Mrs Virginia Saavedra

Profession: Physiotherapist

Registration Number: PH48464

Hearing Type: Voluntary Removal Agreement

Date and Time of hearing: 10:00 01/04/2020 End: 17:00 01/04/2020

Location: This hearing was held remotely on papers

Panel: Conduct and Competence Committee
Outcome: Voluntary Removal agreed

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation


1. On or around 09 March 2017, regarding Patient D, you did not:

a) Complete and/or record an objective assessment of strength and/or balance
b) record a problem list and/or list of goals
c) record clinical reasoning behind subjective / objective assessments or treatment planning
d) document sufficient detail about:

i. mobility deterioration
ii. Mobility improvement
iii. Unsteady gait.

e) record how the walking distances were measured

2. On or around 19 January 2017 regarding Patient C you did not:

a. undertake an assessment of his seating position
b. assess the effect of a T-Roll on his pelvis
c. provide guidance to support staff and/or seek feedback from them
d. record written instructions in the patient’s electronic record

3. On or around 16 March 2017, during a follow up session with Patient D, you did not:

a. measure the walking stick
b. show the support worker how to measure the walking stick
c. provide the support worker with any information on safety checking the walking stick
d. measure strength or balance
e. make a list of problems or goals
f. explain and/or record your clinical reasoning behind home exercise programme
g. record clinical reasoning for strength improving exercises

4. On or around 10 October 2016, regarding Patient E, you did not complete and/or record a subjective assessment.

5. On or around June 2015, in relation to Patient F you did not record;


a. a subjective and/or objective assessment
b. a handover from the Children’s Physiotherapy Service
c. clinical reasoning regarding the patient’s presentation and/or diagnosis
d. a clear physiotherapy plan

6. Between 21 March 2016 and 25 November 2016 you did not complete and/or record an adequate assessment of Patient H in that you did not:

a. take and/or record sufficient measurements for the seating
b. record any consideration of the patient’s leaning to the left and/or whether extra head support was required
c. record any discussion with the speech and language therapist about the patient’s dysphasia
d. ensure that the patient was provided with an appropriate chair
e. undertake and/or record a follow up review of the patient’s armchair

7. Between 1 November 2016 and 10 February 2017, in relation to Patient I, you did not:

a. undertake and/or record adequate assessment of:
i. mobility
ii. risk of falls
b. complete and/or record a risk assessment
c. assess whether the equipment provided to Patient I was appropriate

8. Between 8 February and 22 February 2016, in relation to Patient J, you did not:

a. undertake and/or record an adequate assessment, including a falls risk assessment
b. offer and/or record any advice to Patient J and/or her Care Home in relation to falls

9. Between 23 October 2015 and 5 January 2017, in relation to Patient K, you did not:

a. complete and/or record an adequate assessment
b. complete a reassessment of her new wheelchair

10. In relation to Patient L:

a. Between 10 September 2015 and 17 November 2015 you did not:

i. complete and/or record an adequate assessment
ii. complete and/or record a follow up call following your discussion with Patient L’s daughter on 22 October 2015

b. Between 13 October 2016 and 10 November 2016 you did not complete and/or record a reassessment following provision of a wheelchair

11. Between 20 April 2016 and 26 May 2016, in relation to Patient M, you did not complete and/or record an adequate assessment in that you did not complete and/or record:

a. the clinical reasoning behind the recommended exercise programme

b. a treatment plan

c. follow up in relation to whether the exercises were being properly carried out and/or whether they had been effective

12. Between 2 October 2015 and 17 May 2016, in relation to Patient N, you did not:

a. establish and/or record the aim of hydrotherapy sessions

b. conduct and/or record a re-assessment of the patient’s needs in relation to hydrotherapy sessions

c. review and/or record Patient’s N/s progression following hydrotherapy sessions

d. record a management plan to discharge Patient N

e. appropriately document the GP’s decision regarding Patient N’s drooping face on or around 16 February 2016 and/or follow up with regards to the patient’s condition

