Mr Alexander Fawcett

Profession: Physiotherapist

Registration Number: PH105798

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 30/01/2020 End: 13:00 30/01/2020

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Allegations as found proven at the final hearing
 
During the course of your employment as a Physiotherapist at Medway NHS Foundation Trust between 21 January 2015 and 14 September 2015, you:
 
1. Did not complete your probationary period during which there were concerns regarding:
 
a. your note keeping, in that you;
 
i. completed patient notes with illegible handwriting on at least four occasions between March 2015 and May 2015
 
ii. completed patient notes with spelling errors on at least three occasions between March 2015 and May 2015
 
iii. did not structure your patient records according to the ‘whole systems’ approach on more than one occasion between March 2015 and May 2015
 
iv. did not include the patient’s subjective history in the patient’s records on more than one occasion between March 2015 and May 2015
 
v. failed to demonstrate adequate clinical reasoning in the patient records on more than one occasion between March 2015 and May 2015
 
vi. problem lists consistently lacked sufficient detail
 
b. your assessment skills, in that you:
 
i. during your probation period frequently did not complete comprehensive whole systems assessments;
 
ii. on at least two occasions in or around April 2015, stated that two unidentified patients chests were clear, yet on assessment both patients had significant loads of sputum
 
iii. did not link patient history and then adapt your assessment skills accordingly.
 
iv. on 19 and 20 May 2015 failed to auscultate the lower zones of the lungs of Patient 1 on two occasions andPatient 2 on one occasion.
 
c. your use of monitoring during treatment sessions, in that you:
 
i. on an unknown date in April 2015, removed monitoring equipment from an unidentified patient andinstructed the unknown patient to sit at the side of the bed.
 
ii. on an unknown date and in relation to an unidentified patient, took a blood pressure despite the patient being stable for several days;
 
iii. on an unknown date and in relation to an unidentified patient, did not reconnect an HDU patient back to the ECG monitoring equipment.
 
d. your identification of patient problems, in that you;
 
i. on 19 May 2015, failed to identify the circumstances of when a troponin blood test is required in relation to Patient 1
 
ii. on 19 May 2015, failed to identify that Patient 1 had metabolicalkalosis
 
e. your clinical reasoning, in that on 20 May 2015 you used technical terms incorrectly
 
f. your treatment selection, in that you;
 
i. on one or more occasion in or around April and May 2015 did not alter treatment plans according to the patient’s needs
 
ii. did not prepare bed space adequately
 
iii. did not sufficiently frequently provide patients with exercises for their trunk;
 
iv. on 21 April 2015 did not return a patient’s table within reach of an unidentified HDU patient
 
v. on 21 April 2015 left Oxygen cylinders by an unidentified HDU patient’s bed
 
vi. on or around May 2015needed to be prompted regarding the safe placement of a catheter when treating an unknown patient
 
vii. on 19 May 2015 selected an inappropriate treatment for Patient 1
 
g. your communication skills, in that you:
 
i. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient age;
 
ii. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient needs;
 
iii. on more than one occasion between March 2015 and May 2015 raised your voice unnecessarily to patients;
 
iv. [not proven]
 
2. The matters set out in paragraph 1 constitute lack of competence.
 
3. By reason of your lack of competence your fitness to practise is

Finding

Preliminary Matters:

Service of Notice

1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 17 December 2019 sent to the Registrant’s registered address and also to his e-mail address.

Application to proceed in absence

2. Ms Walsh on behalf of the HCPC, made an application to proceed with the hearing in the absence of the Registrant. She referred the Panel to a note of her telephone conversation with the Registrant dated 27 January 2020 when the Registrant stated that he would not be attending the review hearing. On 27 January 2020 Ms Walsh sent an e-mail to the Registrant advising him that if he changed his mind he could participate in the hearing by telephone.

3. 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”.

4. The Panel was satisfied that it was appropriate to proceed in the Registrant’s absence because the Registrant is aware of the hearing and has decided not to attend. This is a mandatory review which must take place before 1 March 2020. The Panel was satisfied that the Registrant has voluntarily absented himself and that it would not be unfair to proceed in his absence.


Background:

5. The Registrant started work as a newly qualified practitioner in January 2015 and the matters identified in the Allegation arose during a period from January 2015 to September 2015. At the time of the Final Hearing the Registrant was undertaking a course in dementia care and working as a Band 3 Therapy support worker.

6. That panel identified that the Registrant’s practice had fallen short in relation to 10 of the 15 Standards of Proficiency for Physiotherapists expected of a practitioner and had made a finding of lack of competence. In the absence of evidence of remediation, that panel found impairment and imposed a period of suspension of twelve months.

7. At a second review of the order on 1 March 2018 the panel saw a number of documents that were produced by the Registrant who attended the hearing by telephone. They included the following:

• A reflective piece on his shortcomings signed by the Registrant and dated 4 February 2018.

• A number of testimonials and references.

• Evidence of recent training.

• Evidence of remediation of his shortcomings.

• Evidence of continued reading and learning.

