Miss Marion Hazel Le Cornu

Profession: Physiotherapist

Registration Number: PH25781

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 22/10/2018 End: 12:00 22/10/2018

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

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

(As found proved at the Substantive Hearing which took place on 18 – 21 April 2016)

Whilst registered with the Health and Care Professions Council as a Physiotherapist, you:
During the course of your employment as a Physiotherapist at Jersey General Hospital, between November 2012 and May 2013 you:

1. On 23rd November 2012, in respect of Patient A;

a) You did not conduct an effective abdominal assessment in that you advised the patient to get into a brace position

b) You did not identify this patient’s main problem

c) You did not suggest relevant techniques to strengthen her abdominal muscles and function

2. On 29th November 2012, in respect of Patient B;

a) You did not establish that this patient had been on bed-rest for one week and not referred for physiotherapy input

b) You did not establish any information from the midwife in respect of the patient’s bowel movements

c) You did not identify the patient’s main problem

d) You gave the patient pelvic floor exercises, which they had been specifically asked not to do due to a risk of preterm labour at 27 weeks of pregnancy

3. On 30th November 2012, in respect of Patient C;

a) You did not position the position the patient appropriately in order to make a thorough assessment of the abdominals

b) You did not advise the patient to complete pelvic floor exercises

c) You offered the patient contradictory advice about the forms of exercise she should take after giving birth

4. On 17th January 2013, in respect of Patient D;

a) You did not look up the patient’s x-ray as part of the assessment

b) You did not establish that the patient had a lobe removed

c) [Found Not Proved]

d) You did not educate the patient on the important of self-clearing chest

e) You did not educate the patient on mobilizing

f) You did not complete adequate notes in that;

i. [Found Not Proved]
ii. You did not complete adequate notes in that you did not record detail of treatment for the patient

5. On 21st January 2013, in respect of Patient E;

a) You did not establish the patient had suffered a number of falls

b) You did not establish that the patient had low blood pressure, as noted in the patient’s chart

6. On 22nd January 2013, in respect of Patient U;

a) You did not establish whether the patient had stairs at home

7. On 23rd January 2013, in respect of Patient F;

a) You did not adequately assess the height of the patient’s walking aid when assessing the patient’s mobility

8. On 31st January 2013, in respect of Patient G;

a) You continued to walk the patient despite him swaying upon standing

b) [Found Not Proved]

c) [Found Not Proved]

9. On 6th February 2013, in respect of Patient H;

a) You did not look at the latest medical notes in your assessment of the patient

b) You did not look at the x-ray report in your assessment of the patient

c) You did not ascertain the ROM or power in the patient’s hip or left leg before getting the patient to stand and walk

d) [Found Not Proved]

10. On 19th February 2013, in respect of Patient I, you were not able to carry out a neuro assessment in an appropriate manner

11. On 14th March 2013, in respect of Patient J;

a) You did not carry out an objective assessment of the patient’s mobility

c) You did not ascertain the strength of the patient when making the patient’s mobility

12. On 18th March 2013, in respect of Patient K, you;

a) Did not conduct an assessment of the patient to ascertain where her pain was located

b) Did not document your findings on a body chart

c) Did not provide advice and/or recommend treatment to the patient to alleviate her pain

d)[Found Not Proved]

13. On 18th March 2013, in respect of Patient L;

a) You did not read the precious Ax and Rx plan when making your assessment

b) You did not assess the patient in standing as part of your assessment

14. On 18th March 2013, in respect of Patient M;

a) [Found Not Proved]

b) You did not provide appropriate advice to the patient on how she could progress abdominal exercises

c) You did not provide appropriate advice against doing sit-ups

15. On 20th March 2013, in respect of Patient N:

a)[Found Not Proved]

b) You did not provide adequate and/or correct notes of the assessment in that you stated that the patient had lower back pain

c)[Found Not Proved]

d) You did not gather sufficient information from the patient in respect of cauda equine symptoms

16. You were not able to time manage your patient assessment efficiently in respect of:

a) Patient D

b) Patient E

c) Patient I

d) Patient P

e) Patient Q

f) Patient R

g) Patient U

17. The matters set out in paragraphs 1-16 constitute misconduct and/or lack of competence.

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

 

Finding

Preliminary Matters

Service

1. The Panel noted that a Notice of Hearing dated 21 September 2018 was sent to the Registrant at her registered address, by first class post and also by email. The letter gave notice of the hearing date of 22 October 2018.  The Panel had sight of a signed certificate of posting.