13. The matters set out in paragraphs 1 - 2 constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matters

Skeleton Argument

1. For the purposes of this hearing, the HCPC has submitted and the Panel has read a Skeleton Argument, signed by Ms Louisa Simpson and dated 24 March 2020. [the Skeleton Argument]

Service

2. The Panel was aware that written notice of these proceedings was posted by first class post to the Registrant at her registered address on 17 January 2020.  The notice was also sent by email on the same date. The Panel was shown documents which established both the fact of the service and the identity of the Registrant’s registered address and of her email address. In these circumstances the Panel accepted that proper service of the notice had been effected in accordance with the rules.

Proceeding in absence of the Registrant

3. By a written notice dated 26 March 2020, a copy of which was sent to the Registrant’s registered address, the HCPC informed the Registrant, that because of the Covid -19 outbreak and following recent advice from the Government in relation to the Covid -19 outbreak, the hearing of the Registrant’s application to remove her name from the register would proceed on the papers only and without the need for the Registrant or her representative attending. The Registrant was also so informed by email. As a result of the advice received from the Government in relation to the Covid -19 outbreak, the HCPC has determined to stop all public hearings.

4. The Panel heard and accepted the advice of the Legal Assessor.

5. Whilst the Panel is aware that a decision to proceed in the absence of the Registrant is one to be taken with great care and caution, the Panel has decided to proceed in the absence of the Registrant. The reasons are as follows:
• Service of the appropriate notice of this hearing has been properly effected.
• The Registrant has been informed of the HCPC’s intention that the hearing of this application will be conducted on the papers alone.
• The Registrant has not applied for an adjournment or sought to object to this hearing proceeding in her absence or on the papers alone. 
• This is a hearing of the Registrant’s own application for Voluntary Removal from the Register and it is one to which the HCPC consents.
• The procedure being adopted is compliant with the advice given by the Government and is in accord with a policy decision taken by the HCPC not to hold public hearings.
• To proceed on the papers alone will, if the application is approved, ensure that this matter is resolved expeditiously. To do so, in such circumstances, will cause no unfair prejudice to the Registrant and will ensure that the public is protected and the public interest sustained. 

Background as summarised from the Skeleton Argument.

6. The Registrant is a registered Physiotherapist. On 25 May 2017, Bristol Community Health referred the Registrant to the HCPC following competency concerns. They provided records of additional supervision which was provided to the Registrant, and documented the need for a supervisor to intervene and take over treatment on several occasions. They also provided patient records, to cross-reference the concerns highlighted in supervision, incident reporting and feedback records. They also reviewed a sample of case notes which, in their opinion, demonstrated an unacceptably low standard of professional performance in assessment, clinical reasoning and appropriate treatment.
  
7. On 13 September 2018, a Panel of the Investigating Committee determined that there was a case to answer in respect of the original allegation made against the Registrant by Bristol Community Health.

8. The HCPC then instructed solicitors to further investigate the concerns, and prepare the matter for final hearing. In the course of that investigation it was determined that the allegations should be amended, in order to clarify the concerns and better reflect the evidence. The matter was remitted to the Investigating Committee Panel, who considered it on 13 November 2019, and determined there was a case to answer in respect of the following allegation:

1) On or around 09 March 2017, regarding Patient D, you did not:

a) Complete and/or record an objective assessment of strength and/or balance
b) record a problem list and/or list of goals
c) record clinical reasoning behind subjective / objective assessments or treatment planning
d) document sufficient detail about:
i. mobility deterioration
ii. Mobility improvement
iii. Unsteady gait.
e) record how the walking distances were measured

2) On or around 19 January 2017 regarding Patient C you did not:

a) undertake an assessment of his seating position
b) assess the effect of a T-Roll on his pelvis
c) provide guidance to support staff and/or seek feedback from them
d) record written instructions in the patient’s electronic record

3) On or around 16 March 2017, during a follow up session with Patient D, you did not:

a) measure the walking stick
b) show the support worker how to measure the walking stick
c) provide the support worker with any information on safety checking the walking stick
d) measure strength or balance
e) make a list of problems or goals
f) explain and/or record your clinical reasoning behind home exercise programme
g) record clinical reasoning for strength improving exercises

4) On or around 10 October 2016, regarding Patient E, you did not complete and/or record a subjective assessment.

