Mr Santhakumar Senthilvelu

Profession: Physiotherapist

Registration Number: PH98516

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 29/01/2020 End: 17:00 31/01/2020

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

During the course of your employment as a registered Physiotherapist at Southend University Hospital, you:

1. Did not undertake and/or record a full subjective assessment in that:

a) on or around 11 November 2016 while attending to Patient 1 you did not ask relevant questions in relation to his groin pain;

b) on or around 11 November 2016 while attending to Patient 4 you did not obtain relevant information relating to leisure activities, duration of pain, aggravating and/or relieving factors;

c) on or around 16 November 2016 while attending to Patient 1a you did not discuss and/or check the patient’s home exercise programme;

d) on or around 16 November 2016 while attending to Patient 2a you did not ask follow up questions when Patient 2a’s mother mentioned Patient 2a was awaiting an appointment at hospital and was unable to return to sports due to other issues;

e) on or around 16 November 2016 while attending to Patient 4a you did not ask questions including the location of the patient’s pain after he disclosed that he experienced pain in his legs following activity;

f) on or around 9 December 2016 while attending to Patient 6 you did not take a full medical history.

2. Did not give appropriate advice in that:

a) on or around 11 November 2016 while attending to Patient 4 you did not sufficiently address the patient’s pain in your follow up advice;

b) on or around 9 December 2016 while attending to Patient 6 you advised the parents that Patient 6 should sleep in a supported sidelying position when this was unsafe;

c) on or around 2 December 2016 while attending to Patient 7 you advised that they could resume normal activities when this was unsafe;

d) on or around 11 November 2016 while attending to Patient 1 you advised him to return to swimming without conducting a full examination to assess whether this would be appropriate.

3. Did not demonstrate safe and/or effective practice in that:

a) on or around 16 November 2016 while assessing Patient 1a you did not ask Patient 1a to remove their tights.

b) on or around 16 November 2016 while attending to Patient 2a you advised a return to sport without checking whether there were other medical reasons that may have prevented this; and/or

c) on or around 25 January 2017 while attending to Patient 8 you:

i. incorrectly concluded there was full muscle strength in the lower limbs;

ii. did not demonstrate your clinical reasoning in relation to the assessment and/or advice provided;

4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:

a) on or around 11 November 2016 while attending to Patient 1:

i. you did not assess the groin area; and or

ii. assess and/or adequately assess the patient’s hip; and/or

iii. conduct hypermobility testing and/or apply the Beighton scoring system to assign Patient 1 with a hypermobility score.

b) on or around 11 November 2016 while attending to Patient 2 you did not assess their eye-hand coordination;

c) on or around 16 November 2016 while attending to Patient 2a you:

i. did not assess the patient’s right knee and/or muscle strength around the right knee;

ii. did not assess tracking and/or movement of the right patella;

d) on or around 11 November 2016 while attending to Patient 4 you did not:

i. fully test shoulder stability;

ii. test hand writing;

iii. test range of movement of the elbow and/or wrist and/or shoulder.

e) on or around 16 November 2016 while attending to Patient 1a you did not block the contralateral side of the patient’s leg when assessing the hamstring muscles;

f) on or around 16 November 2016 while attending to Patient 4a you did not:

i. complete a thorough assessment for the management of lower limb hypermobility;

ii. assess muscle strength in the lower limbs;

iii. assess calf length;

g) on or around 25 January 2017 while attending to Patient 8 you did not:

i. assess strength of the ankles in standing;

ii. test pelvic stability until prompted to do so;

iii. examine strength of the quadriceps muscle;

5. Did not implement appropriate monitoring procedures in that on or around 09 November 2016 while attending to Patient 3a you arranged a review appointment on/around 16 November 2016, when this was not clinically justified;

6. In relation to setting goals:

a) on or around 21 July 2016 you did not set and/or record any SMART goals for Patient 2;

b) on or around 11 November 2016 while attending to Patient 2 you did not set and/or record any SMART goals;

c) on or around 25 January 2017 while attending to Patient 8 you set goals which were not SMART goals and/or not related to function.

7. In respect of Patient 2 you did not record the recommended exercise programme and/or did not adequately discuss this with Patient 2 during the appointment on 11 November 2016.

8. Did not maintain appropriate records in that:

a) You recorded an incorrect pain score within Patient 4’s clinical notes dated 11 November 2016;

b) in respect of the assessment on or around 22 September 2016 in respect of Patient 5 you:

i. did not record the reason for arranging a review appointment;

ii. did not record the recommended exercise programme.

c) on or around 16 November 2016 while attending to Patient 2a you recorded improved muscle strength when this had not been assessed;

d) in respect of your appointment on or around 16 November 2016 with Patient 3a you recorded calf muscle bulk as ‘improving’ when you did not have a measure from a previous assessment to compare and/or you did not record the measurement of calf muscle bulk on this date;

e) on or around 25 January 2017 while attending to Patient 8 you did not record calf length.

f) you recorded that Patient 2 had completed exercises during thappointment on or around 11 November 2016 including throwing and catching and/or standing and/or bridging, when they had not.

9. On or around 1 November 2016 you denied the existence of a folder which contained incomplete patient records.

10. In or around October and/or November 2016, you had not completed within 24 hours one or more patient records.

11. In or around November 2016 you insecurely stored patient records.

12. You subsequently filed the records found on 9 November 2016 without showing them to management beforehand contrary to a specific instruction from your manager.

13. Your actions described in paragraph 8c, 8f, 9, 11 and/or 12 were dishonest.

14. The matters set out in paragraphs 9, 10, 11, 12 and/or 13 constitute misconduct.

15. The matters set out in paragraphs 1- 8 constitute misconduct and/or lack of competence.

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

Finding

Preliminary matters
Additional material
1. At the start of the hearing the Panel was provided with an additional bundle of documents by Ms Sleeman.

2. The Panel labelled the second bundle of documents provided as R1. R1 contained the following documents:
i. Presentation handout ‘How have you used evidence based practice…’;
ii. Probationary Period Assessment Form (28.08.2014);
iii. Appraisal from Southend (2014-2015);
iv. Email from MB dated 21 June 2016;
v. Feedback from student, MB (17 June 2016);
vi. Datix report (5 October 2016);
vii. Emails from MM to staff (April – August 2016);
viii. Testimonial from MN (09.09.2019);
ix. Testimonial from EW (13.09.2019);
x. Testimonial from GR (18.09.2019);
xi. Patient feedback – Ann Physiocare (August 2018 – August 2019);
xii. Supervision Statements – Ann Physiocare (June 2017 – August 2019);
xiii. Observation records – Ann Physiocare (May 2017 – April 2019); and
xiv. Registrant’s training certificates.

3. On day four of the substantive hearing, the Registrant served his witness statement on the HCPC and the Panel.

Application to amend the Particulars
4. At the outset of the hearing Mr Lloyd made an application to amend the Allegation.

5. The Registrant had been put on notice of the proposed amendment in a letter dated 03 May 2018.

6. Ms Sleeman did not object to the application on the Registrant’s behalf.

7. The proposed amendment was as follows:
i. Particular 13 – insertion of the word ‘or’ after the word ‘and’ and before the number ‘12’.

Panel’s approach
8. The Panel accepted the advice of the Legal Assessor and carefully considered the HCPTS application to amend the Particulars.

Panel’s decision in respect of application to amend Particulars
9. The Panel concluded, after reviewing the proposed amendment, that it would agree to the Particular being amended for the following reasons:
i. the Registrant had been provided with significant notice of the HCPC’s intention to amend the Allegation, having been put on notice in May 2019, five months before the commencement of the substantive hearing;
ii. the Registrant had not provided any objection to the proposed amendment;
iii. the proposed amendment was to provide further clarification of the Allegation; and
iv. the proposed amendment did not seek to materially widen the scope of the Allegation.

10. The Panel concluded that the proposed amendment to the Allegation, did not heighten the seriousness of the Allegation and therefore there was no likelihood of injustice to the Registrant. The Panel therefore allowed the amendment to be made to the Allegation.
 
Admissions
11. At the start of the hearing the Registrant made admissions, in part, to the following Particulars: 1(b), 1(e), 2(a) 4(f)(i) - 4(f)(iii), 4(g)(i) - 4(g)iii, 8(e). Ms Sleeman stated that whilst the Registrant accepted the aforementioned Particulars in part, he did not accept the overarching stem of the Particular and could not accept the Particular in full.

12. Ms Sleeman further indicated that Particular 6 was admitted in its entirety by the Registrant.

13. During the course of the hearing the Registrant made further partial admissions, in respect of Particular 4(a)(i) - 4(a)(ii), 4(d)(iii) (in respect of the shoulder alone), 8(b)(i) - 4(a)(ii) and Particular 10. Ms Sleeman stated that in respect of Particular 10, whilst the Registrant accepted that he had not completed patient records within 24 hours, his actions in this regard had not been dishonest.

14. Ms Sleeman further submitted that in respect of 4(a)(i) - (ii), 4(d)(iii) (shoulder alone) and 8(b)(i) – 8(b)(ii) the Registrant accepted his conduct but that, again, he did not accept the overarching stem to the Particular.

Background
15. The Registrant is a registered Physiotherapist with the Health and Care Professions Council (‘HCPC’).

16. In 2013, the Registrant was employed at Southend University Hospital NHS Foundation Trust (‘the Trust’). He was employed as a Band 6 Paediatric Physiotherapist. The Registrant was initially employed as a locum practitioner between October 2013 and February 2014. Subsequently, he was employed on a permanent basis from 22 April 2014 until 24 February 2017.

17. The Registrant worked within the Rehabilitation Department based at the Lighthouse Child Development Centre (‘the Centre’), providing treatment to children referred with musculoskeletal (‘MSK’) and neurodevelopmental conditions.

18. Concerns initially arose in June 2016 regarding the Registrant’s behaviour. Further concerns were subsequently identified in respect of his record keeping.

19. In November 2016, MM, Clinical Manager, observed one of the Registrant’s clinical sessions and identified concerns in respect of his clinical practice. Performance management procedures were put in place, which included other physiotherapists observing the Registrant’s practice between November 2016 and February 2017.

20. MM subsequently prepared a report outlining the concerns that had been identified and manifested since the performance management plan was put in place.

21. On 10 February 2017, MM made a referral to the HCPC outlining her concerns regarding the Registrant’s practice.

Decision on Facts
Assessment of witnesses
Witness MM
22. Witness MM obtained a Diploma in Physiotherapy in 1992, from the Rijkshoge School Groningen in the Netherlands. She started her career in physiotherapy at the Basildon and Thurrock Hospital in 1993, specialising in paediatric physiotherapy from 1995. She was employed in this role for eleven years.

23. In 2012, the Trust employed MM as a Rehabilitation Community Clinical Manager, based within the Paediatric Department at the Centre.

24. MM informed the Panel that she is a specialist Paediatric Physiotherapist who assesses and provides treatment to children with a variety of medical conditions including neurodevelopmental conditions, MSK conditions and coordination disorders. Her role also involves her managing and providing supervision to Paediatric Occupational Therapists and Physiotherapists.

25. MM stated that the Registrant was initially employed as a Locum Physiotherapist and became a permanent employee in April 2014, working within the Rehabilitation Department of the Centre. MM told the Panel that the Registrant’s line manager, for the latter part of his employment, was MB, who reported directly to her.

26. MM informed the Panel that she did not initially observe the Registrant’s work on a regular basis but as concerns about his practice came to light and progressed, she began to work alongside him on a daily basis.

27. MM told the Panel that concerns regarding the Registrant’s practice came to light in different ways over a period of three months. Initially, the issues appeared to be linked to his communication. However, upon further investigation she found that this was not entirely the case. Concerns became apparent in respect of the Registrant’s ‘paranoid behaviour’, his records and record keeping, and his refusal to see patients.

28. MM gave evidence to the Panel that on 11 November 2016, she observed the Registrant’s clinical sessions. This was the first time his clinical sessions had been observed. MM told the Panel that it became apparent to her during this observation session that more serious concerns needed to be addressed, over and above the original reason for her observation, which was to assess the Registrant’s communication skills.

29. Owing to her concerns, MM requested that other physiotherapists within the team observe the Registrant’s clinics between November 2016 and February 2017. MM told the Panel that MB and GH both informed her that they had encountered difficulty gaining acceptance from the Registrant when providing feedback after they had observed the Registrant’s clinics.

30. MM told the Panel that the Registrant was placed on a Performance Management Programme on 1 November 2016. A Performance Management Action Plan (‘PMAP’) was created for the Registrant on the same date. The PMAP was subsequently updated on 25 November 2016, following additional concerns being raised.

31. MM informed the Panel that she made a referral to the HCPC in February 2017 following the concerns observed by her and others within the team.

32. The Panel found MM to be a credible and balanced witness. The Panel had no reason to doubt her recollection of events. Her oral evidence was consistent with her witness statement. If she was unable to recollect a particular event she said so and provided reasons for any views expressed.

33. The Panel noted that the witness gave credit to the Registrant regarding his conduct prior to the complaints arising and the Panel also noted that the witness reflected on her own involvement, during the investigation process, acknowledging that this was the first disciplinary investigation of this nature that she had conducted at the Trust, and outlined how she might change her approach moving forward.
 
Witness MB
34. Witness MB obtained a Degree in Physiotherapy in 2000 from the University of East London. She informed the Panel that she was currently employed as a Band 7 Physiotherapist at the Trust, working within the Functional Improvement Team of the Paediatric Department of the Centre. MB told the Panel that she was responsible for the operational running of the clinics conducted by the MSK team.

35. MB told the Panel that this role required her to ensure that the clinics are fully booked, taking responsibility for the smooth running of the clinic and liaising with the Accident and Emergency (‘A&E’) department to minimise any delay in a patient’s care.  MB also informed the Panel that she provides supervision and general managerial support to a number of staff members within the MSK team. Further, and in addition to her managerial responsibilities, MB spends the majority of her time completing clinical duties and managing a caseload of patients.

36. MB informed the Panel that she was the Registrant’s line manager from May 2015 until February 2017.

37. MB gave evidence to the Panel that initial concerns were raised, in respect of the Registrant’s conduct. In March 2016 these concerns centred on communication and time management. MB told the Panel that the Registrant repeatedly stated that he was struggling to complete administrative tasks, clinical notes and discharge reports. She stated that the Registrant also appeared to need a large amount of direction in achieving or making developments on his objectives. MB stated that the Registrant had repeatedly stated that he was not coping with his workload and wanted to have non-patient contact time.

38. MB told the Panel that she observed the Registrant’s clinical assessments on the 11, 16, 29 and 30 November 2016 and again on 1 December 2016. MB confirmed that she also observed the Registrant’s clinics on 7 January 2017 and 7 February 2017 and she jointly observed the Registrant’s clinic with MM on 25 January 2017. 

39. The Panel found Witness MB to be credible and consistent. She was clear and concise and gave compelling evidence on the matters covered. She referred to her notes and approached her evidence in a considered and methodical fashion. MB provided a balanced and fair view of the Registrant and her efforts to support him through the performance management process.

40. The Panel was also of the view that MM’s and MB’s evidence, although not identical, corroborated each other’s evidence and provided a clear overview of the Registrant’s working environment and performance.

Witness SM
41. Witness SM obtained a Bachelor’s Degree in Physiotherapy from Kings College London in July 2014. She is currently employed by the Trust as a Senior Physiotherapist, but is currently working within an Essex Partnership University Trust setting.