2. There had been no response to the Notice of Hearing from the Registrant. 

3. The Panel was satisfied in the circumstances that there had been proper service of the Notice of Hearing in accordance with the HCPC (Conduct and Competence Committee) Rules 2003 (“the Rules”).

Application to proceed in absence

4. Mr Mason submitted that the hearing should proceed in the Registrant’s absence. He confirmed that the HCPC had received no contact from the Registrant in response to the Notice of Hearing.  Mr Mason explained that the Registrant had not been in contact with the HCPC since before the substantive hearing in April 2016, in fact since September 2014.  He had sent a letter to the Registrant by email on 15 October 2018 reminding her of the current review.

5. The current order required to be reviewed timeously and it was in the public interest that the hearing proceed today. 

6. The Panel considered the submissions of the HCPC Presenting Officer. It accepted the advice of the Legal Assessor and referred to the guidance in the HCPTS Practice Note dated 22 March 2017, “Proceeding in the Absence of the Registrant”. 

7. The Panel was mindful that its discretion to proceed in the absence of the Registrant was one which must be exercised with great caution and with the overall fairness of the proceedings at the forefront of its mind. It considered the matter in accordance with the factors set out in the case of R v Jones (Anthony) [2003] 1 AC 1HL and the guidance in the case of GMC v Adeogba and GMC v Visvardis [2016] EWCA Civ 162. 

8. The Panel noted there had been no contact from the Registrant in response to the Notice of Hearing.  There was no indication that she wished to attend the hearing but was for any reason unable to do so, or that she sought an adjournment on any ground. 

9. The Panel noted that the Registrant had not attended any of the previous hearings in this matter and had not been represented. The Registrant had not engaged with the HCPC at all since September 2014, well before the substantive hearing in April 2016.  There had been no contact from her regarding the current review hearing. The Panel noted the guidance in the case of Adeogba (above) which refers to the obligation upon a registered professional to engage with their regulator in relation to disciplinary proceedings.   The Panel concluded in the light of the history in this case that the Registrant had disengaged from the HCPC process and had voluntarily waived her right to attend this hearing.  The Panel concluded she would be unlikely to attend on a future occasion if the matter were adjourned today and therefore an adjournment would serve no useful purpose.  

10. The Panel also took into account the overall fairness of the hearing and that it must also consider the public interest in regulatory proceedings being dealt with as expeditiously as possible. The Panel noted that the Notice of Hearing sent to the Registrant informed her of the Panel’s power to proceed in her absence and explained fully the powers which would be available to the Panel at this hearing. 

11. The Panel was mindful that the current order must be reviewed before its expiry on 9 November 2018.  In the circumstances, the Panel was satisfied that it was appropriate and in the public interest that this matter should proceed and be resolved today.  The Panel determined to proceed with the review hearing today in the absence of the Registrant. 


Background

12. This is the third review of a Suspension Order imposed for a period of 12 months by a Conduct and Competence Committee Panel at a hearing on 18 to 21 April 2016.  The Registrant’s fitness to practise was found to be impaired by reason of lack of competence. This was first extended for a period of 12 months on 19 April 2017 and further extended for a period of six months on 11 April 2018. The current Order expire on 19 November 2018.

13. The Registrant worked as a Physiotherapist at the Jersey General   Hospital from 1980 until she resigned on 17 May 2013.  The Allegation  found proved by the original Conduct and Competence Committee   Panel on 21 April 2016 related to flawed assessments, inaccuracies  in documentation and poor clinical reasoning in identifying patients’   main problems.  The Panel also found that the Registrant lacked basic  knowledge and had an inability to improve her knowledge, despite her  employer having put in place a structured development plan.

14. The substantive hearing Panel found that the Registrant’s practice had  consistently fallen below the standards expected of a Physiotherapist,  over a considerable period of time and taking account of a fair sample  of her work.

15. The substantive hearing Panel considered that the Registrant’s actions  and omissions placed patients and service users at risk.  It found that  there was no evidence before it to indicate that the Registrant had subsequently reflected on her practice so as to achieve sufficient insight. Her professional failings were such that they would have brought the profession into disprepute.  Although the Panel considered that the Registrant’s practice was potentially capable of remediation, there was no evidence of remediation and there remained a real risk of repetition.

16. The substantive hearing Panel concluded that the Registrant’s fitness to practise was impaired and imposed a Suspension Order for a period of 12 months.

17. At the substantive hearing and at each of the three review hearings in the Registrant’s case,  the  panel in question recommended the information to be provided by the Registrant which it considered would
assist the next reviewing panel.

18. The Registrant has not attended any of the hearings in this matter and has not provided any submissions or the recommended documentation for the review hearings.


