the 16 months that have elapsed since. She said that in the Registrant’s oral evidence today, he remains more concerned with the impact on him rather than on SUA. She submitted that when the Registrant was asked about SUA, he spoke of his own intentions rather than harm he may have caused SUA. In those circumstances she said that there is current impairment on the personal component because of  his lack of insight.

57. Ms Williams submitted that there is also impairment on the public component. She said the Panel had found that treating SUA in the way he did was equivalent to not acquiring her consent. She said that the public required reassurance in terms of the standards of the profession and the standing of the HCPC.

58. Mr Toms submitted that the Registrant’s misconduct related to one incident during one appointment. He said the Registrant has already accepted the findings amount to misconduct, and that this shows that he recognises that what he did was serious. However, he said that the Registrant had a different perception of what happened, even though that perception was wrong in the circumstances.

59. Further, Mr Toms said that the Registrant had accepted the findings of the Panel and that in itself shows insight on his part. In addition he said that the Registrant has taken steps and advice to address any potential concerns in his practice by going on a course dealing with difficult interactions with patients. He said he is committed to his profession in terms of undertaking CPD.

60. In relation to the Registrant’s oral evidence, Mr Toms said that the Registrant’s response to the impact on SUA was an appropriate one, in that he said that it was never his intention to cause harm or distress. He said that the Registrant had apologised today. By mentioning the impact on himself, he said that the Registrant was treating the matter seriously.

61. In conclusion, Mr Toms said that the Registrant ‘did something wrong’ on one occasion in a long career. He said that the Registrant accepted this. He submitted that it cannot be said that the Registrant is currently impaired on that basis. He said the public would not consider that he is  impaired.

62. The Panel considered the issue of current impairment exercising its own independent judgment.

63. The Panel accepted the advice of the legal assessor and considered the Practice Note on Impairment, which includes consideration of two components:

• the ‘personal’ component: the current competence, behaviour etc. 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.

64. The Panel reminded itself of the case of Cohen v GMC [2008] EWHC 581, namely that not every finding of misconduct will automatically result in a Panel concluding that fitness to practice is impaired.

65. The Panel also considered that case of Grant [2011] EWHC 927 (Admin) para 76:

“Do our findings of fact in respect of the doctor's misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his fitness to practise is impaired in the sense that he:

a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/ or"

66. Before hearing oral evidence from the Registrant in relation to the issue of insight, the Panel recognised the limitations on a Registrant in developing insight into their misconduct, if they have maintained a denial of allegations until a hearing, and that impairment stage immediately follows the facts stage.

67. The Panel considered that the Registrant did not intend to cause deliberate harm to SUA. However, the Panel was of the view that the Registrant’s conduct was serious and fell far below the standard expected of a physiotherapist. The Panels’ findings demonstrate that the Registrant did cause SUA harm in circumstances where SUA repeatedly said to the Registrant “stop stop stop”, thereby causing SUA both physical and emotional harm.

68. The Panel considered whether the Registrant’s conduct is easily remediable, has been remedied and is highly unlikely to be repeated.

69. The Panel carefully considered the oral evidence of the Registrant and concluded that, currently, the Registrant has not satisfied the Panel that he has sufficient insight into his misconduct. As a starting point, the Panel considered that the Registrant expressed limited remorse. His apology to SUA was made today in oral evidence after his initial evidence in chief, cross examination and Panel questions, when Mr Toms sought to ask further questions after Panel questions. The Registrant showed no genuine appreciation of the pain and distress that SUA had suffered at the time, nor the impact on her associated with making the complaint and attending the hearing to give evidence.

70. A further concern was that the Registrant continued to assert, in answer to a question from Ms Williams that he acted within his professional body’s guidelines.

71. In Panel questions the Registrant was asked about how he would do things differently in the future, particularly in relation to explaining to patients the possibility of assessment or treatment techniques causing pain. The Registrant was unable to give any clear indication of how his practice would change in light of the facts found proved in this case.

72. The Panel had regard to the Registrant’s bundle which included a new consent form, details of CPD training and testimonials.

73. In relation to the new consent form, the Registrant indicated that he had changed his practice by altering his consent form and this happened to coincide with the new General Data Protection Regulation (GDPR) regime which came into force in May 2018. After hearing evidence, the Panel considered that the change to the consent form was made some 10 months after the incident, because it coincided with the new GDPR regime, rather than a proactive attempt to alter the terms of the consent form following the incident with SUA.

74. The Panel noted with the number of CPD courses that the Registrant has undertaken over many years and recognised that the Registrant is committed to undertaking training in relation to clinical aspects of his work. The Panel was concerned however that working as a lone practitioner for a number of years, the Registrant had not undertaken any courses to address his patient communication and active listening skills between 1993 – 2018. The Panel found this concerning given the failures that arose in this case.