42. Prior to this role SM was employed as a Junior Rotational Band 5 Physiotherapist at the Trust working within the Centre. Her responsibilities included assessing and treating children between 5 and 16 years old with MSK conditions. She occasionally saw children under 5 years of age if told to do so by the Registrant, who was her supervisor between January 2016 and October 2016.

43. SM told the Panel that during the first few weeks of her role within the Centre, she accompanied the Registrant during all of his physiotherapy clinics and attended lower limb exercise groups with him every week. SM informed the Panel that she saw him on a daily basis as she worked next to the Registrant.

44. The Panel considered SM to be helpful and found that she answered the questions put to her to the best of her recollection. Notwithstanding the limited scope of her evidence, the Panel found SM to be clear and concise. SM also demonstrated, in her evidence that she had tried to support the Registrant whilst she worked alongside him within the team.

Witness GH
45. Witness GH told the Panel that he obtained a Bachelor’s Degree in Physiotherapy from the University of Hertfordshire in 2006 and that he has been employed by the Trust, as a Band 7 Paediatric Physiotherapist, for four years. Prior to this role, he had been employed by the Trust as a Band 6 Physiotherapist for over a year.

46. GH informed the Panel that he did not work directly with the Registrant, but told the Panel that he spoke with the Registrant often as they both worked within the Paediatric team. GH knew the Registrant for approximately two years.

47. GH gave evidence to the Panel that his line manager, MM, asked him to provide some supervision support to the Registrant. GH told the Panel that he provided the Registrant with support during formal supervision sessions that took place approximately once per week between October 2016 and January 2017. GH informed the Panel that during these sessions he discussed ways in which the Registrant could manage his caseload, delegate certain tasks, and support junior members of the team and use problem solving techniques.

48. In addition to the formal support, GH gave evidence to the Panel that he attended approximately five or six informal sessions with the Registrant each week. These sessions often took place at the end of the day and were used to address any concerns that the Registrant had.

49. The Panel considered GH to be an experienced Physiotherapist who was very clear in his evidence. The Panel found GH to be straightforward and fair in respect of the limited evidence that he provided. He accepted when he could not assist the Panel with matters because they were beyond the scope of his knowledge. The Panel felt that GH provided a balanced view of the Registrant.  Indicating that he “liked” the Registrant, stating that they would often spend time chatting, in his car, after they had travelled home together in his car. The Panel also believed GH when he had admitted “feeling hurt”, after he had invested time in the Registrant and the Registrant had made an accusation that he had lied during one of their supervision sessions together.

50. The Panel regarded GH’s evidence as consistent with that of MM and MB and considered that he provided informative evidence regarding the working environment.
 
The Registrant
51. The Registrant completed his Bachelor Degree in 2004, from the Medical University, Chennai, in India. In 2008 the Registrant completed a PG Diploma in Hospital Administration, in India, and a further Diploma in Yoga and Naturopathy in 2009, also in India. In 2009 the Registrant also completed a Masters in Physiotherapy, at the same University at which he had completed his Bachelor Degree and in 2011 he completed a further Masters degree at the University of East London in Science of Physiotherapy.

52. He worked in India from 2005 until 2009 in various roles in paediatrics and adult services. He came to the United Kingdom (‘UK’), after he completed his degree, on a two-year post-study visa. He obtained work placement sponsorships, which permitted him to remain in the U.K. He initially worked as a locum in the public sector in various NHS trusts as a Band 6 Physiotherapist.

53. The Registrant worked as a Locum Physiotherapist, at the Trust, from 30 September 2014 until the end of February 2014 and was appointed as a Senior Physiotherapist, and a permanent member of staff at the Trust, between April 2014 and February 2017.

54. The Panel was of the view that the Registrant provided conflicting and inconsistent evidence. When facts were put to him during cross-examination he would repeatedly indicate that the evidence of MM, MB and GH was mistaken, when their accounts didn’t accord with his own evidence. However, he would readily accept their evidence when their accounts bolstered his own evidence or position.

55. The Panel noted that the Registrant considered the patients’ clinical records and his witness statement regularly during the course of his evidence and seemed unable to provide answers to questions without reference to the documents before him. The Panel found his responses to questions to be calculated, measured yet imprecise.

56. The Panel also noted that the Registrant seemed able to recall matters that were favourable to his position, but had no knowledge of those not favourable to him.

57. Accordingly, the Panel was of the view that little weight could be placed on the Registrant’s evidence.

Panel’s approach
58. The Panel was aware that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the individual Particulars of the Allegation could only be found proved if the Panel was satisfied on the balance of probabilities.

59. In reaching its decision the Panel took into account the oral evidence of the HCPC witnesses and the Registrant, the documentary evidence contained within the hearing bundles as well as the oral submissions made by Mr Lloyd and Ms Sleeman.

60. The Panel accepted the advice of the Legal Assessor and had regard to the documents referred to in her advice.

61. The Panel noted that the Registrant’s representative, Ms Sleeman, had placed the outcome of the Trust’s performance management investigation and process before it. The Panel did not consider the outcome of the Trust’s investigation and process to be of any relevance to the question before it, as different tests and considerations had to be applied by the Panel. The Panel therefore placed no weight upon the outcome of the performance management investigation and process. Nor did the Panel let the outcome of the Trust’s performance management process influence any of its decisions.

62. Similarly, the Panel noted that the Registrant’s bundle contained reference to the Registrant being subject to an Interim Conditions of Practice Order. The Panel did not consider this information at the fact-finding stage of proceedings.

Patients
63. The Panel noted that there was no dispute between the parties regarding the following information in respect of each patient:
i. Patient 1: was referred for physiotherapy treatment for intermittent left groin pain and hypermobility;
ii. Patient 2: was referred for physiotherapy treatment for reduced balance and eye-hand coordination;
iii. Patient 4: required physiotherapy treatment due to experiencing pain in his arm after handwriting;
iv. Patient 5: a two-year old boy, was referred for physiotherapy treatment due to being a late walker and presenting with inward rolling feet;
v. Patient 6: a three-month-old baby with Down’s syndrome. As a result of diagnosis, physiotherapy intervention was required at an early stage to support the patient and the patient’s parents;
vi. Patient 7: a six-year old boy who was referred for physiotherapy treatment to aid his recovery after attending A & E due to fracturing his elbow;
vii. Patient 8: was referred for physiotherapy treatment because he presented with a recurrent ankle problem;
viii. Patient 1a: a 10-year old who had received physiotherapy treatment at the Centre since 2014 as she presented with a habitual tip toe walking pattern;
ix. Patient 2a: a 14-year old girl who was referred for physiotherapy treatment due to experiencing instability in her right patella (knee cap) and on-going left hip pain;
x. Patient 3a: a 6-year-old patient who presented with congenital clubfeet, a foot deformity. Patient 3a underwent corrective surgery when he was 6 months old and again when he was 13 months old; and
xi. Patient 4a: a fourteen-year-old boy who was referred for physiotherapy treatment due to experiencing pain and fatigue after activity.
Particular 1(a) – found proved
During the course of your employment as a registered Physiotherapist at Southend University Hospital, you:
1. Did not undertake and/or record a full subjective assessment in that:
 a) on or around 11 November 2016 while attending to Patient 1 you  did not ask relevant questions in relation to his groin pain;

64. The Panel noted that there was no dispute between the parties, that the Registrant was employed as a registered Physiotherapist at Southend University Hospital during the relevant times. The Panel heard evidence from MM, MB, SM and GH that they had all worked with the Registrant during the relevant times. The Panel therefore find as a matter of fact that the Registrant worked at the Trust during the relevant periods specified within the Allegation.

65. MM provided evidence to the Panel that Physiotherapy assessments require both a subjective and objective assessment of the patient. She explained that subjective assessments involve asking questions to help the physiotherapist form a working hypothesis about what factors may be contributing to a patient’s problem and therefore enable the practitioner to consider what tests need to be conducted when objectively assessing the patient. She stated that the subjective assessment helps in the clinical reasoning process and subjective findings can be used during review appointments to measure progress.

66. She gave evidence that a physiotherapist might ask a patient to describe their pain, symptoms or injury and further ask them what factors increase or decrease the patient’s level of pain, as examples of subjective questioning. The purpose of this subjective questioning, she explained, is to allow the physiotherapist to identify exactly where the pain or problem is located and consider what might be causing the pain. MM stated that a physiotherapist should also ask questions regarding medical history to consider if there is an underlying condition that could be causing or contributing to the patient’s problem and to determine if there are any contra-indications to assessment and or treatment.

67. MM further explained that subjective assessments are also intended to gather as much information as possible about the patient and the patient’s pain, symptoms and injury to inform a working diagnosis. She told the Panel that this initial diagnosis would highlight any specific joints or areas that need to be investigated further during the objective assessment part of an appointment.

68. MM told the Panel that she observed the Registrant’s clinic on 11 November 2016, in respect of Patient 1. MM also drew the Panel’s attention to the contemporaneous notes, which she had made, during the course of the observed clinic with the Registrant, in order to provide feedback to the Registrant after each clinic.

69. MM stated that during the subjective assessment of Patient 1, the Registrant would have been expected to ask Patient 1 to identify specific movements or activities that make the groin pain worse. She indicated that it would also have been important to ask if there were any barriers that might prevent Patient 1 from regaining full activity, what pain level Patient 1 was experiencing compared with that during the previous assessments and if there were any activities that Patient 1 would like to return to but could not do so.

70. MM told the Panel that during the course of the Registrant’s clinic with Patient 1, he did not conduct a subjective assessment of the patient’s groin pain and that he did not ask Patient 1 any questions at all about it. MM informed the Panel that Patient 1 had stated that his groin pain had improved and that the Registrant did not ask Patient 1 any questions in respect of this, nor seek to explore this with him. MM further indicated that as Patient 1 had experienced groin pain for over two years the Registrant should have explored this with him.

71. The Panel noted that the Registrant denied this allegation and had stated that it was not relevant to ask questions about the groin pain in the circumstances owing to the Patient reporting that the pain had settled.

72. After carefully considering the evidence, the Panel was satisfied that the Registrant was under an obligation to conduct a subjective assessment in respect of Patient 1’s groin pain and concluded, based on the evidence before it, that he did not do so. In particular, the Panel noted MM’s contemporaneous note, dated ‘11/11/2016’ which stated ‘Patient reports that groin is getting better. No additional questions were asked by you’. 

73. The Panel also had regard to Patient 1’s clinical records and noted that the patient’s records did not make any reference to, or record, any subjective questions or assessment being undertaken.

74. The Panel was therefore satisfied that the Registrant did not undertake or record, a full subjective assessment, in relation to Patient 1’s groin pain, and did not ask relevant questions on 11 November 2016.

75. Accordingly, Particular 1(a) is found proved. 

Particular 1(b) – found proved
1. Did not undertake and/or record a full subjective assessment in that:
 b) on or around 11 November 2016 while attending to Patient 4 you  did not obtain relevant information relating to leisure activities, duration  of pain, aggravating and/or relieving factors;

76. MM informed the Panel that she had observed the Registrant’s clinic in respect of Patient 4 on the 11 November 2016. MM gave evidence to the Panel that she would have expected the Registrant to have asked Patient 4 a range of questions about his pain to form an initial working diagnosis on which to base Patient 4’s objective assessment. MM stated that the Registrant should have identified, as part of his subjective assessment, what activities Patient 4 needs to carry out and to ask Patient 4 to outline any specific movements or activities that increase Patient 4’s level of pain. MM told the Panel that the Registrant did not conduct a full subjective assessment of Patient 4, as he did not ask if there were any factors which made the pain worse or better, nor did he ask how long the pain lasted. The Registrant also failed to ask if there were any activities that Patient 4 would like to take part in which he was currently prevented from doing.

77. MM drew the Panel’s attention to the contemporaneous note that she had made on the day. It stated ‘Chaotic approach to assessment. You told the mother that he would probably refer to OT handwriting workshops before you commenced the assessment. You did not ask enough subjective info (no leisure, any other aggravating or relieving factors, how long pain lasts, leisure activities, how are general co-ordination skills) did do passive ROM, no palpation of elbow’.

78. The Panel noted that the Registrant admitted not obtaining all of the information, but stated that he did obtain some relevant information, specifically aggravating factors, such as the pain increased while writing and that pain reduced when the patient stops writing. The Registrant gave evidence that the reason that he was unable to obtain all of the subjective information required from Patient 4 was owing to MM asking him to find and retrieve the referral notes, which could not be located in the patient’s file. The Registrant indicated that MM asked him to carry on with the objective assessment and this reduced the time available in order to assess the patient.

79. The Panel noted that Patient 4’s clinical records, which were created by the Registrant on the 11 November 2016, only note ‘pain while writing’ under the aggravating factors.
80. Having regard to the evidence presented, the Panel finds as a matter of fact that the Registrant was under an obligation to conduct a subjective assessment in respect of Patient 4, on 11 November 2016, and that he failed to obtain the relevant information relating to leisure activities, duration of pain and/or relieving factors. The Panel also noted that the Registrant did not record this information on Patient 4’s clinical records.

81. The Panel noted, that the Registrant did record a single aggravating factor on the Patient’s notes in respect of ‘pain while writing’. However, the Panel considered this entry to be the patient’s presenting condition and not an aggravating factor.

82. Accordingly, Particular 1(b) is proved.

Particular 1(c) – found proved
1. Did not undertake and/or record a full subjective assessment in that:
 c) on or around 16 November 2016 while attending to Patient 1a you  did not discuss and/or check the patient’s home exercise programme;

83. MB told the Panel that during the course of the appointment with Patient 1a on 16 November 2016, which she observed, the Registrant did not ask Patient 1a any questions about her Home Exercise Programme (‘HEP’). MB informed the Panel that as a Band 6 Physiotherapist, the Registrant should have been aware that he needed to include these questions in his subjective assessment of the patient.

84. MB also told the Panel that she would have expected the Registrant to ask the patient if the HEP was working and ascertain how often the patient had completed the exercises. She stated that it is important to ask specific questions about the patient’s progress to see if there was any change in terms of muscle stretching. Further, MB indicated that she would have also expected the Registrant to ask the patient to demonstrate each exercise to check if they were holding each exercise for the correct length of time. This was especially so because MB had noted from the Patient’s clinical records that the HEP had been set by another physiotherapist and had been reviewed and amended previously.

85. Further, MB drew the Panel’s attention to her contemporaneous observation notes of the session with Patient 1a which stated ‘Questioned if had been doing exercises but did not asked specifically what and how often?’.

86. The Panel noted that the Registrant’s position in respect of this Particular was that MB had told him not to conduct a subjective assessment of the patient.

87. Having carefully considered the evidence, the Panel is satisfied that the Registrant was under an obligation to conduct and record a full subjective assessment of Patient 1a. Including asking questions about the HEP. The Panel accepted MB’s evidence that this should have included asking the patient to indicate how the exercise was being undertaken, asking how the patient was responding to the HEP and asking the patient to demonstrate the exercises to ensure that they were being conducted properly and were still appropriate.

88. The Panel rejected the Registrant’s explanation and find as a matter of fact that the Registrant did not discuss or ask the patient questions regarding the HEP and that he failed to check the HEP with the patient also. Consequently, the Registrant was unable to record the findings of a full subjective assessment because he had not conducted a full subjective assessment.

