Miss Lois K Appleton
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As found proven at the final hearing on 23 July 2018:
During the course of your employment as a registered Physiotherapist with Western Sussex Hospitals NHS Foundation Trust:
- On or around 16 March 2016, while attending to Patient F, you:
a) did not check the amount of oxygen and flow rate being delivered via the Optiflow
b) did not take the respiratory rate during the assessment
c) relied on the doctor’s documentation of oxygen saturation, flow rate and respiratory rate
d) did not review the patient's bloods
e) were unable to identify indicators of renal failure/impairment
2. On or around 7 April 2016, while attending to Patient L, you did not know the normal/safe range for a troponin test result.
3.On or around 8 April 2016, while attending to Patient J, you did not know the normal/safe range for a troponin test result.
4.On or around 23 April 2016, while attending to Patient A, you:
a) did not check, and/or or take account of, Patient A's x-rays or blood test results
b) suggested an unsafe assessment
c) required intervention from a colleague to prevent an unsafe assessment being carried out
5. On or around 27 April 2016, while attending to Patient I, until prompted to do so, you did not:
a) prepare the area
b) source appropriate footwear
c) clear clutter from the chair
d) sit the patient out of bed
e) check the height of the chair
6. On or around 28 April 2016 assessed a new patient (Patient N) without a senior member of staff being present.
7. On or around 29 April 2016, you attended an unknown patient (Patient M) and did not:
a) calculate the patient’s respiratory rate
b) identify the patient's normal respiratory function
c) identify the patient's normal sputum production
d) identify that the patient had a Glyceryl Trinitrate [GTN] infusion/pump attached
8. On or around 29 April 2016, you attend Patient C and did not identify that intermittent positive-pressure breathing [IPPB] was contraindicated due to a very low blood pressure and pulmonary fibrosis.
9. On or around 6 May 2016, while attending to Patient H, you did not:
a) enquire about past falls
b) obtain a handover from the nursing team
c) check the patient's mobility aid, which they brought from home, for safety
d) assess a Timed Unsupported Steady Stand [TUSS] prior to mobilising
e) establish if the patient needed support whilst mobilising
f) initiate any action in response to the oxygen saturation probe alarm
10. On or around 8 April 2016, while attending to Patient E, you:
a) did not identify that Patient E's oxygen was not turned on at the wall
b) did not assess Patient E's:
i) respiratory rate
ii) oxygen saturation
iii) fraction of inspired oxygen
c) were unable to identify Patient E's target oxygen saturation
11.On or around 9 May 2017, while attending to Patient G, you
a) did not handover the assessment to the nursing team
b) did not document the safety recommendations which were discussed
12. On or around 13 May 2016, while attending to Patient B, did not:
a) identify that a stand aid or rota stand was needed to mobilise a patient
b) use the stand aid safely
13. On or around 27 May, while attending to Patient D, you did not calculate the:
a) respiratory rate
b) oxygen saturation
c) associated oxygen delivery
14. The matters set out in paragraphs 1 - 13 constitute lack of competence.
15. By reason of your lack of competence your fitness to practise is impaired.
Notice of Hearing
1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 19 June 2019 sent to the Registrant’s registered address which informed the Registrant of the date, time and venue of the hearing.
Hearing in the absence of the Registrant
2. Ms Senior made an application for the hearing to proceed in the absence of the Registrant. She referred the Panel to an e-mail from the Registrant dated 20 December 2017 which was sent prior to the substantive hearing. This e-mail stated that the Registrant would not be attending the hearing and she explained her reasons for this decision, including that she had no intention of practising as a Physiotherapist as she was pursuing another career.
3. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
4. The Panel decided to exercise its discretion to proceed in the absence of the Registrant. There has been no information from the Registrant to suggest that her position has changed since December 2017 and she has not made an application for an adjournment of the hearing. The Panel therefore considered that the Registrant has waived her right to attend the hearing and that an adjournment would not secure her attendance. The current Suspension Order is due to expire on 22 August 2019 and it is in the public interest that the review is conducted expeditiously. The Panel therefore decided that the public interest outweighed the Registrant’s interests.
5. The Registrant commenced employment as a Band 6 Physiotherapist within the Acute Admissions and Private Patients Team at St Richards Hospital NHS Foundation Trust in August 2015, having previously been employed as a Bank Band 5 Physiotherapist and then appointed to a permanent Band 5 at another NHS Trust. In around October 2015 concerns were raised about the Registrant’s practice. The informal stage of the Trust’s capability process was implemented from 13 November 2015. As part of this process, the Registrant spent four weeks working full-time in the respiratory team to improve her skills in this area. A decision was taken to progress to the formal capability process and a Final Stage Capability hearing was held on 11 July 2016. As a result of patient safety concerns, toward the latter stage of the Trust’s capability process all of the Registrant’s clinical work was supervised by a Senior Physiotherapist.