75. The Panel next considered the testimonials and noted the absence of any up to date references from a registered physiotherapist. The Panel felt unable to attach significant weight to the testimonials as the Registrant admitted that he did not inform the referees of the details of the allegation against him and the individuals had no recent professional experience of him.

76. Whilst the Panel considers that the conduct of the Registrant is remediable, in light of the factors above, it considered that such conduct has not been remedied and is therefore likely to be repeated.

77. The Panel therefore finds that the Registrant is currently impaired in relation to the personal component in that the public would be put at risk if the Registrant was permitted to practice without restriction.

78. The Panel also considered the Registrant’s conduct, albeit on one isolated occasion, was so serious as to warrant a finding in respect of the public component, in order to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

79. Taking all these circumstances into account the Panel found the Registrant’s fitness to practise currently impaired.

Decision on Sanction

80. The Panel then turned to consider what, if any, sanction to impose.

81. Ms Williams submitted that the Panel should approach sanctions by starting with the least restrictive sanction first in so far as is necessary to fulfil the two aims of protecting the public and upholding the public interest.

82. She said that particularly relevant were the findings of the Panel that the Registrant had not remedied his conduct and it is therefore likely to be repeated, and the public would be put at risk if he were permitted to practice without restriction.

83. Ms Williams stated a caution order is an appropriate sanction for cases 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.

84. Ms Williams submitted that the lapse in this case is isolated, but that it has been found that it is serious, that it is likely to be repeated, that the Registrant has expressed limited remorse and has not remedied his conduct.

85. Ms Williams submitted that if a caution order is insufficient, the Panel should go on to consider a conditions of practice order. She said, if the Panel is able to formulate appropriate, realistic and verifiable conditions and it is satisfied that, subject to these conditions, the Registrant can practise safely and effectively, conditions would be appropriate. If not, she stated that the Panel could consider a suspension order and a striking off order as a matter of last resort.

86. Finally, she reminded the Panel that any sanction must be proportionate, balancing the Registrant’s interests against the need to protect service users and give appropriate weight to the public interest.

87. Mr Toms submitted that the Panel should impose conditions of practice in this case for a 6 month period. He said that the Registrant was prepared to comply with conditions.

88. The Panel accepted the advice of the legal assessor. It bore in mind the Indicative Sanctions Policy. It reminded itself that the purpose of fitness to practise proceedings is not to punish registrants, but to protect the public. It also bore in mind the principle of proportionality and balanced the need to protect the public against the right of the Registrant to practise his profession without restriction.

89. The Panel considered the aggravating factors as being the harm caused to SUA, the limited remorse of the Registrant, and to some extend his lack of insight. The Panel considered that the mitigating factors included the fact that this was an isolated incident; the Registrant had engaged with the HCPC and his previous good character.

90. The Panel considered each sanction in turn, starting with the least restrictive first. The Panel considered taking no action but concluded that, given the seriousness of the Registrant’s misconduct, this would be inappropriate because it would not protect either the public or the wider public interest.

91. The Panel then considered whether to make a caution order. Although the allegation concerns one isolated incident, the Panel considered that the incident was a serious one and that the Registrant’s remorse was limited and his insight insufficient. In these circumstances a caution order is not appropriate.

92. The Panel next considered the imposition of a Conditions of Practice Order. In doing so, the Panel was satisfied that:

• the issues which the conditions seek to address are capable of correction;

• there is no persistent or general failure;

• appropriate, realistic and verifiable conditions can be formulated;

• the registrant can be expected to comply with them; and

• a reviewing Panel will be able to determine whether those conditions have or are being met.

93. The Panel is satisfied that the failure and/or deficiency in the Registrant’s conduct is capable of being remedied, and that the Registrant remaining in practice will not pose a risk of harm to patients, if his practice is restricted by the imposition of conditions.

94. The Panel accepted the following conditions put forward on behalf of the Registrant:

Education and training requirements

(i) No later than 12 weeks prior to the review date, you will undertake a training course which includes communication and active listening skills with patients and forward a copy of your attendance certificate and the course agenda to the HCPC.

Mentoring

(ii) You must register with the Chartered Society of Physiotherapy (CSP) mentoring scheme within 7 days of today

(iii) Within 28 days from today you must obtain a mentor either through the CSP’s mentoring scheme or through another registered Physiotherapist, who should be the equivalent of Band 6 or above and provide their details to the HCPC

(iv) You will discuss the events of this hearing with your mentor and develop a CPD plan to address the deficiencies that have been identified.

(v) You will discuss your cases on a monthly basis with your mentor.

(vi) You will provide a report from your mentor addressing the CPD plan, your progress and the review of your cases, to the HCPC no later than 28 days before the review hearing.