89. Accordingly, Particular 1(c) is proved.

Particular 1(d) – found proved
1. Did not undertake and/or record a full subjective assessment in that:
 d) on or around 16 November 2016 while attending to Patient 2a you  did not ask follow up questions when Patient 2a’s mother mentioned  Patient 2a was awaiting an appointment at hospital and was unable to  return to sports due to other issues;

90. MB told the Panel that during the Registrant’s appointment with Patient 2a on 16 November 2016, which she had observed, the Registrant asked Patient 2a if she had returned to sport as had been advised during her last appointment. MB informed the Panel that Patient 2a’s mother then disclosed that Patient 2a had been unable to return to sports ‘due to other issues’ for which Patient 2a was ‘awaiting an appointment at Brompton Hospital’. MB stated that this immediately highlighted to her that there was a reason that Patient 2a could not return to sports. She expected the Registrant to ask further questions about this because if the patient was suffering from another medical concern this would impact the assessment and treatment of the patient.

91. MB also drew the Panel’s attention to two entries in the patient’s clinical records. The first being one which the Registrant had entered, dated ‘16/11/16’ whereby he stated ‘under consultant @ Brompton Hospital’ and the second being an entry which MB had herself made, dated ‘22.11.16’. MS’s entry stated the following: ‘During appointment – upon further questioning [Patients 2a’s] mum informed us [patient 2a] is waiting for apt @ [banked out] to see Cardiologist for further investigation – [Patient 2a] has been advised not to participate in P.E, sport until after consultation. We reinforced to go upon medical advice not to return to sport until all cleared. Can be re ref to PT for further input @ a later date if req’d to support return to sport’.

92. MB gave evidence to the Panel that the Registrant did not ask any questions about Patient 2a’s appointment at the Brompton Hospital, nor did he ask any questions about Patient 2a’s other medical concerns. MB stated that the implication for not asking these follow up questions is that he could potentially have been putting the patient at risk with inappropriate advice and could have caused damage when conducting an assessment. MB told the Panel that the Registrant should have identified that this information was an important clue about Patient 2a’s health and that this would be central to a physiotherapist’s role of holistic assessment.

93. MB drew the Panel’s attention to her contemporaneous note, made during her observation on 16 November 2016, which stated ‘I interrupted and questioned were there other medical reasons to prevent return to sport. Mum disclosed that they were waiting for apt with Cardiologist due to dizziness, fainting attacks they had been advised no sport until after appt’.

94. The Panel noted that the Registrant’s response, in respect of this Particular, was to deny it. He stated that he did not recall Patient 2a’s mother indicating that Patient 2a was awaiting an appointment at the hospital. The Registrant did accept, under cross-examination, however, that Patient 2a’s mother reported that Patient 2a was under a Consultant for a cardiac problem and blood pressure.

95. After carefully considering the evidence, the Panel was satisfied that the Registrant was under an obligation to conduct a full subjective assessment in respect of Patient 2a, on 16 November 2016. The Panel find as a matter of fact that the Registrant failed to do so by not asking follow-up questions, after Patient 2a’s mother disclosed that Patient 2a was under the care of a Cardiologist and awaiting an appointment at the Brompton Hospital.

96. The Panel was also satisfied that the Registrant did not record the details of the subjective assessment, despite MB’s follow-up questions to Patient 2a’s mother regarding the other health concerns that Patient 2a was encountering.

97. Accordingly, Particular 1(d) is proved.

Particular 1(e) – found proved
1. Did not undertake and/or record a full subjective assessment in that:
 e) on or around 16 November 2016 while attending to Patient 4a you  did not ask questions including the location of the patient’s pain after  he disclosed that he experienced pain in his legs following activity;

98. MB informed the Panel that during the Registrant’s appointment with Patient 4a on 16 November 2016, which she observed, Patient 4a disclosed that he felt pain in his legs after taking part in cross-country running. MB stated that she would have expected the Registrant to question this further by asking Patient 4a to locate where he was feeling this post-activity pain, how long the pain lasted and if the patient was able to continue running or needed to stop due to the pain.

99. MB told the Panel that the Registrant did not ask Patient 4a any further questions about this post-activity pain. MB gave evidence to the Panel that it was important to ask these questions so that the Registrant could understand if the treatment was working by accurately examining and comparing Patient 4a’s level of pain during the initial assessment to later assessments. MB told the Panel that Patient 4a’s disclosure was either an indication that his condition remained the same or had worsened.

100. MB drew the Panel’s attention to her contemporaneous notes, which she had completed during her observations of the Registrant on the 16 November 2016. The Panel noted that MB had stated ‘Patient reported pain after activity, particularly cross-country. Did not question where the pain was. Asked if had been doing exercises’.

101. The Panel noted that the Registrant accepted this Particular and that he did not ask the location of the patient’s pain. However, the Panel noted that the Registrant sought to qualify his admission by stating that MB “repeatedly interrupted” him during the assessment when he was asking Patient 4a a question. The Panel noted when this suggestion was put to MB, during cross-examination, she denied that this was the case.

102. The Panel also noted that the patient’s clinical records make no reference to any questions or responses asked of Patient 4a, by the Registrant, in respect of the pain he was experiencing.

103. After carefully considering the evidence the Panel was satisfied that the Registrant was under an obligation to conduct a full subjective assessment in respect of Patient 4a and that the Registrant failed to do so. The Panel find as a matter of fact that the Registrant did not ask Patient 4a necessary questions, including any questions regarding the location of pain after he disclosed that he experienced pain in his legs following activity.

104. The Panel also find that, owing to the Registrant’s failure to conduct a complete and full subjective assessment, he was unable to record the findings of questions which ought to have been asked, but were not.

105. Accordingly, Particular 1(e) is proved for the reasons set out in the paragraphs above.

Particular 1(f) – found proved
1. Did not undertake and/or record a full subjective assessment in that:
 f) on or around 9 December 2016 while attending to Patient 6 you did  not take a full medical history.

106. MM told the Panel that during a subjective assessment of Patient 6, or any other patient, the Registrant would be expected to ask the patient a number of questions in order to gather relevant information about the patient and how their condition may affect them. She stated that this would include asking the patient or their family for a full medical history so that the Registrant could consider what exercises could be recommended. MM informed the Panel that during her observation of this assessment, the Registrant did not ask a number of questions relating to Patient 6’s medical history and which should have been addressed. MM stated that the Registrant asked about the child’s birth history, but did not explore any other medical issues.

107. MM gave evidence to the Panel that because Patient 6 was born with Downs Syndrome, Patient 6 was at a higher risk of experiencing heart problems and the Registrant should have asked Patient 6’s family about her heart, but he did not. MM stated that it is important to identify this as it may affect how much handling the child is able to tolerate and if extra attention needs to be paid to the child’s colouring during therapy sessions. She also stated that asking questions would also identify if Patient 6 was due to undergo surgery, what the patient’s family is going through and how this will impact the physiotherapy advice that is given. MM told the Panel that Patient 6 was born in the breeched position, which means that there would be a higher chance of hip dysplasia. MM told the Panel that the Registrant did not ask the patient’s family any questions relating to this and that it was important to know if any intervention was planned for hip dysplasia such as bracing, which would affect the handling and positioning of a child.

108. MM also drew the Panel’s attention to her notes of the clinic on the 9 December 2016, which she told the Panel had been written up as she observed the Registrant’s clinics. The Panel noted that MM’s observations notes recorded the following ‘Ask relevant medical history (did not ask cardiac or hips despite the baby being breech)’.

109. The Panel noted that the Registrant’s position was to deny this Particular. Stating that whilst undertaking the subjective assessment the patient’s mother reported that there was nothing significant in her past medical history and that he asked her about the patient’s hip scan and the mother reported no abnormal defects.

110. The Panel noted that Patient 6’s clinical records, written by the Registrant state ‘Mum reports no major past medical history. Hip scan done after birth – no abnormal defect (as mum reported)’. The Panel also noted that when it was put to MM during cross-examination that the Registrant had asked the appropriate questions, MM stated that he had not.

111. After carefully considering the evidence the Panel was satisfied that the Registrant was under an obligation to conduct a full subjective assessment in respect of Patient 6 on 9 December 2016 and that he did not. The Panel find as a matter of fact that the Registrant did not take a full medical history in respect of Patient 6. The Panel also find as a matter of fact that the entries made on Patient 6’s clinical notes, which state that a medical history was taken and hip score checked, were made retrospectively and after MM had provided her feedback to the Registrant. The Panel determined, in respect of this Particular, that the information retrospectively recorded by the Registrant represented the findings of colleague MM and were not as a result of any assessment conducted by the Registrant himself.

112. Accordingly, Particular 1(f) is proved to the extent that the Registrant failed to undertake a full subjective assessment.

Particular 2(a) – found proved
2. Did not give appropriate advice in that:
 a) on or around 11 November 2016 while attending to Patient 4 you  did not sufficiently address the patient’s pain in your follow up advice;
113. MM told the Panel that Patient 4 had a supracondylar fracture in May 2016, which required open reduction fixation. MM reported that Patient 4’s mother stated at the start of the session that her son was presenting with a painful right elbow following handwriting. MM told the Panel that the Registrant did not address the pain at all during his subjective assessment, his objective assessment or in his follow up actions to the patient.

114. MM informed the Panel that she would have expected the Registrant to try to identify the cause of the pain by conducting a full subjective assessment to gather relevant information and that this would have included gathering evidence about how long the pain lasted, whether there is anything that makes pain worse or better and if the pain eases immediately after writing. MM told the Panel that the Registrant should also have asked if he suffered with any problems prior to the fracture.

115. MM told the Panel that she would then have expected the Registrant to conduct a full objective assessment by asking Patient 4 to complete a range of movements assessing the elbow, wrist and shoulder to assess whether there were restrictions. This would indicate a shortening of muscle groups and or problems with joints.  MM told the Panel that she would have expected the Registrant to examine the elbow to look for swelling, discolouring or sensitive scars. MM informed the Panel that there was a prominent scar running over Patient 4’s arm as a result of the surgery.

116. MM informed the Panel that the Registrant did not complete any of these assessments, nor did he establish if Patient 4 had difficulties with handwriting such as difficulties relating to speed, legibility, forming letters and overall posture when writing. Further, MM explained that given that the Registrant did not identify or address Patient 4’s pain, Patient 4 would remain in pain.

117. MM drew the Panel’s attention to Patient 4’s clinical records, which stated under the advice section ‘refer to orthopaedic clinic on Thursday’.

118. The Panel noted that the Registrant admitted this Particular.

119. Having carefully considered all of the evidence, the Panel are satisfied that the Registrant did not give appropriate advice while attending to Patient 4 on 11 November 2016, in that a referral to a handwriting clinic and intervention from orthopaedics, would not have sufficiently addressed Patient 4’s pain. Therefore, the advice provided by the Registrant was inappropriate and did not sufficiently address Patient 4’s pain.

120. Accordingly, Particular 2(a) is proved.

Particular 2(b) – found proved
2. Did not give appropriate advice in that:
 b) on or around 9 December 2016 while attending to Patient 6 you  advised the parents that Patient 6 should sleep in a supported  side-lying position when this was unsafe;

121. MM told the Panel that during her observation with the Registrant on 9 December 2016, the Registrant observed that Patient 6 was not yet able to roll onto her side and told her parents that they should aim to improve this. MM informed the Panel that this advice was not correct, as a baby who is only three months old is not expected to be able to roll onto their side. MM gave evidence to the Panel that the Registrant then advised that Patient 6 should complete a number of exercises that involved using a therapy ball. He also tested complex skills, which did not appear necessary for Patient 6. MM also informed the Panel that the Registrant also advised Patient 6’s parents that Patient 6 should lie on her side with a pillow placed behind her back while she slept. MM stated that Patient 6’s mother then challenged this advice by asking ‘isn’t she supposed to sleep on her back?’ MM stated it was at this point she intervened as the consequence for the Registrant’s incorrect advice was that it could do harm to the child. MM stated that the safe advice to parents is to have the baby sleeping on its back.

122. MM drew the Panel’s attention to her observation feedback notes, made on 9 December 2016, where she had written and highlighted the following ‘*Advice to parents: sleep in supported sidelying. UNSAFE – do not advise to sleep in supported sidelying always [words missing from page]’.

123. The Panel noted that the Registrant denied this Particular stating that he had not provided this advice to the parents of Patient 6.

124. The Panel also had regard to the document titled ‘Tummy time’ produced by the Association of Paediatric Chartered Physiotherapists which stated the following in respect of sleeping positions ‘Official Sudden Infant Death guidelines recommend that your baby sleeps on their backs at home, with their feet at the bottom of the bed until they are 6 months old. Make sure that there are no pillows or soft toys near their face which could obstruct their breathing’.

125. Having carefully considered the evidence, the Panel was satisfied that the Registrant did advise Patient 6’s parents, during the clinical session on the 9 December 2016, to place their child in a side-lying position supported by a pillow, which was dangerous and inappropriate advice to give. Further, the Panel find as a matter of fact that the Registrant provided inappropriate advice by recommending exercises to Patient 6’s parents when it was not reasonable for their child to be expected to complete them.

126. Accordingly, Particular 2(b) is proved.

Particular 2(c) – found proved
2. Did not give appropriate advice in that:
 c) on or around 2 December 2016 while attending to Patient 7 you  advised that they could resume normal activities when this was  unsafe;

127. MM informed the Panel that Patient 7 suffered a fracture in his elbow and that the Registrant should have advised that the patient could not resume normal activities until approximately three months later as this is the recommended amount of time that should pass before a patient resumes normal activity post-fracture. MM told the Panel that it takes 3-6 weeks for a fracture to heal, then it will take some time for the bone to strengthen, and for muscles around the fracture to strengthen so that the injured side is protected.

128. MM told the Panel that she observed the Registrant advising Patient 7 that he could resume normal activities 2 weeks after fracturing his elbow. MM stated that this advice was not appropriate and was unsafe because the implication of this advice was that this could cause Patient 7 to re-injure his elbow, possibly resulting in a further break. MM indicated that she fed this back to the Registrant during their feedback session together, whereupon the Registrant’s response was to request, repeatedly, that he wanted the supervised practice to stop.

129. The Panel noted that the Registrant denied this Particular and stated that his clinical records suggested a gradual return to sport/PE after Christmas (the injury having occurred in late November). The Panel also noted that when this was put to MM in cross-examination, she disputed that the clinical records accurately described the advice, which had been provided to Patient 7 during the observed treatment session.

130. The Panel had regard to MM’s clinical observation notes in respect of Patient 7. The Panel noted that MM had marked the Registrant’s advice as ‘unsafe’ and stated ‘advised to go back to normal activities 2 weeks post [break] unnecessary follow up plan’. 

131. Having regard to all of the evidence, the Panel find as a matter of fact that on 2 December 2016, while attending to Patient 7, the Registrant did advise Patient 7 that he could return to normal activities when this was unsafe to do so.

132. Accordingly, Particular 2(c) is proved.

Particular 2(d) – found proved
2. Did not give appropriate advice in that:
 d) on or around 11 November 2016 while attending to Patient 1 you  advised him to return to swimming without conducting a full  examination to assess whether this would be appropriate.

133. MM told the Panel that during the course of the clinical appointment with Patient 1 the only advice, which was provided by the Registrant to Patient 1, was very “general” advice about stretches for the ankle. MM told the Panel that Patient 1 was referred for physiotherapy treatment due to groin pain.

134. MM also highlighted to the Panel that during the Registrant’s initial assessment of Patient 1, Patient 1 indicated that swimming made his groin pain increase. MM stated that during her observation of the Registrant, on 11 November 2016, she witnessed the Registrant advise Patient 1 to return to swimming without conducting a full examination to assess whether this was appropriate. MM stated that the Registrant’s assessments were not linked to his findings or the advice that he provided to Patient 1.

135. The Panel noted that the Registrant denied providing this advice to Patient 1 and that he stated that he did not record this advice in his notes, which he claimed he would have done had he provided the advice.

