Mr Salim M Ahmaida Makhlouf
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The following Allegation was considered by a Panel of the Conduct and Competence Committee at the substantive hearing on 19 – 21 March 2018.
During the course of your employment as an Operating Department Practitioner with the York Teaching Hospital NHS Foundation Trust between 25 April 2016 and 17 June 2016:
a) did not take appropriate steps when a patient’s laryngeal mask airway had been lost;
b) did not obtain a pump for an infusion on 13 June 2016;
c) did not provide a reversal drug in a timely manner when this was requested by an anaesthetist on 13 June 2016;
d) did not adequately monitor a patient when working with Colleague X.
2. You demonstrated a lack of clinical knowledge and skills, in that you:
a) did not adequately check an anaesthetic machine on approximately 3 occasions;
b) were unable to do a stocking up list without prompting on what was needed;
c) did not appear to understand the method of keeping a patient asleep, i.e. induction with propofol and maintenance of anaesthesia with gas and inhalation agents;
d) did not list suxamethonium as a required rapid sequence induction and/or an emergency drug when completing competency questions;
e) had to be reminded to label intravenous infusions drips.
3. The matters set out in paragraphs 1 and 2 constitute lack of competence
4. By reason of your lack of competence your fitness to practise is impaired
Service of Notice
1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 12 February 2019 which informed the Registrant of the date, time and venue of the review hearing.
Proceeding in the absence of the Registrant
2. Ms Iskander made an application for the hearing to proceed in the absence of the Registrant.
3. The attention of the Panel was drawn to an email from the Registrant to the HCPC, dated 04 March 2019, in which he stated that he couldn’t attend today’s hearing because he was busy with his studies.
4. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
5. The Panel was satisfied that the Registrant was voluntarily absenting himself from today’s hearing. There was no evidence that there was any application for an adjournment. The Panel determined that it was in the public interest for this mandatory review to proceed in the absence of the Registrant.
6. The Registrant commenced employment as a Band 5 Operating Department Practitioner (ODP) at the York Teaching Hospital NHS Foundation Trust (the Trust) on 25 April 2016. The Registrant had a six week induction period during which he was orientated to the Trust. He was also given a local induction package to complete. During this time he was supernumerary. This was his first ODP job in the UK. He was supported by other ODPs and registered practitioners who provided guidance and orientation when required.
7. On 7 June 2016, the Principal ODP and Team Leader for chronic pain in the Theatres, Anaesthetics and Critical Care Department, carried out a review of the Registrant’s probation. The Registrant’s induction period was extended due to concerns that had been raised by colleagues during this period. In summary there was serious concern about the Registrant’s clinical knowledge and skills and his ability to practise as an autonomous practitioner.
8. The Registrant was asked to answer a set of questions in line with the expected knowledge of a newly qualified ODP to try to ascertain whether he felt under pressure in clinical situations, had difficulty in communicating, or if he simply did not have the required clinical knowledge. The answers that were received raised concerns about the Registrant’s knowledge and skills.
9. At the HCPC substantive hearing on 19 – 21 March 2018 a panel of the Conduct and Competence Committee found the Registrant’s fitness to practise to be impaired and imposed a 12 month Suspension Order.
10. Despite a suggestion made by the previous Panel that the Registrant’s cause today might be assisted by his personal attendance and production, by him, of evidence of steps taken to address his deficiencies, the Registrant informed the HCPC that he was “so busy” with his studies that he could not attend the hearing. He had failed to provide any information about steps taken to improve his clinical knowledge and skills.
Review Hearing (today):
11. Ms Iskander, on behalf of the HCPC, submitted that the fitness to practise of the Registrant remained impaired. All the criticisms of his knowledge and skills made by the last panel remained. There has been no material change. The Panel has no clear information as to what he has been doing since the substantive hearing.
Decision on Impairment:
12. The Panel considered the Registrant’s fitness to practise at today’s date. The Panel applied the guidance in the HCPTS Practice Note “Finding that Fitness to Practise is Impaired” and accepted the advice of the Legal Assessor.
13. The Panel noted the contents of the Registrant’s email of 04 March 2019, in which he stated that he was “busy with my study and… I will do course for back to practice ODP course”.
14. In the absence of any independent evidence of what the Registrant has been studying and intends to study there remains, in the view of the Panel, a significant risk of harm to service users if the Registrant was permitted to return to unrestricted practice. There is no evidence that the Registrant has made any attempts to remedy his serious and wide ranging clinical deficiencies. Bearing this in mind and the need to protect the public and to maintain public confidence in the profession and the regulatory process, in the Panel’s view the Registrant’s fitness to practise remains impaired.
Decision on Sanction:
15. In determining its approach to sanction, the Panel took into account the contents of the HCPC Indicative Sanctions Policy and applied the principles of proportionality.
16. The Panel reminded itself that the purpose of imposing a sanction is not to punish the practitioner, but to protect the public and the wider public interest.
17. The Panel adopted the approach of the previous panel, and shares the view that a conditions of practice order would be inappropriate in this case and that the only appropriate and proportionate sanction in this case would be a further period of suspension for a period of 12 months.
18. The Panel strongly recommends that, at the next review hearing, the Registrant provides full information about what he has done to remediate the significant and wide ranging deficiencies which were identified by the Panel at the substantive hearing. In addition, a reviewing panel would benefit from information about how he has been keeping up with his Continuing Professional Development (CPD). A reviewing panel would also benefit from the Registrant’s attendance at the hearing.
The Registrar is directed to suspend the registration of Mr Salim M Ahmeida Makhlouf from the Register for a further period of 12 months.
The order imposed today will apply from the expiry of the current order on 18 April 2019.
This order will be reviewed again before its expiry.
History of Hearings for Mr Salim M Ahmaida Makhlouf
|Date||Panel||Hearing type||Outcomes / Status|
|14/03/2019||Conduct and Competence Committee||Review Hearing||Suspended|
|19/03/2018||Conduct and Competence Committee||Final Hearing||Suspended|