5) On or around June 2015, in relation to Patient F you did not record;

a) a subjective and/or objective assessment
b) a handover from the Children’s Physiotherapy Service
c) clinical reasoning regarding the patient’s presentation and/or diagnosis
d) a clear physiotherapy plan

6) Between 21 March 2016 and 25 November 2016 you did not complete and/or record an adequate assessment of Patient H in that you did not:

a) take and/or record sufficient measurements for the seating
b) record any consideration of the patient’s leaning to the left and/or whether extra head support was required
c) record any discussion with the speech and language therapist about the patient’s dysphasia
d) ensure that the patient was provided with an appropriate chair
e) undertake and/or record a follow up review of the patient’s armchair

7) Between 1 November 2016 and 10 February 2017, in relation to Patient I, you did not:

a) undertake and/or record adequate assessment of:
i. mobility
ii. risk of falls
b) complete and/or record a risk assessment
c) assess whether the equipment provided to Patient I was appropriate

8) Between 8 February and 22 February 2016, in relation to Patient J, you did not:

a) undertake and/or record an adequate assessment, including a falls risk assessment
b) offer and/or record any advice to Patient J and/or her Care Home in relation to falls

9) Between 23 October 2015 and 5 January 2017, in relation to Patient K, you did not:

a) complete and/or record an adequate assessment
b) complete a reassessment of her new wheelchair

10) In relation to Patient L:

a) Between 10 September 2015 and 17 November 2015 you did not:
i. complete and/or record an adequate assessment
ii. complete and/or record a follow up call following your discussion with Patient L’s daughter on 22 October 2015
b) Between 13 October 2016 and 10 November 2016 you did not complete and/or record a reassessment following provision of a wheelchair

11) Between 20 April 2016 and 26 May 2016, in relation to Patient M, you did not complete and/or record an adequate assessment in that you did not complete and/or record:

a) the clinical reasoning behind the recommended exercise programme
b) a treatment plan
c) follow up in relation to whether the exercises were being properly carried out and/or whether they had been effective

12) Between 2 October 2015 and 17 May 2016, in relation to Patient N, you did not:

a) establish and/or record the aim of hydrotherapy sessions
b) conduct and/or record a re-assessment of the patient’s needs in relation to hydrotherapy sessions
c) review and/or record Patient’s N/s progression following hydrotherapy sessions
d) record a management plan to discharge Patient N
e) appropriately document the GP’s decision regarding Patient N’s drooping face on or around 16 February 2016 and/or follow up with regards to the patient’s condition

13) The matters set out in paragraphs 1 - 2 constitute misconduct and/or lack of competence.

14) By reason your misconduct and/ or lack of competence your fitness to practise is impaired

Correspondence between the HCPC and the Registrant.

9. The Registrant sent a response to the Investigating Committee via her Representative by way of an email dated 3 October 2019. In this response the Registrant’s Representative stated that the Registrant “is not practising as a physiotherapist and does not intend to practise as a physiotherapist in the future. She is not required to be registered with the HCPC for her current role”.

10. Following notification that the Investigating Panel had determined that there was a Case to Answer, the Registrant’s representative wrote again on 3 December 2019 and stated “I am instructed to ask if the HCPC would be prepared to dispose of this matter by way of consent ….the Registrant accepts all of the factual allegations. She also accepts that the factual matters constitute misconduct and /or lack of competence and that her fitness to practise is impaired. The Registrant is no longer practising as a physiotherapist and does not intend to practise again”.