136. Having carefully considered the evidence before it, the Panel accepted MM’s account and was satisfied that the Registrant did advise Patient 1 to return to swimming despite having not conducted a full examination to assess whether it would be appropriate to do so.

137. Accordingly, Particular 2(d) is proved.

Particular 3(a) – found proved
3. Did not demonstrate safe and/or effective practice in that:
 a) on or around 16 November 2016 while assessing Patient 1a you did  not ask Patient 1a to remove their tights.

138. MB told the Panel that the second part of a physiotherapy assessment, after a subjective assessment is to conduct an objective assessment. This is directed by information obtained about the patient’s injury or pain during the subjective assessment and it involves carrying out tests and observations to determine a diagnosis. An objective assessment will involve observing the patient to examine posture, how the patient walks, and any change in colour or bruising on the skin. It will also involve examining the range of motion in the limb that is being assessed and looking at the patient’s muscle strength.

139. MB told the Panel that Patient 1a was referred for tip-toe walking and that at the start of every appointment the Registrant should always ask the patient if they are happy to remove any clothing that is covering the affected area. MB stressed the importance of this to allow the physiotherapist to be able to examine the patient “properly”.

140. MB informed the Panel that the Registrant assessed Patient 1a without asking her to remove her tights. MB also informed the Panel that it would be necessary to remove clothing to assess the patient’s balance and that it would not be possible to determine balance, with her legs and feet covered. MB also stated that if Patient 1a had specified that she was unwilling to remove her tights then an assessment with tights on could have been conducted, but that this was not the case on this date.

141. Further, MB also stated that without asking Patient 1a to remove her tights, this could also have caused a slip hazard and constituted a risk to Patient 1a’s safety if she was asked to walk, jump or run during the assessment.

142. MB also drew the Panel’s attention to her ‘Peer Review Clinic Observation’ notes, dated ‘16.1.16’, which stated ‘In assessment did not ask for tights to be removed’.

143. The Panel noted that the Registrant denied this Particular stating that the patient was wearing leggings, which she rolled up to just above her calf muscle and that consequently, there was no need to ask the patient to remove them. The Panel also noted that during his cross-examination, the Registrant accepted that even if Patient 1a had been wearing leggings, which were rolled up, (which was not the HCPC case) this would have impinged on his ability to conduct a full assessment.

144. Having regard to all of the evidence, the Panel find as a matter of fact that Patient 1a was wearing tights during her clinical appointment with the Registrant on 16 November 2016 and that the Registrant failed to ask her to remove the tights. The Panel was also satisfied that by failing to ask Patient 1a to remove her tights, the Registrant placed Patient 1a in an unsafe position, in that should could have slipped or fallen during the clinical appointment. Further, the Panel was also satisfied that by failing to ask Patient 1a to remove her tights, the Registrant did not demonstrate safe or effective practice.
145. Accordingly, Particular 3(a) is proved.

Particular 3(b) – found proved
3. Did not demonstrate safe and/or effective practice in that:
 b) on or around 16 November 2016 while attending to Patient 2a you  advised a return to sport without checking whether there were other  medical reasons that may have prevented this;

146. MB informed the Panel that after Patient 2a’s mother disclosed that Patient 2a had booked an appointment at the Brompton Hospital for separate medical concerns, the Registrant should have considered these concerns before recommending a treatment plan because any additional medical concerns may have had an impact on the patient’s physiotherapy treatment plan. Further, MB also told the Panel that without asking any follow-up questions about Patient 2a’s medical concerns, the Registrant advised that Patient 2a should continue to carry out her physiotherapy exercises, return to swimming and take part in PE classes.

147. MB stated that if Patient 2a was suffering from an underlying cardiac issue then this advice could be dangerous for Patient 2a’s safety.

148. MB told the Panel that at this point during the clinical assessment that she intervened and asked Patient 2a and her mother about her additional medical concerns and Patient 2a’s mother indicated that Patient 2a had been told not to take part in sport until after her appointment. It was at this point, MB told the Panel, that Patient 2a’s mother expressed concern about the Registrant’s advice, for Patient 2a, to return to sports.

149. The Panel noted that the Registrant denied this Particular stating that he did not provide this advice.

150. After carefully considering all of the evidence, the Panel accepted MB’s account and find as a matter of fact that the Registrant did advise Patient 2a, and her mother, that Patient 2a could return to sport, notwithstanding the other medical concerns. The Panel determines that this advice was unsafe. In so doing, the Panel determined that the Registrant did not demonstrate safe and effective practice in his assessment of Patient 2a.

151. Accordingly, Particular 3(b) is proved.

Particular 3(c)(i), and 3(c)(ii) – found proved
3. Did not demonstrate safe and/or effective practice in that:
 c) on or around 25 January 2017 while attending to Patient 8 you:
  i. incorrectly concluded there was full muscle strength in the    lower limbs;
  ii. did not demonstrate your clinical reasoning in relation to the   assessment and/or advice provided;

152. In respect of Patient 8, the Panel heard from both MM and MB, as they had both observed the Registrant’s clinic on the 25 January 2017.

153. MM told the Panel that Patient 8 had been experiencing a recurrent ankle sprain and consequently, the Registrant would be expected to assess patient 8’s ankles and muscle strength in her lower limbs. MM stated that this would include examining Patient 8’s calf strength in standing and assessing the strength of Patient 8’s quadriceps muscles, hamstrings, hip adductors and hip abductors. MM stated that the Registrant should have used the standard testing, taught during physiotherapy training, to test the strength in these muscle groups.

154. MM also told the Panel that the Registrant did not assess the muscle strength in Patient 8’s lower limbs during this appointment. MM also told the Panel that the effect of this is that the Registrant would not have been able to assess whether there had been any improvement after Patient 8 had completed the HEP, set previously.

155. In respect of clinical reasoning, MM told the Panel that the Registrant concluded that Patient 8 had full muscle strength in her lower limbs and that he advised Patient 8 to perform calf stretches, despite having assessed that Patient 8’s calf muscles were not tight. MM told the Panel that it was therefore not appropriate to advise Patient 8 to perform calf stretches, as this would have been unnecessary. MM stated that the Registrant’s assessment of Patient 8’s ankles was also incomplete in that he did not assess the strength of the ankles. MM drew the Panel’s attention to her observation notes, from the session, which recorded that the patient had presented with weakness in her pelvis, hips and quadriceps. MM told the Panel that the Registrant did not manage Patient 8’s pain correctly as he did not locate the structure in the ankle causing the pain.

156. MB told the Panel that the Registrant did not demonstrate adequate clinical reasoning during this assessment. MB told the Panel that through observation of balance testing, Patient 8 displayed weakness around the hips, pelvis and quadriceps, which appeared to contribute to reduced balance. MB informed the Panel that Patient 8 previously received treatment for an ankle injury but then returned for further physiotherapy treatment with what appeared to be a recurrent ankle problem. MB stated that this should have raised questions about what was causing Patient 8 to reinjure her ankle. MB told the Panel that the Registrant should have considered that this may not be an acute injury but a chronic condition and that he should have conducted further tests, led from observations, to understand why Patient 8 had reinjured her ankle, but that he did not do this.

157. MB also informed the Panel that the Registrant’s conclusion after conducting this assessment was incorrect and that there were a number of inconsistencies between what he had documented had taken place in his clinical records and what she had observed to have taken place. For example, MB stated, that the Registrant’s clinical records concluded that Patient 8 demonstrated full muscle strength in her lower limbs when performing hip flexion, hip abductions, adductions and hip extensions. MB told the Panel that this was simply not correct. MB stated that when she observed Patient 8 in a standing position, it was clear from the way that Patient 8’s foot was reacting that there was weakness around the hip and there was weakness and instability in the ankles.

158. MB told the Panel that the implication of not reaching the correct conclusions when conducting an assessment is that the physiotherapist would be unable to direct the treatment appropriately. If the physiotherapist’s conclusion is incorrect then the treatment plan will also be incorrect and this would delay patient 8 from recovering.

159. The Panel noted that the Registrant denied Particulars 3(c)(i) and 3(c)(ii). The Registrant stated, during his evidence, that MM took over the session and did not allow him to complete the assessment or demonstrate clinical reasoning.

160. Having carefully considered all of the evidence, the Panel accepted MB’s and MM’s accounts, which accorded with one another, and was satisfied that the Registrant did incorrectly conclude that there was full muscle strength in Patient 8’s lower limbs on the 25 January 2017. The Panel was also satisfied that the Registrant did not demonstrate his clinical reasoning in relation to his assessment and the advice provided to the patient in respect of the continued exercises for the calf muscles.
161. The Panel determined that in respect of Patient 8, the Registrant did not demonstrate safe or effective practice, as there remained a further risk of ankle injury.

162. Accordingly, Particulars 3(c)(i) and 3(c)(ii) are proved.

Particular 4(a)(i), 4(a)(ii) and 4(a)(iii)
4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:
 a) on or around 11 November 2016 while attending to Patient 1:
  i. you did not assess the groin area; and or
  ii. assess and/or adequately assess the patient’s hip; and/or
  iii. conduct hypermobility testing and/or apply the Beighton    scoring system to assign Patient 1 with a hypermobility score.

163. MM informed the Panel that during Patient 1’s assessment she would have expected the Registrant to conduct a range of tests based on the findings of his subjective assessment. MM stated that this would have included, but is not limited to, asking the patient to walk, run, jump, hop and perform a single leg stance. MM also stated that she would have expected the Registrant to try and identify which of the structures around Patient 1’s hip were causing Patient 1’s pain and carry out a ‘full compression test’. MM also stated that because the patient was referred for hypermobility, the Registrant should also have applied the ‘Beighton scoring system’ to provide an indication of the level of generalised hypermobility in the patient.

164. MM told the Panel that the Registrant did not assess or even look at Patient 1’s groin at all during the appointment.

165. MM also told the Panel that the Registrant did not assess or ask the patient about his pain in his hip or look at the patient’s hip movements during the session on the 11 November 2016. Further MM confirmed to the Panel that the Registrant did not conduct the Beighton scoring test on the patient either.

166. The Panel noted that the Registrant accepted that he did not assess the groin area or adequately assess the patient’s hip, but that the Registrant denied the need for a Beighton scoring test, indicating that he was told not to perform one. The Registrant also denied the overarching stem of the Particular.

167. Having carefully considered all of the evidence before it, the Panel concluded that the Registrant was under an obligation to conduct relevant assessments and to use appropriate assessment techniques in respect of Patient 1 on the 11 November 2016. The Panel was satisfied, upon reviewing the evidence, that the Registrant did not conduct a relevant assessment of Patient 1’s groin area and that the Registrant also failed to assess the patient’s hip. Further, the Panel was satisfied that the Registrant should have conducted hypermobility testing, in the form of a Beighton score test, to assign Patient 1 with a hypermobility score and that he failed to do so.

168. Accordingly, Particulars 4(a)(i), 4(a)(ii) and 4(a)(iii) are proved.

Particular 4(b) – found proved
4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:
 b) on or around 11 November 2016 while attending to Patient 2 you  did not assess their eye-hand coordination;

169. MM told the Panel that during Patient 2’s appointment she would have expected the Registrant to assess Patient 2’s eye-hand coordination by observing Patient 2’s throwing and catching ability and that it would also have been important to assess or ask about Patient 2’s hand-writing and ask questions about Patient 2’s ability to fasten buttons and zips or use cutlery. MM informed the Panel that she would also have expected the Registrant to conduct a full coordination test, including shoulder and trunk stability testing, as well as eye-hand coordination. This would have involved Patient 2 demonstrating a range of movements and activities, assessing how long Patient 2 could hold each position for and how well Patient 2 could perform the movement. MM also told the Panel that the Registrant should have tested Patient 2’s shoulder.

170. MM told the Panel that, on 11 November 2016, the Registrant did not assess Patient 2’s eye-hand coordination at all during the appointment. She also told the Panel that the Registrant’s patient records state that Patient 2 completed throwing and catching exercises stood on one leg and knelt on one knee but that this was untrue, as she did not observe Patient 2 performing any of these movements.

171. MM stated that the Registrant also noted, in the patient records, that Patient 2 demonstrated bridging and half-bridging, but Patient 2 did not perform these movements and that she did not witness the Registrant conducting any assessment of the patient’s eye-hand coordination at all.

172. MM also told the Panel that that the implication of not measuring Patient 2’s coordination issue is that Patient 2’s coordination cannot be treated. MM informed the Panel that the Registrant should have known that he needed to assess Patient 2’s eye-hand coordination because this is what the patient was referred for.

173. The Panel noted MM’s observation notes, which were completed during MM’s observation of the Registrant on 11 November 2016, and which stated “Eye-hand co-ordination was not assessed during this appointment, even though that was the reason that the child was originally referred to physiotherapy”.

174. The Panel also noted that the Registrant denied this allegation.

175. Having carefully considered all of the evidence before it, the Panel was satisfied that the Registrant was under an obligation to conduct relevant assessments of Patient 2 and that he failed to do so. Accepting and preferring MM’s account of the assessment of Patient 2, the Panel found as a matter of fact that MM did not leave the room during Patient 2’s assessment and that the Registrant did not assess Patient 2’s eye-hand coordination during the appointment.

176. Accordingly, Particular 4(b) is proved.

Particular 4(c)(i) and 4(c)(ii) – found proved
4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:
 c) on or around 16 November 2016 while attending to Patient 2a you:
  i. did not assess the patient’s right knee and/or muscle strength   around the right knee;
  ii. did not assess tracking and/or movement of the right patella;

177. MB gave evidence to the Panel that Patient 2a was initially referred for physiotherapy due to instability around her right patella (knee cap). In order to treat this, the Registrant would need to focus on strengthening Patient 2a’s muscles around the knee joint to increase stability. MB stated that the Registrant could have assessed strength by asking Patient 2a to extend her leg at the knee and carry out a strength resistance test by applying pressure against the knee. She informed the Panel that the Registrant could then score the patient’s strength using a grading system such as the ‘Oxford System’, which ranges from 0-5. MB told the Panel that the Registrant should also have observed how the knee responds when Patient 2a performs a static quadriceps contraction, which involves the patient contracting their quadriceps muscle by pushing their knee downwards into a bed as this would have allowed the Registrant to track the effect of this movement on Patient 2a’s knee cap. MB also informed the Panel that the Registrant should have also asked Patient 2a to carry out a straight leg raise to observe the stability around Patient 2a’s knee when performing a squat or single leg squat to see how the knee reacts to these movements.

178. MB told the Panel that the Registrant should have assessed the patella movement by asking the patient to perform a static quadriceps contraction, which involves tensing the quadriceps muscle so that the Registrant can examine how the patella moves and note whether it goes straight up or tracks to one side. MB stated that this could indicate muscle imbalance as it means that there is tightness in the structures located on the outside of the leg or a weakness of the muscles in the inside of the leg.

179. MB also told the Panel that she did not observe the Registrant assessing Patient 2a’s right knee or the muscle strength around her knee at all during the assessment on 16 November 2016. Further, she also informed the Panel that the Registrant did not assess the tracking and movement of the right patella.

180. The Panel noted that the Registrant denied this particular. The Registrant indicated that he had asked Patient 2a to stretch her right knee fully from a bending position and that Patient 2a also bent her knee from a fully stretched position against resistance, which was performed when assessing the knee muscle strength. The Registrant also stated that kneecap movement was assessed.

181. The Panel carefully considered all of the evidence before it. In particular the Panel had regard to MB’s observation note, which stated “did not assess the knee fully, did not assess muscle strength, patella tracking, movement of patella”.