Hearing of 22 October 2018

Submissions on behalf of the HCPC

19. Mr Mason, on behalf of the HCPC, set out the background to the case.  He informed the Panel there was no new information from the Registrant.  He explained that she had last been in contact with the HCPC in September 2014.

20. Mr Mason submitted that the Panel should conclude that the Registrant’s fitness to practise remained currently impaired, as there had been no change in circumstances and no new information was available. The Registrant had not taken the opportunity offered by the period of suspension to address her lack of competence and the issue of the impairment of fitness to practise.  

21. Mr Mason referred to the Panel’s powers under Article 30(1) of the Health and Social Work Professions Order (“the Order”).  He submitted that in the circumstances that the Registrant had now been continuously suspended for more than 2 years, given her complete lack of engagement, the Panel should exercise its powers under Article 29(6) to impose a Striking Off Order. 


Decision

22. The Panel received and accepted the advice of the Legal Assessor. The Panel was mindful of its powers upon a review of a Suspension Order under Article 30(1) of the Health and Social Work Professions Order 2001. The Panel must first decide whether it finds the Registrant’s fitness to practise to be currently impaired by reason of her lack of competence. The Panel was referred to the HCPTS Practice Note, Finding that Fitness to Practise is Impaired, of 22 March 2017, and to the HCPC Indicative Sanctions Policy.

23. If the Panel found the Registrant’s fitness to practise to be currently impaired, then it would consider what steps to take in accordance with its powers under Article 30(1)(a) to (c), all of which powers were available to the Panel at this hearing.

24. The Panel was further advised that the option of imposing a Striking Off Order was available in accordance with Article 29(6): the Registrant had now been continuously suspended for two years. 

25. The Panel carefully considered all the documents presented and the submissions of Mr Mason on behalf of the HCPC.

26. The Panel first considered whether the Registrant’s fitness to practise remained currently impaired.  It was mindful that the Registrant had not engaged with the HCPC process. There was no new or up to date information from the Registrant.  She had not taken up the guidance offered by previous panels as to information which might have assisted this review Panel.

27. The circumstances therefore remained as they were at the original hearing.   The Panel had carefully considered the findings of the previous panels.   This Panel concluded that there was no evidence that the Registrant had addressed the issues identified by the previous Panels, that she had attempted to remediate her lack of competence or that she had gained any insight.  The Panel concluded that the risk presented by the Registrant remained.  There was nothing to satisfy the Panel that the lack of competence would not continue if the Registrant were permitted to return to practise.  Further, the Panel considered that the risk to public confidence the profession and to the reputation of the profession remained. It considered that public confidence in the profession would be undermined if a finding of current impairment was not made. 

28. The Panel was therefore satisfied that the Registrant’s fitness to practise remains currently impaired.

29. The Panel considered the available sanctions in ascending order of seriousness. It was satisfied that, given the Registrant’s lack of engagement, to take no action or to mediate would not provide the necessary public protection, and nor would a caution. 

30. The Panel could not have confidence that the Registrant would engage or comply with a conditional order, given the history of her failure to communicate with the HCPC since September 2014, which was well before the initial hearing in April 2016.  It also did not consider that  suitable conditions could be formulated which would address the lack of basic competence identified by the original Panel and given the history of lack of engagement, the Panel could not have any confidence that she would now engage or comply with conditions. 

31. The Panel very carefully considered whether a further period of suspension would be appropriate. It was concerned that the Registrant has not taken the opportunity provided by the previous periods of suspension to commence remediation of the lack of competence.  The Panel reached the view that she was not likely to do any differently if a further period of suspension was ordered.

32. Given the Registrant’s failure to co-operate with throughout the HCPC process, the Panel concluded the Registrant has disengaged from this process and a further period of suspension would therefore serve no useful purpose. The Panel notes that the Registrant had been alerted in the correspondence that the Panel would be able to make a Striking Off Order at this hearing. The Panel concluded in all the circumstances that the only sanction which would adequately protect the public and the public interest was a Striking Off Order. 

Order

Order: That the Registrar is directed to strike the name of Miss Marion Hazel Le Cornu from the Register on the date this order comes into effect.

Notes

The order imposed today will apply from 19 November 2018.

Hearing History

History of Hearings for Miss Marion Hazel Le Cornu

Date Panel Hearing type Outcomes / Status
22/10/2018 Conduct and Competence Committee Review Hearing Struck off
11/04/2018 Conduct and Competence Committee Review Hearing Suspended
19/04/2017 Conduct and Competence Committee Review Hearing Suspended
18/04/2016 Conduct and Competence Committee Final Hearing Suspended