Mr Marin Stinca
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Allegation
While employed as a Physiotherapist with Great Western Hospital NHS Foundation Trust:
1. Between 26 February 2016 and 16 March 2016, in respect of Patient A, you:
a) found not proved
b) Did not complete and/or record an adequate assessment on 26 February 2016 in that you:
i. Did not record clear clinical reasoning;
ii. found not proved
iii. Did not perform and/or record an adequate assessment of active range of movement and/or muscle strength;
iv) found not proved
v) found not proved
vi) Recorded that the passive range of movement for Patient A's left hip was normal, which was factually incorrect.
c) Did not make a distinction between objective Ax and Rx.
d) found not proved
2. Did not complete and/or record an adequate assessment on 8 March 2016 in respect of Patient B, in that:
a) You recorded the patient's transfer and mobility was back to baseline which was factually incorrect;
b) found not proved
3. On 7 March 2016 in respect of Patient C, you did not complete and/or record an adequate assessment, in that you did not:
a) found not proved
b) Recommend any exercises to strengthen Patient C's knees and/or record why no recommendation for exercises to strengthen Patient C's knees was made;
c) Clearly record which limbs were tested during the assessment.
4. Between 26 February 2016 and 11 March 2016, in respect of Patient D, you:
a) Did not complete any or any adequate record of the assessment on 26 February 2016;
b) Did not record an adequate treatment plan or goal in your assessment recorded on 26 February 2016;
c) Did not make a distinction between objective Ax and Rx in your assessment recorded on 26 February 2016;
d) Did not use clear clinical terminology in your assessment recorded on 11 March 2016;
e) found not proved
f) found not proved.
5. On 18 January 2016, in respect of Patient E, you had to be prompted to loosen the leg straps when placing Patient E in the hoist.
6. On 22 January 2016, in respect of Patient F you:
a) Used advanced instructions at points during the assessment, which were inappropriate given the patient's presentation;
b) Did not ask adequate questions about Patient F's pain;
c) found not proved.
7. The matters set out in paragraphs 1 - 6 constitute misconduct and/or lack of competence.
8. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
Finding
Notice of Hearing
1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 29 April 2019 sent to the Registrant’s registered address which informed him of the date, time, and venue of the hearing.
Proceeding in Absence
2. Ms Ktisti made an application for the hearing to proceed in the absence of the Registrant.
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 Registrant sent an e-mail to the Hearings Team dated 9 May 2019 stating that he planned to attend the hearing. However, there has been no further communication from the Registrant. The Panel considered that the Registrant was aware of the hearing and that his absence was voluntary. The Panel noted that he had not attended the substantive hearing, or the first review hearing and that his engagement with the HCPC has been minimal. The Panel did not consider that the Registrant would attend a hearing at a later date.
5. The Panel considered the Registrant’s interests. The e-mail sent by the Registrant suggested that he was considering attending the hearing. If the Panel was to decide to proceed, the Registrant would continue to have the option to engage with the HCPC. The most restrictive Order available to the Panel would be an extension of the current Suspension Order.
6. The Panel considered the public interest. The hearing was to consider a mandatory review of a Suspension Order, due to expire in approximately one month. The Panel considered that it would not be in the public interest for the Suspension Order to lapse because there would be no protection for the public. It would also be in the public interest for the review to be conducted expediently.
7. The Panel decided that the public interest outweighed the Registrant’s interests and exercised its discretion to proceed in the absence of the Registrant.
Background
8. The Registrant is a physiotherapist registered with the HCPC. He commenced employment with the Great Western NHS Foundation Trust (the Trust) on or around 15 November 2015 as a Band 5 physiotherapist in the Marlborough Community Team. The first six months of his employment contract was a probationary period. For the first three months of the probationary period the Registrant worked on the rehabilitation ward of the Savernake Hospital where he was responsible for assessing and treating a wide variety of patients. In February 2016, the Registrant was transferred to work in the community where he was responsible for assessing and treating patients in their homes.
9. It became apparent that there were concerns in respect of the Registrant’s clinical practice in the Community Team. In an attempt to find a placement where he could be more effective, the Registrant was transferred to the Musculo Skeletal Out-Patient Department at Salisbury Hospital. This placement lasted for two days due to concerns about the Registrant’s practice. Supervising staff at Salisbury Hospital wanted the Registrant to return to Savenake Hospital, but the Registrant handed in his notice and left immediately.