182. Accepting MB’s account of events, the Panel was satisfied that the Registrant was under an obligation to conduct relevant assessments of Patient 2a and that he did not do so in that he failed to assess Patient 2a’s right knee and muscle strength around the knee and that he did not assess tracking and movement of the right patella.

183. Accordingly, Particulars 4(c)(i) and 4(c)(ii) are proved.

Particular 4(d)(i), 4(d)(ii) and 4(d)(iii) – found proved
4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:
 d) on or around 11 November 2016 while attending to Patient 4 you  did not:
  i. fully test shoulder stability;
  ii. test hand writing;
  iii. test range of movement of the elbow and/or wrist and/or    shoulder.

184. MM told the Panel that if the Registrant suspected that Patient 4’s pain was caused by poor hand writing, she would have expected him to test Patient 4’s shoulder stability. MM informed the Panel that this could have been assessed by asking Patient 4 to perform some weight bearing activities such as press-ups against the wall, perform a wheel-barrow movement or stand on their arms and legs to perform half-press ups. MM told the Panel that she would have expected the Registrant to test Patient 4’s full range of movement in the shoulder. MM told the Panel that the Registrant did not test Patient 4’s shoulder stability.

185. MM also informed the Panel that as Patient 4 was referred for physiotherapy treatment for experiencing pain after using his hand to write, that she would have expected the Registrant to try and find out why handwriting was causing him pain and that he could have done this by assessing Patient 4 writing. This would have allowed the Registrant to assess if he was holding the pen correctly, whether his arm was in the correct position or whether his arm was tight around his shoulder, when he completed the task. MM informed the Panel that the Registrant did not assess Patient 4’s handwriting during this appointment and then told Patient 4 that he would be referred to a handwriting group.

186. MM also described the Registrant’s assessment of Patient 4 as “crazy” and indicated that she had to intervene in this appointment and tested the full motion of Patient 4’s elbow, shoulder and wrist.

187. The Panel noted that the Registrant had made a partial admission in respect of this particular, in that he admitted not fully testing the shoulder stability or the handwriting. He stated that he did test the range of movement of the elbow and wrist, but that he did not test the shoulder range of movement because he was prevented from doing so, owing to MM intervening.
 
188. The Panel also noted MM’s observation note for the 11 November 2016 which stated “You did not fully test shoulder stability or hand writing, but you did assess spinal alignment and balance on a wobble board. Not sure what you were assessing”.

189. Having regard to all of the evidence before it, the Panel accepted MM’s evidence that the Registrant did not initially conduct relevant assessments in respect of Patient 4 on the 11 November 2016 but only did so after the intervention of MM. The Panel was satisfied that the Registrant should have fully tested Patient 4’s shoulder stability, hand writing and range of movement of the elbow, wrist and shoulder and that he failed to do so until after MM had intervened and demonstrated the assessment required.

190. Accordingly, Particulars 4(d)(i), 4(d)(ii) and 4(d)(iii) are proved.

Particular 4(e) – found proved
4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:
 e) on or around 16 November 2016 while attending to Patient 1a you  did not block the contralateral side of the patient’s leg when assessing  the hamstring muscles;
191. MB informed the Panel that based on Patient 1a’s condition the Registrant would need to measure the patient’s hamstring muscles during his objective assessment of the patient. She described that this would involve examining the length of Patient 1a’s hamstring by asking Patient 1a to carry out a straight leg raise or examining the popliteal angle. She explained that the popliteal angle is measured by asking the patient to bend their leg to 90 degrees from the hip before then holding the knee at a 90-degree angle. MB stated that the Registrant should then block the contralateral (other) leg and the leg being tested would be passively straightened from the knee as far as possible. MB stated that it was important to block the contralateral side of Patient 1a’s leg during this assessment to effectively measure the muscle accurately and that the implication of not blocking it is that you may record a false measurement as Patient 1a’s leg may spring upwards to compensate for the movement.

192. MB informed the Panel that she observed that the Registrant did not block the contralateral side of Patient 1a’s leg when carrying out the assessment. MB stated that the Registrant should have known that he needed to do this because she had explained this to him on a previous occasion. She stated that in isolation she would not have felt significantly concerned by this error, but that it was a repeated error that took place as part of a wider context of errors on the Registrant’s part. This concerned her.

193. The Panel noted that the Registrant denied this particular. In his witness statement he stated “I deny this allegation. I did not assess the hamstring muscle length so it was not necessary to block the leg”.

194. The Panel had regard to MB’s observation notes, which were made during her observation of the Registrant on the 16 November 2016, where the notes stated ‘In assessing the hamstrings Santha did not block the contralateral side’.
195. The Panel was satisfied, after carefully considering all of the evidence before it, that the Registrant was under an obligation to use appropriate assessment techniques and that he failed to do so in respect of Patient 1a, on the 16 November 2016, by failing to block the Contralateral side.

196. Accordingly, Particular 4(e) is proved.

Particular 4(f)(i), 4(f)(ii), and 4(f)(iii) – found proved
4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:
 f) on or around 16 November 2016 while attending to Patient 4a you  did not:
  i. complete a thorough assessment for the management of    lower limb hypermobility;
  ii. assess muscle strength in the lower limbs;
  iii. assess calf length;

197. MB gave evidence to the Panel that Patient 4a presented with hypermobility in his lower limbs. She stated that hypermobility means that the ligaments around the joints, which are there to stabilise the joints, are lax, which results in instability. MB told the Panel that she would have expected the Registrant to assess the strength of the patient’s muscles around their hips by conducting a number of movements. MB also stated that she would have expected the Registrant to test Patient 4a’s knee strength, quadriceps strength, and ankle strength and ankle stability. MB added that when assessing patients with joint hypermobility the Beighton Score system would be used to grade the patient’s hypermobility on a scale between 1 and 9. She stated that she would have expected the Registrant to use this system.

198. MB also told the Panel that the treatment for hypermobility is focussed towards strengthening the muscles so that they can take over the role of the patient’s ligaments in order to stabilise the hypermobile joint and that this requires hands-on manual muscle testing to identify areas of weakness and would include resistance testing. MB informed the Panel that she did not witness the Registrant assessing the muscle strength of Patient 4a’s lower limbs at all and that the Registrant did not provide the correct treatment to Patient 4a during this appointment. MB told the Panel that the Registrant was examining function rather than specific muscle strength and that it was important for him to test muscle strength as this is fundamental to the management of hypermobility. MB told the Panel that she could see no clinical reason behind the assessments that the Registrant was conducting during the appointment with Patient 4a.

199. MB also told the Panel that during this appointment Patient 4a disclosed that he was suffering with pain in his calf muscles after taking part in physical activity. MB informed the Panel that she would have expected the Registrant to assess Patient 4a’s calf strength and calf length to understand what was causing Patient 4a to feel pain and that such an assessment would involve passively stretching the calf muscle to measure how far the Registrant is able to move Patient 4a’s foot while his knee is bent and when it is straight. MB stated that the Registrant did not assess Patient 4a’s calf strength or calf length at all.

200. The Panel noted the Registrant’s admission in respect of Particulars 4f)i, 4f)ii and 4f)iii. In particular the Panel noted that the Registrant, in his witness statement, stated “I admit that I did not conduct these relevant assessments. As I have mentioned previously, from the beginning of the appointment MB kept intervening which prevented me from doing the full assessment”.

201. Having regard to all of the evidence before it, the Panel was satisfied that on 16 November 2016, in respect of Patient 4a, the Registrant did not conduct an appropriate assessment for the management of lower limb hypermobility, when he was under an obligation to do so.

202. Further, the Panel was also satisfied that the Registrant did not conduct the relevant assessments for muscle strength in the lower limbs or calf strength, when he was under an obligation to do so.

203. Accordingly, Particulars 4(f)(i), 4(f)(ii) and 4(f)(iii) are proved.

Particular 4(g)(i), 4(g)(ii), 4(g)(iii) – found proved
4. Did not conduct relevant assessments and/or use appropriate assessment techniques in that:
 g) on or around 25 January 2017 while attending to Patient 8 you did  not:
  i. assess strength of the ankles in standing;
  ii. test pelvic stability until prompted to do so;
  iii. examine strength of the quadriceps muscle;

204. MM told the Panel that both she and MB had observed the Registrant on 25 January 2017. MM also told the Panel that she would have expected the Registrant to assess Patient 8’s ankles and muscle strength in her lower limbs, which would have included examining Patient 8’s calf strength in standing and assessing the strength of Patient 8’s quadriceps muscles, hamstrings, hip adductors and hip abductors.
205. MM informed the Panel that the Registrant did not assess the muscle strength in Patient 8’s lower limbs during this appointment and that he also did not examine strength in standing, pelvic stability, calf strength, quadriceps muscle strength or hip strength. MM also stated that the Registrant would have been expected to conduct a range of movement assessments of the ankle as Patient 8’s original referral was for ankle sprain.

206. MB informed the Panel that as Patient 8 presented with an ankle injury the Registrant should have assessed Patient 8 by focussing on the lower limbs and examining the range of movement of the ankle as well as conducting resistance testing. Resistance testing would involve asking Patient 8 to carry out a number of movements before applying pressure to prevent Patient 8 from completing the movement in order to observe the level of strength that Patient 8 demonstrated.

207. MB told the Panel that as Patient 8 had experienced a recurrent ankle sprain, she would have expected the Registrant to examine the strength and stability of Patient 8’s ankle when standing in a weight bearing position. She stated that this would be important, as it would assess Patient 8’s ability to function while experiencing the injury. MB told the Panel that based on her observation notes of the Registrant’s assessment of Patient 8 on 25 January 2017, he did not complete an adequate assessment of Patient 8’s muscle strength.

208. MB informed the Panel that the Registrant’s assessment of Patient 8 appeared to be fairly logical initially, but that he required prompting to carry out the correct tests. She stated that as an example it was clear to her that Patient 8 had reduced stability around the pelvis and that the Registrant did not notice this. MB stated that he should have observed this was the case and therefore assessed Patient 8’s strength and stability around the hips but he did not do this.

209. MB also told the Panel that during the appointment with Patient 8 the Registrant should have observed and identified that there was a weakness in Patient 8’s quadriceps that needed to be tested. She stated that when the Registrant started to assess Patient 8’s hip strength, he asked Patient 8 to perform a single leg bridge. Patient 8’s quadriceps muscle demonstrated weakness based on his notes of the appointment and he did not examine the strength of Patient 8’s quadriceps muscle.

210. The Panel noted that the Registrant accepted that he did not do the three assessments outlined in Particulars 4g)i, 4g)ii and 4g)iii and that he also accepted that they should have been completed.

211. Having regard to all of the evidence before it, the Panel was satisfied that the Registrant was under an obligation, on the 25 January 2017, to conduct a relevant assessment in respect of Patient 8’s ankle strength, pelvic stability and the strength of the quadriceps muscle. He failed to do so.

212. Accordingly, Particulars 4(g)(i), 4(g)(ii), 4(g)(iii) are found proved.

Particular 5 – found proved
5. Did not implement appropriate monitoring procedures in that on or around 09 November 2016 while attending to Patient 3a you arranged a review appointment on/around 16 November 2016, when this was not clinically justified;

213. MB informed the Panel that the appropriate amount of time that should pass between review appointments for physiotherapy patients varies according to the patient’s condition or injury.

214. MB told the Panel that Patient 3a was suffering from a chronic condition and that chronic conditions should be monitored using review appointments less frequently than acute injuries and Patient 3a had received treatment from the Centre for approximately 11 months. Therefore, MB stated that she would have expected the interval between physiotherapy appointments to be approximately 8-12 weeks.

215. MB told the Panel that the Registrant’s clinical records of his previous assessment with Patient 3a on 9 November 2016 do not justify why a review appointment was booked within a week of the assessment on the 9 November 2016. MB informed the Panel that she asked the Registrant to explain why Patient 3a had been booked in for another appointment within a week and the Registrant said that there was a vacant appointment in his clinic and as he was undergoing a performance review, he wanted to be pro-active and fill his appointment slots. MB told the Panel that she felt that there was no clinical justification that this patient be assessed again within one week as there is no possibility that there would be any difference in the size of Patient 3a’s calf muscle bulk as it would take 6-8 weeks to notice a change in strength and bulk.

216. The Panel noted that the Registrant denied this Particular. However, after carefully considering all of the evidence before it, the Panel accepted MB’s account and was satisfied that the Registrant did not implement appropriate monitoring procedures in that, on 9 November 2016, the Registrant arranged a review appointment on 16 November 2016 when this was not clinically justified.

217. Accordingly, Particular 5 is found proved.

Particular 6(a) – found proved
Particular 6(b) – found not proved
6. In relation to setting goals:
 a) on or around 21 July 2016 you did not set and/or record any  SMART goals for Patient 2;
 b) on or around 11 November 2016 while attending to Patient 2 you  did not set and/or record any SMART goals;
218. The Panel noted that the Registrant admitted to not setting or recording SMART goals for Patient 2 on 21st July 2016.

219. The Panel had regard to MM’s evidence, which had informed it that the Registrant’s clinical notes did not contain any reference to SMART goals and therefore there was no benchmark against which the Registrant could measure Patient 2’s progress. Further, MM also told the Panel during her evidence that the Registrant did not set any SMART goals during the appointment with Patient 2 nor did he inform Patient 2 which activities he should aim to complete or what he needed to achieve by carrying out the half-bridging and pelvic-lift movements.
 
220. The Panel also noted Patient 2’s clinical records, dated 21 July 2016. In particular, the Panel noted that the Registrant had made an entry in respect of Patient 2’s goals, including long-term goals to be achieved. However, the Panel also noted that the goals, as recorded, were not SMART goals.

221. Having regard to all of the evidence, the Panel were satisfied that the Registrant was under an obligation to set SMART goals for Patient 2 during the appointment on the 21 July 2016 and the Registrant failed to set any SMART goals and consequently could not record what had not been discussed or set.

222. Accordingly, Particular 6(a) is proved.

223. The Panel noted that the Registrant admitted to not setting or recording SMART goals for Patient 2 during the appointment on 11 November 2016. However, the Panel also noted that the Registrant also sought to qualify his admission by stating that it was not necessary to set SMART goals as Patient 2 was being discharged from physiotherapy care, and therefore it was unnecessary.

224. The Panel had regard to MM’s oral evidence, and concession, which had informed the Panel that it was not necessary to set SMART goals when a patient was being discharged from physiotherapy care.

225. The Panel had regard to the evidence before it. The Panel noted, from Patient 2’s clinical notes that SMART goals had not been set. The Panel also accepted MM’s oral evidence that it would not have been necessary to set SMART goals for a patient who was being discharged from physiotherapy care.

226. Taking each of these matters into account, the Panel was satisfied that it was not necessary for the Registrant to set SMART goals for Patient 2 on 11 November 2016. The Panel was also satisfied therefore that it was also not necessary to record SMART goals that did not need to be set.

227. Accordingly, the Panel found Particular 6(b) not proved.

Particular 6(c) – found proved
6. In relation to setting goals:
 c) on or around 25 January 2017 while attending to Patient 8 you set  goals which were not SMART goals and/or not related to function.

228. The Panel noted that the Registrant admitted this Particular. However, the Panel also noted that the Registrant sought to qualify his admission by stating that MM took over the patient interaction and appointment and this did not provide, or allow, the Registrant with an opportunity to set SMART goals for Patient 8.