6. The HCPC Allegation, which related to the incidents which arose during the period of the Registrant’s supervised practice, was considered by a substantive hearing Panel on 23-25 July 2018. The Registrant had informed the HCPC that she would not attend the hearing and she did not do so. The Panel found all the facts proved and that they constituted a lack of competence. In its decision on impairment the substantive hearing Panel explained that although the Registrant engaged fully with the capability process, she did not appear to have any insight into her failings or to understand the seriousness of them with regard to patient safety. There was also no evidence of remediation. The substantive hearing Panel was of the view that the Registrant had repeatedly demonstrated wide-ranging failings in basic physiotherapy skills relevant to her role. In the absence of remediation there was a real risk of repetition. That panel found impairment also on the public interest limb in that they concluded that there was a serious risk of an adverse impact on public confidence in the profession and in the regulatory process if a finding of impairment was not made in the circumstances.
7. The substantive hearing Panel decided that the appropriate and proportionate sanction was a Suspension Order to address issues of public protection and the wider public interest considerations. The Panel suggested that a future review Panel might be assisted by evidence from the Registrant of relevant continuing education and professional development, relevant work experience and references from any employers, and evidence that the Registrant wishes to continue to work as a physiotherapist.
8. Ms Senior submitted that the Registrant’s fitness to practise remained impaired in circumstances where there was no evidence of any change in circumstances since the substantive hearing and in particular no evidence of the development of insight or remediation. She submitted that the Panel might consider that the continuation of the current Suspension Order was appropriate and proportionate.
9. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Notes “Finding that Fitness to Practise is Impaired”, “Review of Article 30 Sanction Orders” and the Indicative Sanctions Guidance (July 2019).
10. The Registrant’s last engagement with the HCPC was her e-mail dated 20 December 2017. There is no new information and nothing to persuade the Panel that the wide-ranging concerns identified by the substantive hearing Panel have been addressed. There is no evidence of a change in the level of the Registrant’s insight or any remedial steps. In these circumstances the Panel decided that there remains a real risk of repetition and an ongoing risk to the public. The wider public interest is very much engaged, given the nature of the Registrant’s failings and the absence of any evidence that the concerns have been addressed.
11. The Panel therefore decided that the Registrant’s fitness to practise remains impaired.
12. The Panel next considered the appropriate sanction. It noted the guidance in the HCPC Indicative Sanctions guidance on serious cases and considered that there were some serious aspects within the findings made by the substantive hearing Panel including a failure to work in partnership (attending two patients without a qualified senior physiotherapist, having been instructed not to do so) and not raising concerns.
13. The Panel considered the Registrant’s interests and noted the only available information is her e-mail dated 20 December 2017 which stated that she does not intent to practise as a physiotherapist.
14. The Panel considered the sanctions available to it in ascending order of severity. The Panel considered that the option of taking no action or imposing a Caution Order would not be appropriate given that there remains a risk of repetition and an ongoing risk to members of the public.
15. The Panel considered a Conditions of Practice Order, but decided that the concerns identified could not currently be addressed or managed by conditions. Conditions would also not be the appropriate order where the Registrant’s last stated position is that she does not intend to practise as a physiotherapist. There is no information to suggest that the Registrant has changed her mind and is now committed to resolving her deficiencies in her practice identified by the substantive hearing Panel.
16. The Panel next considered an extension of the current Suspension Order which is the most serious sanction available to the Panel. The Panel decided that a Suspension Order would be an appropriate and proportionate sanction to address public protection and the wider public interest considerations.
17. The Panel considered the appropriate length of time for the Suspension Order. The Panel’s view was that if the Registrant changed her mind and decided to engage with the fitness to practise process she would need a considerable period of time to address the matters and to prepare evidence for a reviewing panel. The Panel therefore decided that the appropriate length of the Suspension Order is a further period of twelve months.
18. This Order will be reviewed prior to its expiry. It may assist a future Panel if the Registrant were to engage with the HCPC and attend a future hearing. In addition a future Panel may also be assisted with the following:-
• Evidence of relevant continuing education and professional development;
• Evidence of relevant work experience and references from any employers;
• Evidence that the Registrant now wishes to continue to work as a physiotherapist.
The Registrar is directed to suspend the registration of Miss Lois K Appleton for a period of 12 months from the date the current order expires.
This Order will be reviewed again before its expiry on 22 August 2020.