8. The panel on that review found that Mr Fawcett’s fitness to practise was still impaired but that it was appropriate to replace the order of suspension with a conditions of practice order: The conditions were:

1. At all times during any employment as a Physiotherapist,  you  must place yourself and remain under the supervision  of a workplace physiotherapist supervisor registered by the HCPC and supply details of your supervisor to the HCPC within seven days of the date of your employment.  You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must work with your supervisor  to  formulate  a Personal Development Plan designed to address the concerns raised in the allegations including:

• Note Keeping

• Clinical Assessments, Clinical Reasoning, the identification of patient problems, and Treatment Selection

• Use of monitoring of Patients during treatment sessions

• Communication with Patients and Colleagues

• Caseload and Time Management Skills

• Participation in Feedback

3. Within three months of the date you are employed as a physiotherapist, you must forward a copy of your Personal Development Plan to the HCPC.

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

5. 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.

6. You must provide to the HCPC a report from  your  supervisor no later than seven days before any review of this interim order detailing the progress you have made towards achieving the aims set out in your Personal Development Plan and in relation to compliance with this Interim Order.

7. 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 as a Physiotherapist;

b. any agency you are registered with or apply to be registered with as a Physiotherapist (at the time of application); and

c. any prospective employer of you as a Physiotherapist (at the time of your application).

9. The Registrant did not attend the third Review Hearing on 1 February 2019 and did not submit documentation for the panel. There was no information about the Registrant’s circumstances. The panel on 1 February 2019 decided that the Registrant’s fitness to practise remained impaired and that the appropriate sanction was a Suspension Order for a period of twelve months. The panel considered the option of a Striking Off Order, but decided that it would be disproportionate given that the Registrant had attended the last Review Hearing and demonstrated that he was capable of remediating his clinical failings. The panel decided that a twelve month Suspension Order would give the Registrant the opportunity to apply for voluntary removal from the Register if he chose to do so.

Today’s hearing:

Decision on Impairment

10. Ms Walsh submitted that the Registrant’s fitness to practise remained impaired. She referred the Panel to the documentation recording the correspondence with the Registrant between 26 January 2020 and today’s date. In an e-mail dated 29 January 2020 the Registrant stated that “I would like to withdraw from the register”. Ms Walsh submitted that the Panel should impose either a Striking Off Order or Suspension Order for a period of 4-6 months. She submitted that the Registrant had not taken any pro-active steps, but she acknowledged that the Registrant may not have understood that the proceedings were ongoing and the options which may be available to him.

11. The Panel has considered the HCPTS Practice Note on Article 30 Reviews and accepted the advice of the legal assessor. The information about the Registrant’s current circumstances is that he is working as a therapy assistant in a hospital. He has considered his career path and decided that he does not wish to work in the healthcare area in the long term. He does not wish to practise as a Physiotherapist.

12. The Panel has concluded that Mr Fawcett’s fitness to practise is still impaired. The Registrant’s clinical failings were widespread and basic. There is no evidence that the Registrant has remediated the deficiencies in his practice or that there has been any material change in the circumstances since the last review hearing. Therefore, the Panel concluded that an order is still necessary to protect members of the public, to maintain proper standards   of clinical performance, to maintain public confidence in the profession and in the HCPC as its regulator.

13. The Panel then went on to consider what order if any, is appropriate. It took into account the principles of proportionality balancing the interests of the Registrant with the public interest.

14. The Panel had regard to the HCPTS Indicative Sanctions Policy and approached the available sanctions in ascending order of severity. This Panel is aware that the purpose of sanction is not punitive but to protect members of the public and to safeguard the public interest by maintaining standards within the profession and public confidence in the profession and in its regulatory process.

15. The Panel decided that a Caution Order would be inappropriate because of the nature and gravity of the facts found proved. Such an Order would not sufficiently protect the public or is in the public interest.

16. The Panel next considered a Conditions of Practice Order. The Registrant does not wish to practise as a Physiotherapist and the Panel decided that conditions of practice would not be realistic or workable.

17. The Panel next considered the more serious sanctions of a further Suspension Order or a Striking Off Order. The Panel decided that a Striking Off Order would be disproportionate in all of the circumstances.  A short Suspension Order would be sufficient to protect the public and    would not undermine confidence in the profession and the regulatory process. A short period of suspension of four months would allow time for the Registrant to take proactive steps to make an application for voluntary removal if he choses to do so. A four month period is appropriate because the Panel would expect the Registrant to take those steps in good time, given that he has been given full guidance on the process and this matter was part of the consideration and determination of the previous review panel.

18. The Suspension Order will be reviewed before it expires and at the next review the panel will have all options open to it, including the option of imposing a Striking Off Order.

19. This Panel considers that the panel at the next review hearing is likely to be assisted by any up-to-date information regarding the Registrant’s current circumstances and any employment whether paid or unpaid.

Order

Order: The Registrar is directed suspend the registration of Alexander Fawcett for a period of 4 months on expiry of the existing order.

Notes

This order will be reviewed again before its expiry on 1 July 2020.

Hearing History

History of Hearings for Mr Alexander Fawcett

Date Panel Hearing type Outcomes / Status
26/05/2020 Conduct and Competence Committee Voluntary Removal Agreement Removed
30/01/2020 Conduct and Competence Committee Review Hearing Suspended
01/02/2019 Conduct and Competence Committee Review Hearing Suspended
01/11/2016 Conduct and Competence Committee Final Hearing Suspended