229. The Panel noted that the witness evidence in respect of this Particular was unclear. MM’s witness statement was silent on the issue of SMART goals for Patient 8, on 25 January 2017, and MB’s witness statement evidence was conflicting. She first stated that the goals set by the Registrant were not SMART goals or related to function and then went on to state that SMART goals are usually set at an initial appointment with a patient. The appointment on 25 January 2017 between the Registrant and Patient 8 was a follow up appointment; the intimation being that SMART goals would not have been set at a follow-up, but rather discussed and reviewed during this appointment. The Panel were of the opinion that in the absence of setting SMART goals on the 1 August 2016, that they should have been set on the follow up appointment on 25 January 2017.
 
230. The Panel had regard to MB’s clinical observation notes, which stated ‘Goals not smart and not related to function’. The Panel also noted the contents of Patient 8’s clinical records, which confirmed MB’s observation notes, that the goals set were not SMART.
 
231. Accordingly, the Panel find Particular 6(c) proved.

Particular 7 – found proved
7. In respect of Patient 2 you did not record the recommended exercise programme and/or did not adequately discuss this with Patient 2 during the appointment on 11 November 2016.

232. The Panel had regard to MM’s witness statement which stated that as part of physiotherapy, patients are advised to carry out certain exercise programmes to improve their strength, ability or endurance, which in turn helps to reduce pain or recover from injury. Additionally, an exercise programme must state how often each exercise must be completed and how many repetitions are recommended. She also told the Panel that exercise programmes need to be recorded and monitored and a copy of the exercises needs to be provided to the patient and that it should be reviewed at the next appointment to determine if the programme is effective or if it needs to be modified.

233. MM was clear in her evidence before the Panel that it would not be possible to review an exercise plan’s effectiveness if it was not recorded, as a physiotherapist would have to rely on their memory alone as to what the patient had been advised to do. Further, if a different physiotherapist was to review the patient, they would not know what programme had previously been set, which would make the review appointment inefficient.
234. The Panel had regard to Patient 2’s clinical notes and noted, in particular, that during the initial assessment on 21 July 2016, the Registrant wrote ‘HEP: physio tool given’. Further, the Panel also noted that in a discharge letter, dated 11 November 2019, the Registrant also placed an ‘X’ in the box which stated that the ‘Home exercise programme’ had been completed.

235. The Panel also had regard to MM’s contemporaneous clinical observation notes from 11 November 2016, which stated ‘Patient was informed to continue with exercise programme, but no exercise programme was found in the notes. Patient was discharged (told when he entered the room, before he was even reviewed that that was going to happen), but to continue with the exercises particularly during growth spurts. Not sure what exercises were referred to’.

236. The Panel noted that the Registrant denied this Particular in his witness statement, but during cross-examination accepted the following:
i. there was no way that a second physiotherapist coming to review the patient afresh could determine what the exercise programme was or whether it should be amended;
ii. there was no record of the recommended exercise programme or details of the exercises prescribed or the frequency with which they should be performed; and
iii. that he should have ‘of course’ recorded the exercises.

237. Having regard to all of the evidence before it, the Panel was satisfied that the Registrant was under an obligation to record the recommended exercise programme for Patient 2 and to adequately discuss it with him. The Panel was also of the view that the Registrant did not record the HEP and that he also failed to adequately discuss it with the patient during the course of the appointment.

238. Accordingly, Particular 7 is proved.

Particular 8(a) – found proved
8. Did not maintain appropriate records in that:
 a) You recorded an incorrect pain score within Patient 4’s clinical  notes dated 11 November 2016;

239. MM informed the Panel that she would expect the Registrant to record all of his findings from both his subjective and objective assessments for Patient 4 and that this would have included the patient’s pain score. She stated that a pain score is a subjective score that the patient uses to describe the level of pain that they are experiencing and that it was important to record it as it enabled the practitioner to monitor whether the patient’s pain was increasing or decreasing. It was also an indication as to whether physiotherapy was effective or not.

240. MM told the Panel that she would have expected the Registrant to have assessed the patient during the appointment but that his appointment with Patient 4 was “chaotic” and he did not assess the child at all. 

241. The Panel had regard to MM’s contemporaneous observation notes, dated 11 November 2016, which stated ‘Child reports 7/10 you noted 5/6 in the records’.

242. The Panel also noted the patient’s clinical records, dated 11 November 2016, which showed that the Registrant had circled boxes ‘5’ and ‘6’ on the numerical scale.

243. The Panel accepted and preferred MM’s evidence to that of the Registrant’s. The Panel was satisfied that the Registrant was under an obligation to accurately record the patient’s pain score and that he failed to do so in that he noted an incorrect pain score for Patient 4 in the patient’s clinical notes.

244. Accordingly, the Panel found Particular 8(a) proved.

Particular 8(b)(i) and 8(b)(ii) -  found proved
8. Did not maintain appropriate records in that:
 b) in respect of the assessment on or around 22 September 2016 in  respect of Patient 5 you:
  i. did not record the reason for arranging a review appointment;
  ii. did not record the recommended exercise programme.

245. The Panel noted that the Registrant admitted, part way through the hearing, to not recording the reason for arranging a review appointment and that he did not record the recommended exercise programme for Patient 5. However, he denied this amounted to a failure to maintain appropriate records.

246. MM told the Panel that Patient 5 presented with inward rolling feet and that during an initial assessment she would have expected the Registrant to assess whether there may be an underlying neurological or orthopaedic reason for any tight muscles that might be causing the patient’s condition. If there was no underlying condition, the Registrant should discharge the patient as most children outgrow the condition. However, if he had identified Patient 5 suffered with an identified underlying condition then a review appointment should have been arranged. MM told the Panel that the Registrant did not record a reason for arranging a review appointment with Patient 5 in his notes on the assessment on 22 September 2016. MM also told the Panel that when she raised this point with the Registrant that he stated that he had arranged for the review appointment as Patient 5’s mother was concerned about Patient 5’s balance.

247. The Panel had regard to MM’s contemporaneous notes, dated 11 November 2016, which stated ‘Not sure why the child was being reviewed today as no abnormalities found at his first assessment. You said that you were reviewing balance as the mum had been concerned, however, this is nowhere in the notes’.
248. The Panel also noted the patient’s clinical records made no mention of the reason for arranging a review appointment.

249. The Panel was of the view that the Registrant was under an obligation to record the reason for arranging a review appointment and that he had failed to do so.

250. MM also told the Panel that the Registrant would have been expected to record any exercise programme that he recommended in Patient 5’s clinical records. She explained that this information would allow the Registrant to understand if the exercise programme was effective and would allow the Registrant to monitor Patient 5’s progress. MM drew the Panel’s attention to the clinical records where the Registrant had stated that he had ‘advised exercises to improve ankle position and bridging’; but that he did not record which exercises that he was referring to.

251. The Panel also noted MM’s contemporaneous observation notes where she stated ‘No exercises where [sic] documented although this was what the review appointment was for’.

252. The Panel had regard to the patient’s clinical records which stated ‘Advised exs to improve ankle position and bridging. Advised swimming activities’. The Panel noted that no other mention of exercises was made in the patient’s clinical records dated 22 September 2016.

253. Taking all of the aforementioned evidence into account, the Panel was satisfied that the Registrant did not record the recommended exercise programme for Patient 5 on or around the 22 September 2016. Further, the Panel was also satisfied that having failed to record the exercise programme, the Registrant had failed to maintain appropriate records.

254. Accordingly, the Panel found Particulars 8(b)(i) and 8(b)(ii)  proved.

Particular 8(c) – found proved
8. Did not maintain appropriate records in that:
 c) on or around 16 November 2016 while attending to Patient 2a you  recorded improved muscle strength when this had not been assessed;

255. MB told the Panel that Patient 2a was initially referred for physiotherapy due to instability around her right patella (knee cap). MB told the Panel that she would have expected the Registrant to re-assess the patient to determine the strength in her knee during the appointment. MB informed the Panel that the Registrant did not reassess the patient’s knee or muscle strength during the appointment.

256. The Panel also had regard to MB’s clinical observation notes, dated 16 November 2016. In particular, the Panel noted that MB had stated ‘Did not assess the knee fully, did not assess muscle strength, patella tracking, movement of patella.’ She also stated, later in her note, ‘Improved muscle strength documented but not assessed.’
257. Having regard to all of the evidence before it, the Panel preferred MB’s evidence and was satisfied that the Registrant did not assess Patient 2a’s muscle strength, to the required standard, during the appointment and that he then proceeded to record it within the patient’s clinical records. The Panel were also satisfied that the Registrant’s actions amounted to a failure to maintain appropriate records.

258. Accordingly, Particular 8(c) is proved.

Particular 8(d) – found proved
8. Did not maintain appropriate records in that:
 d) in respect of your appointment on or around 16 November 2016  with Patient 3a you recorded calf muscle bulk as ‘improving’ when you  did not have a measure from a previous assessment to compare  and/or you did not record the measurement of calf muscle bulk on this  date;
259. MB told the Panel that Patient 3a presented with reduced calf muscle bulk and that in order to assess this, the Registrant should use tape to measure around Patient 3a’s calf muscle and record it and this would form part of the objective assessment. The Registrant would then have a measure by which to compare any increase or decrease in muscle bulk at later assessments.

260. MB told the Panel that whilst she was not present at the start of the consultation between the Registrant and Patient 3a, she noted that the Registrant had entered, in the patient’s records that muscle bulk had improved. However, when she reviewed the notes of his previous assessment with the patient she could not find the measurement recording the patient’s calf muscle bulk by which it could be compared. This would have meant, she said, that the Registrant did not have an objective measurement relating to muscle bulk or muscle strength of Patient 3a on 16 November 2016.

261. The Panel had regard to MB’s contemporaneous observation notes which stated ‘Santha stating muscle bulk has improved, but no measure from previous ax to compare. From notes identified was seen last week 9.11.16. Questioned why he had been brought back in one week. Santha relied [sic] to look at ROM and muscle bulk, I explained that this would not have changed in a week. Santha said he had cancellation and tried to feel [sic] slot thought he could do episodes of care.’

262. The Panel had regard to Patient 3a’s clinical records and in particular noted that the Registrant had stated on the 09 November 2016, ‘improving calf muscle bulk’ but that no specific measurement had been recorded. Further, in the same patient records, the Panel also noted that on 16 November 2016, the Registrant had noted the calf muscle bulk as improving but no specific measurements were recorded.

263. Having regard to all of the evidence before it, the Panel was satisfied that the Registrant was under an obligation to measure and record Patient 3a’s calf muscle bulk and that he had failed to do so. The Registrant recorded Patient 3a’s calf muscle bulk as improving when he did not have a previous measure to compare it against. Further, the Panel was also satisfied that the Registrant had failed to record the measurement of calf muscle bulk on a previous occasion, when he was under an obligation to do so. The Panel was also satisfied that in respect of both of these actions the Registrant failed to maintain appropriate records.

264. Accordingly, Particular 8(d) is proved.

Particular 8(e) – found proved
8. Did not maintain appropriate records in that:
 e) on or around 25 January 2017 while attending to Patient 8 you did  not record calf length.

265. MB told the Panel that as Patient 8 presented with an ankle injury, it would be necessary to objectively measure Patient 8’s calf length. MB told the Panel that according to the clinical records of this appointment, the Registrant did not note down the measurement of Patient 8’s calf length, although she did observe him assessing it.

266. The Panel noted that the clinical observation notes, completed by MB, stated ‘calf muscle length not mentioned but was assessed’.

267. The Panel had regard to the Patient 8’s clinical records and noted that they were silent as to calf muscle length.

268. The Panel also noted that the Registrant admitted to not recording Patient 8’s calf muscle length.

269. The Panel was satisfied, having regard to the evidence before it, that the Registrant was under an obligation to record the muscle calf length for Patient 8, on 25 January 2017, and that the Registrant failed to do so. The Panel was also of the view that this failure meant that the Registrant had failed to maintain accurate records.

270. Accordingly, Particular 8(e) is proved.

Particular 8(f) – found proved
8. Did not maintain appropriate records in that:
 f) you recorded that Patient 2 had completed exercises during the  appointment on or around 11 November 2016 including throwing and  catching and/or standing and/or bridging, when they had not.

271. MM gave evidence to the Panel that as Patient 2 presented with reduced eye-hand co-ordination, she would have expected the Registrant to assess Patient 2’s eye-hand co-ordination by throwing and catching objects.

272. MM told the Panel that the Registrant did not assess Patient 2’s eye hand co-ordination during the appointment on 11 November 2016. She also drew the Panel’s attention to the clinical records for Patient 2 in which the Registrant stated that Patient 2 completed throwing and catching exercises, stood on one leg and stood on one knee. MM told the Panel that this was untrue and that she did not observe Patient 2 performing any of these movements. MM also highlighted to the Panel that the Registrant had also noted that Patient 2 had demonstrated bridging and half-bridging when Patient 2 had not conducted any of these movements. MM stated that the Registrant did not conduct any assessment of the patient’s eye-hand coordination at all.

273. The Panel had regard to MM’s clinical observation notes, dated 11 November 2016, which stated ‘Eye-hand co-ordination was not assessed during the appointment, even though that was the reason that the child was originally referred to physiotherapy’.

274. The Panel observed that Patient 2’s clinical records stated ‘O/E- demonstrated HEP Exs. Bridging, ½ bridging, SLR on prone, ½ kneeling exercises with throwing activities’

275. The Panel accepted and preferred MM’s evidence in respect of the dispute of fact concerning this Particular, finding her evidence more credible that the Registrant’s. The Panel was satisfied that the Registrant was under an obligation to assess the patient by requiring them to complete exercises for eye-hand coordination. The Panel find, as a matter of fact that the Registrant did not complete throwing or catching exercises whilst in standing position or kneeling position and that he recorded them in Patient 2’s clinical record when they had not occurred.

276. In doing so, the Panel was content that the Registrant had failed to maintain appropriate patient records.

277. Accordingly, Particular 8(f) is found proved.

Particular 9 – found proved
9. On or around 1 November 2016 you denied the existence of a folder which contained incomplete patient records.

278. MM told the Panel that during a meeting held on 1 November 2016, MB specifically asked the Registrant about a red folder containing incomplete records. She stated, we also asked ‘are there any notes that we don’t know about and you need help with?’ She stated that the Registrant denied the existence of a red folder but then admitted that he did have a red folder, but denied it contained any incomplete patient records. She told the Panel that the Registrant claimed that the folder was used to contain the notes for the clinics that he was due to run each day and also used for records, which required additional reports to be completed for the patient.

279. MM gave evidence to the Panel that on 9 November 2016 MB had told her that the Registrant had stored over 20 sets of incomplete patient notes in a red folder.

280. MM drew the Panel’s attention to a letter sent from her to the Registrant, dated 10 November 2016, which stated ‘It has come to our attention that since we held your informal performance meeting last week there has been a new incident regarding patient record keeping. You were found to have a folder which held over 20 sets of patient files which were incomplete and filed outside of our patient filing system’.

281. Further, MM also drew the Panel’s attention to a letter from her to the Registrant, dated 24 November 2016, which outlined the ‘Outcome of Informal Performance Management meeting’.  In it, MM stated ‘At our previous meeting on 1/11/2016 [MB] specifically asked you about this folder as she suspected that you had a folder with incomplete records. At that meeting you first denied the existence of the red folder. You then admitted that you do have a red folder, but that it does not contain any incomplete patient records. You explained that the folder is used to place the notes for the clinic that you run on the day and sometimes for records where you have to do an additional report for the patient.’

282. The same letter continues ‘The evidence of the impact of your retaining patient records outside of the shared filing system is as follows: 1. On 9/11/2016 the band 5 therapist could not find a set of patient records and you produced the above named red folder which contained over 20 sets of incomplete records. They included the set of notes that were needed by the band 5.  2. Another set of notes was incomplete, and your appointment dated more than 6 months ago. 3. Some other records were from patients that you saw more than 3 weeks ago. 4. Some of your patient records had not even been started… My additional concern is that you were not truthful when we discussed the whereabouts and content of these notes at the meeting on 1/11/2016’.