Reflective piece

(vii) You must compile a reflective statement concerning the issues that arose during and after the appointment with Service User A on 14 July 2017. Such statement to be provided to the HCPC within 8 weeks of the next review.

Informing the HCPC and others

(viii) You must promptly inform the HCPC if you take up any offer of employment.

(ix) You must promptly inform the HCPC of any disciplinary proceedings taken against you in relation to physiotherapy practice.

(x) 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 physiotherapy work involving the treatment of patients

b. any agency you are registered with or apply to be registered with to carry out any physiotherapy work involving the treatment of patients (at the time of application); and

c. any prospective employer (at the time of your application).

95. The Panel considered that the appropriate and proportionate length of the conditions is 12 months. This would allow the Registrant time to reflect on his misconduct, comply with the conditions of practice and provide the necessary information to the HCPC prior to a review hearing. The Panel considered that 6 months was too short a period for the Registrant to complete the necessary work in the conditions of practice.

96. The Panel also considered whether a period of suspension would be appropriate to enable the Registrant. The Panel did not consider this was a proportionate sanction in the circumstances of this case, and particularly that the conditions of practice devised are sufficient to protect the public and the wider public interest.

97. The Panel was satisfied that a striking off order was neither necessary nor proportionate in this case. The Panel did not consider that the Registrant’s actions are such as to be fundamentally incompatible with registration as a physiotherapist.

98. In all the circumstances the Panel imposed a conditions of practice order for a 12 month period with a review hearing.

Order

Order: The Registrar is directed to impose a Conditions of Practice Order for a period of 12 months from the date this Order comes into effect. Mr Alex Anzelmo must comply with the following conditions of practice:

Education and training requirements

(i) No later than 12 weeks prior to the review date, you will undertake a training course which includes communication and active listening skills with patients and forward a copy of your attendance certificate and the course agenda to the HCPC.

Mentoring

(ii) You must register with the Chartered Society of Physiotherapy (CSP) mentoring scheme within 7 days of today

(iii) Within 28 days from today you must obtain a mentor either through the CSP’s mentoring scheme or through another registered Physiotherapist, who should be the equivalent of Band 6 or above and provide their details to the HCPC

(iv) You will discuss the events of this hearing with your mentor and develop a CPD plan to address the deficiencies that have been identified.

(v) You will discuss your cases on a monthly basis with your mentor.

(vi) You will provide a report from your mentor addressing the CPD plan, your progress and the review of your cases, to the HCPC no later than 28 days before the review hearing.

Reflective piece

(vii) You must compile a reflective statement concerning the issues that arose during and after the appointment with Service User A on 14 July 2017. Such statement to be provided to the HCPC within 8 weeks of the next review.

Informing the HCPC and others

(viii) You must promptly inform the HCPC if you take up any offer of employment.

(ix) You must promptly inform the HCPC of any disciplinary proceedings taken against you in relation to physiotherapy practice.

(x) 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 physiotherapy work involving the treatment of patients

b. any agency you are registered with or apply to be registered with to carry out any physiotherapy work involving the treatment of patients (at the time of application); and

c. any prospective employer (at the time of your application).

95. The Panel considered that the appropriate and proportionate length of the conditions is 12 months. This would allow the Registrant time to reflect on his misconduct, comply with the conditions of practice and provide the necessary information to the HCPC prior to a review hearing. The Panel considered that 6 months was too short a period for the Registrant to complete the necessary work in the conditions of practice.

96. The Panel also considered whether a period of suspension would be appropriate to enable the Registrant. The Panel did not consider this was a proportionate sanction in the circumstances of this case, and particularly that the conditions of practice devised are sufficient to protect the public and the wider public interest.

97. The Panel was satisfied that a striking off order was neither necessary nor proportionate in this case. The Panel did not consider that the Registrant’s actions are such as to be fundamentally incompatible with registration as a physiotherapist.

98. In all the circumstances the Panel imposed a conditions of practice order for a 12 month period with a review hearing.

Notes

Interim Order

1. 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. 


2. Ms Williams submitted that an interim convictions of practice was necessary for the protection of the public and otherwise in the public interest. Mr Toms did not make any submission in response.

3. The Panel has already decided that a Conditions of Practice Order is required to protect the public. Accordingly, the Panel is satisfied that an Interim Conditions of Practice Order is necessary for the protection of the public and otherwise in the public interest.

4. The Panel has concluded that the appropriate length of this Interim Order is to be 18 months to allow for the disposal of any appeal. It has concluded that the conditions imposed should have immediate effect.

5. 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; or (if an appeal is made against the Panel’s decision and Order) upon the final determination of that appeal, subject to a maximum period of 18 months.

 

 

Hearing History

History of Hearings for Mr Alex Anzelmo

Date Panel Hearing type Outcomes / Status
26/11/2018 Conduct and Competence Committee Final Hearing Conditions of Practice