Mr Inderjit Singh Sagar

Profession: Chiropodist / podiatrist

Registration Number: CH13419

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 18/01/2019 End: 12:00 18/01/2019

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

As found proven at the final hearing on 29 January 2018:

 

In March 2011, whilst registered as a Chiropodist, you:

  1. Did not complete an adequate assessment of Patient A prior to undertaking a nail ablation by not:
  1. assessing Patient A's vascular supply;
  2.  obtaining Patient A’s medical history.

 2. Did not complete adequate records in respect of Patient A.

 3. Provided inappropriate treatment to Patient A's right toe nail in that:

  1.  you used phenol for the nail ablation when this was contraindicated for Patient A;
  2. you did not refer Patient A to a GP or vascular consultant for assistance.

 4. Did not obtain informed consent from Patient A prior to undertaking a nail ablation by not:

  1. providing Patient A with a sufficient explanation of the treatment options;
  2. providing Patient A with a sufficient explanation of the risks and benefits of each of the treatment options.

 5. Your actions described in paragraphs 1- 3 amount to misconduct and/or lack of competence.

 

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

 

Finding

Preliminary Matters:

Hearing in Private

1.Ms Mbah made an unopposed application that those parts of the hearing that affected the private life of the Registrant should be heard in private. After receiving advice from the Legal Assessor, the Panel granted this application.

Background

2.The Registrant, the owner of ‘The Chorley Chiropody Practice’, has practised as a sole practitioner as a Registered Chiropodist/Podiatrist for over 20 years. In March and April 2011, the Registrant gave treatment to Patient A that resulted in a complaint made three years later to the HCPC about its poor standard.

3.At a Substantive Hearing that ended on 30 January 2018, a panel of the HCPC’s Conduct and Competence Committee found proved the Particulars that the Registrant had not completed adequate assessments of Patient A’s vascular supply before he undertook a nail ablation. Nor had he adequately obtained Patient A’s medical history. The Panel also found proved that the Registrant had not completed adequate records, had not referred the patient to a GP or Vascular Consultant and had provided inappropriate treatment to Patient A’s right toe nail. The Registrant, it was also found proved, had not obtained informed consent from Patient A before he performed a nail ablation. 4.That panel judged that these failures amounted to misconduct, that the Registrant’s fitness to practise was impaired and that the appropriate sanction to impose was a Conditions of Practice Order for a period of 12 months as set out below:

1. You must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC and supply details of your supervisor to the HCPC within 28 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must promptly inform the HCPC if you cease to be in self-employment or take up any other or further employment.

3. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any employer.

4. 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 (at the time of application); and

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

5. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies identified in this hearing, including:

-vascular assessment and clinical reasoning

-record keeping

-obtaining informed consent

6. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

7. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

8. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

9. You must maintain a record of reflective practice detailing every occasion when you undertake a procedure using local anaesthesia and must provide a copy of that profile to the HCPC on a monthly basis or confirm that there have been no such occasions in that period, the first profile or confirmation to be provided within 2 months of the Operative Date.

10. You must arrange an independent audit of your record-keeping every 4 months to demonstrate progress on remediating the record-keeping deficiencies identified in this hearing and provide details of each audit to the HCPC.

11. You will be responsible for meeting any and all costs associated with complying with these conditions.

12. Any condition requiring you to provide any information to or obtain the approval of the HCPC is to be met by you. You must send the information required to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.

Decision

5.Even though a majority of the imposed conditions have been breached, Ms Mbah suggested to the Panel that it might consider continuing the current order. 6.The Registrant informed the Panel that he would be content to continue to have his registration subject to conditions “if the Panel thinks this is the way forward”. 7. The Registrant provided what was termed a reflection document and a number of testimonials from patients. He also furnished the Panel with copies of up to date patient records but did not provide any of the other documents required by the Conditions of Practice Order.

8.However, he had failed to place himself under the supervision of a work place supervisor (Condition 1). He explained that he had made efforts to contact his professional body to find such a supervisor but they had been in vain. Instead, he had been assisted in his practice by a colleague of his whom he had known for some time and who acted as an unofficial mentor.

9.He told the Panel that, as a sole practitioner, it was difficult not to feel isolated. He said he found solace in working as an escape from stressful issues outside.

10.The Panel listened to both submissions with care and paid due regard to the HCPTS Practice Note ‘Finding that Fitness to Practice is Impaired’. Very little, it seems to the Panel, has changed over the last 12 months and it is evident that the stress in the Registrant’s private life had contributed to his failure to abide by so many of these conditions. The failings identified at the Substantive Hearing were serious ones and the Panel’s view is that neither full insight nor full remediation has been gained. As such, it is plain to the Panel that the Registrant’s fitness to practise remains impaired. Both statutory grounds apply, namely protection and the wider public interest.