283. Having regard to all of the evidence before it, the Panel was satisfied that the Registrant, during his meeting with MM and MB on 1 November 2016, denied the existence of a folder which contained incomplete patient records.

284. Accordingly, Particular 9 is found proved.

Particular 10 – found proved
10. In or around October and/or November 2016, you had not completed within 24 hours one or more patient records.

285. The Panel noted that the Registrant admitted this particular.

286. MM and MB both gave evidence to the Panel that Physiotherapists must complete all patient notes within 24 hours after the appointment has taken place so that the notes are accurate and that this was guidance provided by Chartered Society of Physiotherapist (‘CSP’) and the HCPC.

287. MB drew the Panel’s attention to a note made in respect of an ‘Urgent Supervision meeting regarding notes’ dated 09 November 2016, between herself and the Registrant. The note stated:

‘JF was running the RRLC1 clinic unable to find a set of FU notes previously seen in RPSP3 clinic.
I asked Santha if he had the notes as we had checked the file. He produced a red folder with over 20 sets of notes in it. I ask what all the notes were, he said some were discharges and some were for cancellation appointments. I reinforced what was said at the meeting on 1.11.2016, that notes need to be filed and kept in secure manner.
The missing notes were in the piles of notes. I asked why, he replied he had not completed them, he had not documented when the review appt was due.

I requested to look through the rest of the notes from the file.

Over 10 were discharges most within the 2 weeks or discharge.

There were 3 sets of notes from 24.10.2016 which were not completed at all. Np’s where objective ax had not been documented. On one set of notes the Subjective PMH, social history had been completed by the Mum the rest had not been completed at all. Santha said patients had arrived late that day he got behind. I explained that this is now over 2 weeks ago. 

7 sets of notes had not been completed, most small bits of info missing: Dates, unit numbers, plan. Others had more detailed info missing. One set had 2 entries missing from august and September, Another vestibular patient from April the objective ax was not completed and follow up conservations with management and parents not documented.
 3 sets were completed but had just not been filed…’

288. GH told the Panel that an incident occurred in November or December 2016 when ‘several piles of old and unfinished notes were found in his draw and tray’. GH told the Panel that he understood that the Registrant had previously told MB that his paperwork was up-to-date but that a short time after this another pile of paperwork containing incomplete patient records had been found in the Registrant’s drawer.
289. Having regard to all of the evidence before it, the Panel was satisfied that in around October and November 2016 the Registrant had not completed patient records within 24 hours.

290. Accordingly, Particular 10 is found proved.

Particular 11 – found proved
11. In or around November 2016 you insecurely stored patient records.

291. MM and MB gave evidence to the Panel that all patient records, including discharge reports and clinical notes, must be completed and stored in one of the three lockable filing cabinets inside the rehabilitation therapy office and that all patient notes are stored together so that they are accessible to all of the clinicians and can be reviewed if a patient calls the office and requests information about their physiotherapy treatment.

292. MB also told the Panel that on 09 November 2016, records were found in the side of the Registrant’s drawer and had not been locked away in one of the three lockable cabinets. The notes were found in the therapy team’s office in the Centre and that this was not an appropriate place to store notes as the office is not locked and the patient notes contain identifiable information about patients.

293. The Panel find as a matter of fact that the Registrant did leave patient records in his desk and that his actions in doing so did not conform to the standard expected; which was that patient records should be stored securely in the lockable cabinets provided.

294. Accordingly, Particular 11 is found proved.

Particular 12 – found proved
12. You subsequently filed the records found on 9 November 2016 without showing them to management beforehand contrary to a specific instruction from your manager.

295. MM told the Panel that after it was discovered that the Registrant had a number of incomplete patient records contained within a folder, she advised that the Registrant should be given time to complete them and that because she wanted to review the notes to ensure that they were correct and complete, she stated that the records should be handed to her or MB before filing. However, MM told the Panel that the notes were filed prior to her checking them.

296. MB told the Panel that she was not sure who had told the Registrant that they wanted to review the notes before they were filed away, to ensure that they were completed. However, it transpired, that when he was later questioned, the Registrant had filed the patient records away without passing them to a manager for checking.

297. In addition to the aforementioned evidence, the Panel also noted the contents of a letter from MM to the Registrant, titled, ‘Outcome of Informal Performance Management meeting’, dated 24 November 2016, which stated ‘On having become aware of the notes, Marie looked through all of the notes that you had kept in the file and gave you specific instructions on how to complete them and to show them to her for checking following completion. You chose to ignore that instruction and after completion of the notes you filed them in the filing cabinet so that Marie was unable to check them’.

298. Taking all of the aforementioned into account, the Panel find as a matter of fact that the Registrant was asked, on 09 November 2016, to show the completed records to a manager prior to filing them away and that he did not do so.
299. Accordingly, the Panel find Particular 12 proved.

Particular 13 – found proved
13. Your actions described in paragraph 8(c), 8(f), 9, 11 and/or 12 were dishonest.

300. The Panel find that the Registrant’s conduct and actions in respect of Particular 8(c), 8(f) and 9 were dishonest.

301. In respect of Particulars 8(c) and 8(f) these particulars concerned patient care sessions. MB made contemporaneous notes of each of the sessions she observed on the 11 November 2016 and 16 November 2016. She was clear and emphatic in her evidence that the information contained within each of the patient’s records did not reflect what she had observed, as taking place, during the Registrant’s sessions with each of the patients.

302. The Panel was satisfied that each entry, into each patient’s individual record was a conscious and deliberate act on the Registrant’s part to record matters so that his colleagues would believe that he had conducted a thorough assessment of each of the patients, when he had not done so.

303. In respect of Particular 9, the Panel noted the Registrant had originally denied the existence of a folder containing patient records to his managers, but had subsequently admitted the existence of the folder. The Registrant was a man whose practise was under scrutiny and the Panel was of the view that the Registrant had lied about the existence of the folder in an attempt to hide the incomplete patient records from his managers and his conduct had therefore been dishonest.

304. In respect of Particular 11, the Panel was satisfied that the Registrant had not sought to hide or lock patient records away. His colleagues knew that the folder with patient records existed and SM, in particular, gave evidence to the Panel as to the likely location of the folder in the office. The Panel was therefore satisfied that whilst Particular 11 amounted to poor record keeping and misconduct, the Registrant had not sought to act dishonestly.

305. The Panel was also satisfied that the Registrant had not acted dishonestly in respect of Particular 12. The Panel formed the view that whilst the Registrant had filed the records away without his mangers reviewing them, and in doing so had denied his managers of an opportunity to review the records; his actions had been done to avoid further scrutiny of his work.

Decision on Grounds
306. Having found all but one of the Particulars proved, the Panel went on to consider whether the Registrant’s conduct amounted to misconduct and/or a lack of competence.

Panel’s Approach
307. The Panel first considered whether any of the facts found proved amounted to lack of competence or misconduct. In doing so, it took account of the evidence before it, the parties’ submissions and accepted the advice of the Legal Assessor.

308. The Panel also considered the relevant Practice Note issued by the HCPTS, ‘Drafting Fitness to Practise Decision, together with the HCPC’s Standards of Conduct, Performance and Ethics 2016 and the HCPC’s Standards of Proficiency Physiotherapists in England 2013.

Lack of Competence
309. The Panel noted that the term ‘competence’ describes knowledge and skills, i.e. what a registrant ‘can-do’ and that the appropriate standard to be applied is that applicable to the post to which the practitioner had been appointed and the work he was carrying out; [Holton v GMC]. Competence of a Registrant is generally to be decided by reference to a fair sample of their work; R (on the application of Calhaem) v GMC [2007] EWHC2606admin.

310. The Panel considered that the matters charged in the Particulars of the Allegation represented a fair sample of the Registrant’s work as a Physiotherapist. The Panel noted that the Registrant had worked for the Trust for a number of years without incident. There was no evidence before the Panel that the Registrant had previously lacked competence in his role. Indeed, the evidence before the Panel from the witnesses was that the Registrant’s practice had deteriorated for reasons that were not clear to them, despite enquiry. Further, the witnesses also stated that they had put measures in place, such as observation sessions, by managers and colleagues, and action plans, in an attempt to address and support the Registrant’s identified issues. The evidence, which was consistent before the Panel, was that the Registrant was working in a supportive environment and that he had demonstrated poor attitude and application in response to the measures put in place for him.

311. The Panel was therefore satisfied that this was not a case where the Registrant did not possess the requisite understanding or competence for his role as a Physiotherapist and therefore the Panel did not find lack of competence applied in this case.

Misconduct
312. In considering the issue of misconduct, the Panel bore in mind the explanation of that term given by the Privy Council in the case of Roylance v GMC (No.2) [2000] 1 AC 311 where it was stated that:
 “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

313. The Panel considered whether any of the facts found proved amounted to misconduct.

314. The Panel found serious and wide ranging breaches of the HCPC’s Standards of Conduct, Performance and Ethics (dated 2016), but in particular:
3.5  You must ask for feedback and use it to improve your practice;
6.2  You must not do anything, or allow someone else to do something, which could put the health or safety of a service user, carer or colleague at unacceptable risk;
9.1  You must make sure that your conduct justifies the public’s trust and confidence in you and your profession;
10.1  You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to;
10.2  You must complete all records promptly and as soon as possible after providing care, treatment or other services; and
10.3  You must keep records securely by protecting them from loss, damage or inappropriate access.

315. The Panel also found breaches of the following parts of the HCPC’s standards of proficiency for Physiotherapists in England (dated 2013):
1.2 recognise the need to manage their own workload and resources effectively and be able to practise accordingly;
4 be able to practise as an autonomous professional, exercising their own professional judgement;
4.1 be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem;
4.2 be able to make reasoned decisions to initiate, continue, modify or cease techniques or procedures, and record the decisions and reasoning appropriately;
4.4 recognise that they are personally responsible for and must be able to justify their decisions;
4.5 be able to make and receive appropriate referrals;
8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues, and others;
10 be able to maintain records appropriately;
10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines;
10.2    recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines;
11      be able to reflect on and review practice;
12     be able to assure the quality of their practice;
14.3    be able to gather appropriate information;
14.4    be able to select and use appropriate assessment techniques;
14.7  be able to analyse and critically evaluate the information collected;
14.8   be able to form a diagnosis on the basis of physiotherapy assessment;
14.9  be able to demonstrate a logical and systematic approach to problem solving;
14.11  be able to formulate specific and appropriate management plans including the setting of timescales;
14.13 recognise the need to discuss, and be able to explain the rationale for, the use of physiotherapy interventions;
14.16 be able to select, plan, implement, and manage physiotherapy interventions aimed at the facilitation and restoration of movement and function; and
14.17 know how to position or immobilise service users for safe and effective interventions.

316. The Panel was aware that breach of the standards alone does not necessarily constitute misconduct. However, the Panel was satisfied that the Registrant’s conduct and behaviour, which persisted over many months, fell seriously below the standards expected of a Physiotherapist by repeatedly breaching numerous professional standards. 

317. The Panel found that of Particulars 1 – 13, which had been found proved, each amounted to misconduct.

318. The Panel was of the view that the Registrant was an experienced practitioner who had been practising at the Trust without previous difficulty, first as a Locum Physiotherapist and then as a full-time employed member of staff. The Panel heard evidence that the Registrant had gone from being a well-liked and well-regarded practitioner, who was helpful in clinic, to one who had communication issues, demonstrated paranoid behaviour, and one who also had performance and record keeping failings. The Panel noted that the Registrant’s managers consistently stated that they had been unable to account for the change in the Registrant’s demeanour. The Panel also noted that the Registrant himself had not provided any reason for this apparent change in conduct.

319. The Panel was particularly concerned that the Registrant had given incorrect and unsafe clinical advice to Patient 6’s mother in respect of her baby’s sleeping position, to Patient 2a regarding resuming exercise (notwithstanding that she was under the care of a Cardiologist at the Brompton Hospital) and to Patient 7 regarding resuming normal activities. The Panel was further concerned that the thoroughness of assessments carried out by the Registrant in relation to a number of patients fell well below the standards expected of him.

320. The Registrant, as a qualified Physiotherapist, had a professional obligation to safeguard and protect the well-being of patients. Service users and their families and the public have the right to expect that the Registrant in performing his professional role would act with honesty and integrity at all times, as important decisions are made based the assessments and records completed by a Physiotherapist.

321. The Panel was also very troubled that the Registrant had acted dishonestly in respect of his record keeping. Further, that he had acted dishonestly whilst he had been under direct supervision. In the Panel’s view the Registrant was well aware that he was under scrutiny for the quality of his records and the timeliness within which they were produced, but had sought to produce a false documentary account of his practice, with the intention of providing a misleading impression that he was compliant with appropriate practises, when he was not.

322. The Panel found the Registrant’s behaviour, in terms of denying the existence of patient records, and ignoring express managerial instruction, concerning patient records, to be very concerning. The Panel was of the view that members of the public would expect significantly higher performance from a Physiotherapist and his actions may have resulted in confidence in the profession and his employer being undermined. Honesty is a fundamental tenet of the profession and one that ought to have featured more prominently on the Registrant’s mind. His failure to maintain appropriate records clearly amounted to misconduct on his part.
323. The Panel was also disturbed by the Registrant’s attitude at this time in respect of the support being offered to him by his managers, noting that he had asked GH to make his supervision sessions “stop”. The Registrant repeatedly closed down discussions or debate, with his managers or colleagues, when things became difficult without providing a justifiable explanation for doing so. The Panel was of the view that as a qualified Physiotherapist he should have welcomed the additional support offered to him and acted upon the feedback accordingly. His behaviour frustrated the genuine attempts of his managers to provide support to him and to improve his practice.

324. In particular, the Panel considered that the above matters represented breaches of professional standards, falling far below the behaviour expected of a registered Physiotherapist.

Reconvened hearing:
Joint application for a short adjournment:
325. At the start of the reconvened hearing Mr Millin informed the Panel that Mr Lloyd, who had previously represented the HCPC, had required emergency medical treatment shortly before the hearing reconvened and, as such, was unable to appear on behalf of the HCPC. Mr Millin requested some time to review the Panel’s findings but submitted that he could be ready to present the HCPC’s case before the end of the day.

326. Mr Stevens informed the Panel that Ms Sleeman, who had previously represented the Registrant, had suffered a family bereavement and was also unable to appear on the Registrant’s behalf. Mr Stevens requested an adjournment of the proceedings, to the following day, so that he could take full instructions from the Registrant.

Panel decision on the application for adjournment:
327. The Panel was of the view that the applications for additional time, albeit for different reasons, were both reasonable and fair. In particular, the Panel noted that neither party were to blame for the events that had led to their respective applications being made. The Panel was also of the view that should an adjournment not be granted, in light of the circumstances presented, the Registrant may not be in a position to fully present his case. The Panel therefore determined that an adjournment of the proceedings, to the following day, was both fair and in the parties’ interests.

328. At the start of the second day of the reconvened hearing, Mr Millin provided written submissions outlining the HCPC position on impairment.

329. Mr Stevens also provided the Panel with the following additional documents:
i. an employer Reference from MN, Director at Ann Physiocare, dated 30 January 2020; and
ii. a ‘Reflective Statement’ from the Registrant signed and dated 30 January 2020.