11. Following this correspondence, the HCPC reviewed the case and considered the circumstances suitable for disposal by way of a Voluntary Removal Agreement. This was because the Registrant did not wish to return to practice, admitted to the allegations in full, and the concerns did not raise matters of such seriousness or nature that they would require determination at a final hearing.

12. The HCPC therefore wrote to both the Registrant and her Representative on 4 December 2019. The Registrant and the Representative were provided with information on the process of disposal by consent, including the Practice Note. She was advised that voluntary removal agreements have the same effect as a striking off order. In the light of the full information the Registrant was asked to confirm her position and intentions in respect of the voluntary removal of her name from the register.

13. The Registrant responded, via her Representative, on 06 December 2019. He confirmed again, that the Registrant accepts all of the allegations, now works in sales and no longer wishes to practise as a physiotherapist. He also confirmed that the Registrant has read and understood the HCPC’s email of 04 December 2019, as well as the Practice Note, and would like to enter into a Voluntary Removal Agreement with the HCPC.

14. The Registrant subsequently signed and returned the Voluntary Removal Agreement, thereby accepting that her current fitness to practise is impaired and confirming that she has no intention of returning to practice.

Submissions by the HCPC as set out in the Skeleton Argument

15. The HCPC submits that, in all the circumstances, voluntary removal from the Register would be an appropriate means of resolving the current matter.

16. Given that voluntary removal is equivalent in effect to a strike-off, the HCPC submits that the necessary public protection would be ensured by this course of action. The HCPC also submits that it would not be detrimental to the wider public interest to dispose of this matter by way of voluntary removal. It is submitted that this case does not raise concerns in regards to the wider public interest to such an extent that the matter must be disposed of at a final hearing.

17. The HCPC reiterates that the Registrant has admitted the substance of the allegations and that voluntary removal from the register will have the same effect as a strike-off. It is submitted that these factors are sufficient to maintain public confidence in the profession and to declare and uphold proper standards of behaviour.

18. It is therefore submitted that the Voluntary Removal Agreement is an appropriate and expeditious way of dealing with this matter and the HCPC respectfully invites the Panel to approve the proposed agreement.

Decision of the Panel

19. The Panel has considered the submissions of the HCPC as set out in the Skeleton Argument. The Panel has further considered all the documents that have been produced by the HCPC.

20. The Panel has read the proposed VRA, the other documents relevant to the VRA and all the communications from the Registrant’s Representative which are identified above. 

21. The Panel heard and accepted the advice of the Legal Assessor.

22. In deciding whether or not to approve the agreement for Voluntary Removal the Panel has had regard to the Practice Note published by the HCPTS in March 2018 and entitled Disposal of Cases by Consent.

23. The Panel has concluded that the VRA should be approved and that an order should be made in the terms set out below. Its reasons are as follows;

• The Registrant has admitted the Allegation in full and did so soon after the Investigating Committee determined that she had a case to answer in respect of the Allegation detailed above. She has also admitted that her fitness to practise is thereby impaired.
• The public will be adequately protected by the voluntary removal of the Registrant’s name from the register, which will have the same effect as if she had been struck off.
• There are no reasons of a public interest kind to require a hearing of the Allegation.  

24. For all the reasons that are set out above, the Panel has determined to approve the outcome sought in the VRA with immediate effect: In particular the Panel agrees that the HCPC should be permitted to withdraw the Allegation and that the Registrant shall voluntarily remove her name from the Register with effect from today’s date.

Order

That the HCPC may withdraw the allegation set out above and Mrs Virginia Saavedra is permitted to remove her name from the HCPC Register, with immediate effect and on the terms set out in the VRA.

Notes

No notes available

Hearing History

History of Hearings for Mrs Virginia Saavedra

Date Panel Hearing type Outcomes / Status
01/04/2020 Conduct and Competence Committee Voluntary Removal Agreement Voluntary Removal agreed