11.Although the Panel considered the possibility of imposing an order of suspension, it concluded that, in all the circumstances, the appropriate and proportionate sanction to impose is a continuation of the current order of conditions for a further period of 12 months, albeit in amended form.12. However, the Panel is anxious to stress that the Registrant hereafter should make much greater efforts to abide by the conditions which are to be amended in the following fashion;

1. You must only perform partial or total nail avulsion under local anesthetic whilst under the direct physical supervision of a Chiropodist/Podiatrist registered with the HCPC with a minimum of five years post graduate qualification experience. You must supply details of your supervisor to the HCPC within 28 days of the Operative Date. You must follow the advice and recommendations of this supervisor and provide the HCPC with their feedback before the next review hearing.

2. You must work with a supervisor, who is a Chiropodist/Podiatrist registered with the HCPC with a minimum of five years post graduate qualification experience, who may or may not be your direct clinical supervisor referred to in Condition 1, to formulate a Personal Development Plan designed to address the deficiencies identified in this hearing, including:

-vascular assessment and clinical reasoning

-record keeping

-obtaining informed consent

3. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

4. You must meet with the supervisor referred to in Condition 5 above on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

5. You must allow your supervisor referred to in Condition 2 above to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

6. You must maintain a record of reflective practice detailing every occasion when you undertake a procedure using local anaesthesia and must provide a copy of that profile to the HCPC on a monthly basis or confirm that there have been no such occasions in that period, the first profile or confirmation to be provided within 2 months of the Operative Date.

7. You must arrange an independent audit of your record-keeping every 4 months to demonstrate progress on remediating the record-keeping deficiencies identified in this hearing and provide details of each audit to the HCPC within 14 days of completion.

8. You must promptly inform the HCPC if you cease to be in self-employment or take up any other or further employment.

9. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any employer.

10. 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 (at the time of application); and

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

11. You will be responsible for meeting any and all costs associated with complying with these conditions.

12. Any condition requiring you to provide any information to or obtain the approval of the HCPC is to be met by you. You must send the information required to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.

13. It would assist the Reviewing Panel for the Registrant to provide the following:

1.Reports from the workplace supervisor(s) referred to in Conditions 1 and 5 above evidencing;

i.the extent to which you have demonstrated that you have achieved the aims set out in your Personal Development Plan.ii.that all aspects of nail surgery have been carried out to a satisfactory and competent professional standard

2. Copies of the results of your record-keeping audits.

3. Evidence of reflection which demonstrates tangible assurance of relevant learning embedded in your practice.

Order

ORDER: The Registrar is directed to annotate the Register to show that, for a period of one year from the date that this Order comes into effect (“the Operative Date”), you, Inderjit Singh Sagar, must comply with these conditions of practice.

1. You must only perform partial or total nail avulsion under local anesthetic whilst under the direct physical supervision of a Chiropodist/Podiatrist registered with the HCPC with a minimum of five years post graduate qualification experience. You must supply details of your supervisor to the HCPC within 28 days of the Operative Date. You must follow the advice and recommendations of this supervisor and provide the HCPC with their feedback before the next review hearing.

2. You must work with a supervisor, who is a Chiropodist/Podiatrist registered with the HCPC with a minimum of five years post graduate qualification experience, who may or may not be your direct clinical supervisor referred to in Condition 1, to formulate a Personal Development Plan designed to address the deficiencies identified in this hearing, including:

-vascular assessment and clinical reasoning

-record keeping

-obtaining informed consent

3. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

4. You must meet with the supervisor referred to in Condition 5 above on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

5. You must allow your supervisor referred to in Condition 2 above to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

6. You must maintain a record of reflective practice detailing every occasion when you undertake a procedure using local anaesthesia and must provide a copy of that profile to the HCPC on a monthly basis or confirm that there have been no such occasions in that period, the first profile or confirmation to be provided within 2 months of the Operative Date.

7. You must arrange an independent audit of your record-keeping every 4 months to demonstrate progress on remediating the record-keeping deficiencies identified in this hearing and provide details of each audit to the HCPC within 14 days of completion.

8. You must promptly inform the HCPC if you cease to be in self-employment or take up any other or further employment.

9. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any employer.

10. 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 (at the time of application); and

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

11. You will be responsible for meeting any and all costs associated with complying with these conditions.

12. Any condition requiring you to provide any information to or obtain the approval of the HCPC is to be met by you. You must send the information required to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.

Notes

The order imposed today will apply from the 27 February 2019 (the Operative Date). This order will be reviewed before its expiry.

Hearing History

History of Hearings for Mr Inderjit Singh Sagar

Date Panel Hearing type Outcomes / Status
18/01/2019 Conduct and Competence Committee Review Hearing Conditions of Practice
29/01/2018 Conduct and Competence Committee Final Hearing Conditions of Practice
15/11/2017 Conduct and Competence Committee Final Hearing Adjourned part heard
03/07/2017 Conduct and Competence Committee Final Hearing Adjourned