Submissions:
331. Mr Millin, on behalf of the HCPC, submitted the following:
i. the determination as to the Registrant’s impairment was a matter of professional judgement for the Panel;
ii. it is very difficult for to the Registrant to remediate a finding of dishonesty on either the ‘personal component’ or on the ‘public component’ given the Registrant’s denial of the facts;
iii. it is ‘virtually impossible’ for the Registrant to demonstrate remorse or insight, given his denial of the facts, and therefore there remains a risk of repetition;
iv. maintaining public confidence in the profession and maintaining professional standards required the Panel to make a finding of current impairment on the public component; and
v. the Registrant had breached a fundamental tenet of the profession (honesty) and as such a finding of impairment is required in order to protect the public as well as to maintain public confidence in the profession.
 
332. Mr Millin also drew the Panel’s attention to following caselaw:
i. Cheatle v GMC [2009] EWHC 645 (Admin);
ii. Meadow v GMC [2007] 1 WB 462;
iii. Cohen v GMC [2008] EWHC 581;
iv. Yeong v GMC [2009] EWHC 1923; and
v. CHRE v NMC and Grant EWHC 927 (Admin).

333. Mr Stevens, on behalf of the Registrant, submitted:
i. that he did not take any issue with the case law cited by Mr Millin;
ii. that he was not instructed to challenge a finding of current impairment in respect of the ‘public component’. The Registrant accepted the serious nature of the Panel’s findings and this position was entirely consistent with the view expressed by the Registrant in his reflective statement;
iii. the Registrant accepted that his failings impacted not only on his own reputation but that they also had wider ramifications in so far as public confidence in the profession was concerned;
iv. the Panel should have careful regard to the ‘personal component’ in this case and should have careful regard to the Registrant’s insight. Notwithstanding that the Registrant denied the allegations, it should not automatically follow that the Panel conclude that he has no insight into the concerns that have been proved as this was an overly simplistic approach to adopt;
v. that the Panel should carefully consider the Registrant’s reflective piece and what steps he has taken during the last three years to remedy his failings;
vi. the Registrant has been working under conditions of practice for a considerable length of time and over that period of time, the conditions have become less stringent. That the Registrant has provided the Panel with documentary evidence, in the form of supervisors reports and statements for the last three months, confirming that the Registrant’s current employer has no concerns regarding his record keeping, assessments, advice and communication. Also, that there has been a marked improvement in the Registrant’s practice during this timeframe;
vii. that the risk of repetition, having regard to the aforementioned improvements, was low;
viii. that the Registrant’s acts of dishonesty require careful scrutiny. The Registrant’s practice was not indicative of engrained or entrenched attitudinal failings on his part, but rather a momentary lapse of judgement in response to the intrusive review of his performance;
ix. that his conduct was capable of being remedied. His dishonesty, regarding the folder, had been remedied within a short period of time and the Panel had evidence of his corrective action in that regard; and
x. that his dishonesty in respect of his record keeping should be regarded in light of his current supervisors reports that he was currently exceeding the standards expected of him and that there were no concerns about the accuracy of the Registrant’s records or of his professional integrity.

Decision on Impairment
Panel’s approach
334. Having found misconduct, the Panel went on to consider whether, as a result of his misconduct, the Registrant's current fitness to practise is impaired. The Panel weighed up all of the evidence and the submissions made by Mr Millin and Mr Stevens and considered all of the documentary evidence before it.

335. The Panel took into account the HCPTS Practice Note: “Finding that Fitness to Practise is Impaired”.

336. The Panel also accepted the advice of the Legal Assessor. The Legal Assessor advised the Panel that in determining current impairment the Panel should have regard to the following:
i. A holistic view should be adopted when determining the issue of impairment, having regard to the Panel’s earlier findings, the nature of the Registrant’s conduct, any insight shown, evidence of remediation and the risk of repetition;
ii. the Panel should have regard to the wider public interest considerations including: protecting patients; protecting public confidence in the profession and the regulatory process; and declaring and upholding proper standards of conduct and behaviour;
iii. there is no statutory definition of impairment and that the Panel should have regard to the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin) which has approved of certain features which were likely to be present when impairment is found:
(a) that the Registrant has in the past and/or is liable in the future to service users at unwarranted risk harm.
(b) that the Registrant has in the past brought and/or is liable in the future to bring the profession into disrepute,
(c) that the Registrant has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession; and
(d) that the Registrant has in the past acted dishonestly, and/or is liable to act dishonestly in the future.
iv. the Panel should have regard to the ‘personal’ component: the current behaviour of the individual Registrant and also  the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

Personal component:
337. The Panel found the matters in this case to be serious. The Registrant’s misconduct had been carried out during his employment with the Trust.

338. The Panel noted that dishonest conduct was of itself difficult to remediate. However, the Panel was particularly concerned that the Registrant had, throughout these proceedings, failed to provide any explanation for his deteriorating and dishonest performance. The Panel also had regard to the Registrant’s reflective statement, which had been provided at the start of the days proceedings, and noted, in particular, that the Registrant stated:

 ‘I have tried to understand why I came to be in this position. Having reflected on matters I appreciate the impact that external matters may have had on my work. For example, at this time I was uncertain about my future visa status. I also found the performance review extremely stressful which may have led to nervousness in my work’.

339. Whilst the Panel noted that the Registrant’s reflective statement demonstrated that he was at the beginning of his reflective journey, the Panel was not satisfied that the explanation provided demonstrated sufficient insight into why his practice had deteriorated in the way that it had, or why he had felt it acceptable to lie to his managers on more than one occasion and over a sustained period of time. In the Panel’s view his actions were not as a result of a momentary lapse of judgement on his part. His failings and dishonesty were over a sustained period, despite being offered help and support by his colleagues.
340. Consequently, the Panel was also of the view that the lack of the insight demonstrated by the Registrant, in respect of his clinical failings and dishonest conduct combined with an inability to explain what coping mechanisms or strategies that he would implement, leaves the Panel unable to determine that the Registrant’s conduct would not be repeated if unknown or similar circumstances were to arise again. The Panel is not satisfied therefore, that the Registrant’s dishonest conduct would not be repeated in the future. The Panel is of the view that there is a real risk of repetition of his failings being repeated.

341. The Panel was also very concerned by the Registrant’s clinical failings in this case. The Panel reminded itself that a number of service users had been placed at risk of harm as a result of the Registrant’s clinical failings. The Panel noted that the Registrant had provided a number of documents, including supervisor’s reports and references which tended to support the Registrant’s contention that he had taken a number of steps to remediate his clinical failings. The Panel was reassured by these documents in respect of the Registrant’s practice for those over the age of 10. However, the Panel remained concerned that a number of the facts found proved related to service users under the age of 10. The Panel could not find any evidence before it that the Registrant had sought to rectify his conduct in this regard. Notwithstanding the conditions of practice order placed upon the Registrant, which the Panel recognised restricted his practice pending the outcome of this hearing in this regard, the Panel did not find any evidence of appropriate courses or CPD undertaken which would allay its concerns. Consequently, and in totality, the Panel was of the view that there also remained a risk of repetition in respect of the Registrant’s clinical failings.

Public component:
342. The Panel went on to consider whether this was a case that required a finding of impairment on public interest grounds in order to maintain public confidence in the profession and the Regulator. The Panel was satisfied that a fully informed member of the public, who was aware of all of the background to this case, would have their confidence in the profession and the Regulator undermined if a finding of impairment were not made given the Registrant’s dishonest conduct, clinical failings and limited insight. The Panel was also satisfied that there was a need to uphold proper standards of conduct and behaviour in the physiotherapy profession and that an informed member of the public would expect there to be a finding of impairment in respect of the misconduct found in this case.

343. Accordingly, the Panel found the Registrant’s fitness to practise is impaired in respect of both the personal and public component and therefore concluded that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction
Submissions on Sanction
344. Mr Millin, on behalf of the HCPC, submitted that the HCPC remained neutral on the question of sanction. However, he drew the Panel’s attention to the HCPC Sanctions Policy and to relevant excerpts from the Panel’s determination, in respect of the Registrant’s insight and the aggravating and mitigating features of the case.

345. Mr Stevens, on behalf of the Registrant, submitted that whilst the case law, which had been highlighted to the Panel by Mr Millin, was a factor for the Panel to consider; it was not determinative of any sanction that the Panel must impose. He also submitted the following:
i. the Registrant had, over the last three years, and whilst subject to the Conditions of Practice Order, made improvements in his practice;
ii. the Registrant had engaged throughout the regulatory process; he had complied with the very restrictive Conditions of Practice Order imposed on him and had, in addition, engaged in the learning and development;
iii. the Registrant is on a “journey” and has shown some insight into his failings and conduct;
iv. “Joe Public” would not wish for the Registrant to be struck off from the Register;
v. allowing him to continue to practise would afford the Registrant with the opportunity of continuing to demonstrate that the Panel’s concerns had been allayed;
vi. the Registrant, whilst working under the Conditions of Practice Order did not pose a risk to service users; and
vii. the Registrant’s personal circumstances were such that he was the only person in his household earning a wage, owing to the fact that his wife is currently on maternity leave with their seven month old son. If the Panel were to impose a strike-off on the Registrant it would have devastating consequences for the Registrant and his family.

Panel’s Approach
344. In reaching its decision on sanction, the Panel took into account the submissions made by Mr Millen and Mr Stevens.

345. The Panel also referred to the ‘Sanctions Policy’ issued by the HCPC.

346. The Panel had in mind that the purpose of sanction was not to punish the Registrant, but to protect the public, maintain public confidence in the profession and maintain proper standards of conduct and performance. The Panel was also aware of the need to ensure that any sanction is proportionate.

347. The Panel accepted the advice of the Legal Assessor.

348. The Panel considered the aggravating factors in this case to be that:
i. the Registrant acted dishonestly and over a sustained period of time;
ii. there was risk of harm posed to a number of vulnerable service users as a result of the Registrant’s misconduct; 
iii. the Registrant demonstrated an unwillingness to concede that his clinical decisions may have been flawed, in relation to each of the service users, when challenged by his supervisors; and
iv. the Registrant has failed to demonstrate any insight in respect of his dishonest conduct.

349. The Panel considered the following mitigating factors and found that:
i. the Registrant has demonstrated some, limited, insight into his clinical failings;
ii. the Registrant, in his reflective statement, detailed his ‘regret’ at his situation and apologised to the public and the Panel;
iii. the Registrant provided documentary evidence, which verified that his clinical practice had improved significantly, in respect of children over ten years of age, during the last three months and whilst he has been subject to the Conditions of Practice Order; and
iv. the Registrant has an otherwise unblemished career.

350. The Panel considered the option of taking no action. This is an exceptional outcome and the Panel did not consider that the circumstances of this case were exceptional. The Panel decided that the option of taking no action was not sufficient to uphold the public interest in this case.

351. The Panel next considered the option of a Caution Order. The Panel considered the guidance in the Sanctions Policy that ‘A Caution Order is an appropriate sanction for cases, where the lapse is isolated, limited, or relatively minor in nature, there is a low risk of repetition, the registrant has shown good insight and has undertaken appropriate remediation’.

352. The Panel was of the view that such a sanction would not reflect the seriousness of the findings in this case. The Registrant’s failings put vulnerable service users at risk of harm and the Panel has already concluded that there is a risk of the Registrant’s behaviour being repeated. A caution, therefore, would not protect the public from any such risk. Further, in view of the Registrant’s dishonest conduct, the Panel was also of the view that public confidence in the profession, and the HCPC as its Regulator, would be undermined if such behaviour were dealt with by way of a caution.

353. The Panel next considered whether to place conditions on the Registrant’s registration. The clinical failings identified are of a kind that could be remedied and ordinarily conditions of practice might have been considered to be the most appropriate sanction in this case. However, the Panel had regard to the Sanctions Policy and noted that the guidance indicates that given the serious impact that dishonesty has on the trust placed in professionals, sanctions relating to dishonesty are likely to result in more serious sanctions being imposed. Further, the Panel noted that the Registrant’s dishonest conduct occurred on multiple occasions, over a sustained period of time and whilst the Registrant did eventually make admissions to his managers, in respect of the existence of a folder, his admissions were not immediately forthcoming. Dishonesty undermines working relationships, public confidence in the profession and its regulator and in light of the Registrant’s dishonesty and his lack of insight into his dishonest conduct, the Panel was not satisfied that conditions would meet its objective of protecting the public and upholding public trust and confidence in the profession and its regulator.

354. The Panel next considered whether to impose a Suspension Order. The Registrant’s conduct represents a serious breach of the Standards of Conduct Performance and Ethics. The Panel was of the view that a Suspension Order would provide the necessary degree of protection for the public, whilst leaving open the possibility of further remediation and further development of the Registrant’s insight. The Panel considered that a Suspension Order would reflect the seriousness of the Registrant’s failings and send out a clear message to the profession of the standards expected. The Panel was also satisfied that a period of suspension would also afford the Registrant with an opportunity to reflect on the reasons for the change in his conduct, noting that he was previously regarded as a well-liked and able practitioner. In light of all the matters highlighted in this case, the Panel considered that this was a suitable case for a period of suspension.

355. The Panel considered a Strike Off Order. However, having regard to the fact that the Registrant had demonstrated some insight, had provided the Panel with some evidence of remediation in respect of his clinical failings and had indicated through his engagement with proceedings that he was attempting to resolve matters, the Panel was of the view that to strike the Registrant from the Register, which is a sanction of last resort, would be disproportionate at this time. The Panel was of the view that a lesser sanction was appropriate in this case at this time.

356. The Panel had regard to the impact that imposing a Suspension Order would have on the Registrant. However, the Panel was of the view that imposing a suspension order was necessary for the aforementioned reasons and outweighed any detriment that the Registrant may suffer as a consequence.

357. Accordingly, the Panel made an Order directing the Registrar to suspend the registration of the Registrant for a period of 12 months.

358. The Panel was of the view that a 12-month suspension would provide the Registrant with a period of reflection and would also afford him with an opportunity to remediate his failings and demonstrate further insight into his failings and dishonest conduct.

359. The Panel considered that a reviewing Panel would be assisted by the following:
i. the Registrant’s attendance at the review hearing;
ii. a detailed reflective piece on values and ethics, specifically focussing on the Panel’s findings in respect of his dishonest conduct and the matters which led to the change in his conduct and attitude within the Trust; 
iii. the reflective piece should also discuss the impact of his clinical failures and errors had on patients and colleagues. Further, it should discuss his response to professional supervision and management scrutiny.
iv. evidence of how he has kept his Physiotherapy knowledge up-to-date; and up to date testimonials from any employer, whether paid or unpaid.

Order

That the Registrar is directed to suspend the registration of Mr Santhakumar Senthilvelu for a period of 12 months from the date this order comes into effect.

Notes

Right of Appeal
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you.  The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

European Alert Mechanism
In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been prohibited.

You may appeal to the County Court against the HCPC’s decision to do so.  Any appeal must be made within 28 days of the date when this notice is served on you. This right of appeal is separate from your right to appeal against the decision and order of the Panel.

Interim Order
1. The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001. For the same reasons given in its determination on sanction, the Panel concluded that an Interim Conditions of Practice Order would not be appropriate. It concluded that the only proportionate interim order was an Interim Suspension Order for the period of 18 months to cover any appeal period and was necessary for public protection and is otherwise in the public interest. The Panel has made a finding that the Registrant should not practice unrestricted for at least 12 months owing to his misconduct. To make no order would be inconsistent with that finding.

2. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

Hearing History

History of Hearings for Mr Santhakumar Senthilvelu

Date Panel Hearing type Outcomes / Status
29/01/2020 Conduct and Competence Committee Final Hearing Suspended