10. The Registrant did not attend the previous substantive hearing and that panel referred to his “minimal” engagement with the proceedings and noted that there was no indication the Registrant had reflected on his clinical deficiencies in “any meaningful way”, or that he had any sense of the potential impact these deficiencies might have on patients. As there was no evidence before that panel that the Registrant had taken steps to remedy the clinical deficiencies, or brought his knowledge and skills up to date, it concluded there was a serious and ongoing risk of repetition. That panel was also satisfied that where a registrant was unable to work as an autonomous practitioner with vulnerable patients, a finding of impairment was in the public interest to uphold professional standards, and to safeguard public confidence in the profession and in its regulatory body. Having decided that the Registrant’s fitness to practise was impaired, the substantive hearing panel imposed a six month Suspension Order.
11. The Suspension Order was reviewed by a review panel on 29 May 2018. The Registrant did not attend that hearing or provide any information for the review panel. The Registrant had not, at that time, engaged with the HCPC since his early “minimal” contact. The review panel took the view that the Registrant’s lack of competence was potentially capable of being remedied, but that the Registrant’s continuing lack of engagement left it in no doubt that the risk of repetition was high and that there remained a real risk of harm to patients. The review panel decided that the appropriate and proportionate order was a Suspension Order for twelve months.
12. The Review Panel considered that a future reviewing panel might be assisted by evidence from the Registrant of up to date physiotherapy specific skills and knowledge such as:
• Short course (online or otherwise)
• Seminars
• Reading journals
• Volunteering or work shadowing or substantive employment as a healthcare assistant
• Testimonials from individuals able to comment on the Registrant’s skills and knowledge relevant to a physiotherapy role
• A reflective statement on skills and knowledge that the Registrant has acquired
Decision
13. Ms Ktisti submitted that the Registrant’s fitness to practise remained impaired and that the appropriate Order was to extend the current Suspension Order.
14. The Registrant did not provide any written submission or documents for the review hearing.
15. The Panel accepted the advice of the Legal Assessor. It had regard to the HCPTS Practice Note “Finding that Fitness to Practise is Impaired”.
16. The Panel considered that there had been no change in circumstances since the last review hearing. There was no evidence that the Registrant had taken any remedial action or that his level of insight had changed. There was no evidence that he had considered or addressed any of the suggestions made by the first review panel.
17. In these circumstances, the Panel was unable to conclude that the Registrant has developed insight or that he has taken any steps to remedy his lack of competence. The Panel noted that the competency matters related to the fundamental skills of a physiotherapist such as treatment planning, clinical reasoning, and recording of information. The risk of repetition is unchanged and therefore there remains a real risk of harm to patients.
18. The Panel considered that informed members of the public would be concerned about the ongoing risk of repetition, the lack of evidence of remediation and insight. The Panel decided that a finding of impairment is required to maintain confidence in the profession and the regulatory process.
19. The Panel considered the available sanctions in ascending order of seriousness in order to determine the appropriate sanction.
20. The Panel decided that the option of taking no action or a Caution Order would not be sufficient to protect the public. These options would permit the Registrant to practise as a physiotherapist without ongoing monitoring and therefore would not manage the risks in this case.
21. The Panel next considered the option of a Conditions of Practice Order. The Panel decided that conditions were not sufficient or appropriate. The Registrant has not engaged with the HCPC and has not demonstrated any insight. The Panel did not have sufficient confidence that the Registrant would comply with a Conditions of Practice Order.
22. The Panel therefore concluded that the appropriate and proportionate Order is a Suspension Order for a period of twelve months. The Panel decided that the maximum period for a Suspension Order was appropriate to give the Registrant time to reflect on his options and to decide whether he wishes to engage with the HCPC. If he decides to engage, the Panel considered that twelve months provided sufficient time for him to develop insight and take remedial action. The Registrant may apply for an early review if he wishes to present new evidence to a Panel. The Panel noted that at the next mandatory review hearing, once the Registrant has been continually suspended for more two years, that panel will have all options available to it, including the option of a Striking Off Order.
23. The Panel considered that the next reviewing Panel might be assisted by the same information as suggested by the panel at the substantive hearing:
24. Evidence of up to date physiotherapy specific skills and knowledge such as:
• Short course (online or otherwise)
• Seminars
• Reading journals
• Volunteering or work shadowing or substantive employment as a healthcare assistant
• Testimonials from individuals able to comment on the Registrant’s skills and knowledge relevant to a physiotherapy role
• A reflective statement on skills and knowledge that the Registrant has acquired
Order
Order: the Registrant is directed to suspend the registration of Mr Marin Stinca for a further period of 12 months on the expiry of the existing order.
Notes
No notes available
Hearing History
History of Hearings for Mr Marin Stinca
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 19/05/2020 | Conduct and Competence Committee | Review Hearing | Struck off |
| 28/05/2019 | Conduct and Competence Committee | Review Hearing | Suspended |