Mr Marin Stinca
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Allegations as found proven at the Final Hearing
While employed as a Physiotherapist with Great Western Hospital NHS Foundation Trust:
1. Between 26 February 2016 and 16 March 2016, in respect of Patient A, you:
a) [Found not proved]
b) Did not complete and/or record an adequate assessment on 26 February 2016 in that you:
i. Did not record clear clinical reasoning;
ii. [Found not proved]
iii. Did not perform and/or record an adequate assessment of active range of movement and/or muscle strength;
iv) [Found not proved]
v) [Found not proved]
vi) Recorded that the passive range of movement for Patient A's left hip was normal, which was factually incorrect.
c) Did not make a distinction between objective Ax and Rx.
d) [Found not proved]
2. Did not complete and/or record an adequate assessment on 8 March 2016 in respect of Patient B, in that:
a) You recorded the patient's transfer and mobility was back to baseline which was factually incorrect;
b) [Found not proved]
3. On 7 March 2016 in respect of Patient C, you did not complete and/or record an adequate assessment, in that you did not:
a) [Found not proved]
b) Recommend any exercises to strengthen Patient C's knees and/or record why no recommendation for exercises to strengthen Patient C's knees was made;
c) Clearly record which limbs were tested during the assessment.
4. Between 26 February 2016 and 11 March 2016, in respect of Patient D, you:
a) Did not complete any or any adequate record of the assessment on 26 February 2016;
b) Did not record an adequate treatment plan or goal in your assessment recorded on 26 February 2016;
c) Did not make a distinction between objective Ax and Rx in your assessment recorded on 26 February 2016;
d) Did not use clear clinical terminology in your assessment recorded on 11 March 2016;
e) [Found not proved]
f) [Found not proved]
5. On 18 January 2016, in respect of Patient E, you had to be prompted to loosen the leg straps when placing Patient E in the hoist.
6. On 22 January 2016, in respect of Patient F you:
a) Used advanced instructions at points during the assessment, which were inappropriate given the patient's presentation;
b) Did not ask adequate questions about Patient F's pain;
c) [Found not proved]
7. The matters set out in paragraphs 1 - 6 constitute misconduct and/or lack of competence.
8. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
1. The Panel found that there had been good service of the Notice of Hearing by Email sent to the Registrant’s registered email address on 3 April 2020 which informed him of the date and time, and that the hearing would be conducted on the papers. The emailed Notice has not “bounced” back and was sent to an email address that the Registrant has communicated with the HCPC before this review hearing.
Proceeding in Absence
2. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
3. The Panel noted that there has been no communication from the Registrant since 9 May 2019.The Panel considered that the Registrant was aware of the hearing and that his absence was voluntary. The Panel noted he had not attended the substantive hearing, nor had he attended the two previous review hearings held on 29 May 2018 and 28 May 2019 respectively. The Panel did not consider that the Registrant would attend a hearing at a later date.
4. The Panel considered the public interest. The hearing was to undertake a mandatory review of a Suspension Order, due to expire in approximately one month. The Panel considered that it would not be in the public interest for the Suspension Order to lapse because there would be no protection for the public. It would also be in the public interest for the review to be conducted expeditiously. The Panel decided that the public interest outweighed the Registrant’s interests and exercised its discretion to proceed in the absence of the Registrant.
5. The Registrant is a physiotherapist registered with the HCPC. He commenced employment with the Great Western NHS Foundation Trust (the Trust) on or around 15 November 2015 as a Band 5 physiotherapist in the Marlborough Community Team. The first six months of his employment contract was a probationary period. For the first three months of the probationary period the Registrant worked on the rehabilitation ward of the Savernake Hospital where he was responsible for assessing and treating a wide variety of patients. In February 2016, the Registrant was transferred to work in the community where he was responsible for assessing and treating patients in their homes.
6. It became apparent that there were concerns in respect of the Registrant’s clinical practice in the Community Team. In an attempt to find a placement where he could be more effective, the Registrant was transferred to the Musculoskeletal Out-Patient Department at Salisbury Hospital. This placement lasted for two days due to concerns about the Registrant’s practice. Supervising staff at Salisbury Hospital wanted the Registrant to return to Savernake Hospital, but the Registrant handed in his notice and left immediately.
7. The Registrant did not attend the substantive hearing held November 2017 and that panel referred to his “minimal” engagement with the proceedings and noted that there was no indication the Registrant had reflected on his clinical deficiencies in “any meaningful way”, or that he had any sense of the potential impact these deficiencies might have on patients. As there was no evidence before that panel that the Registrant had taken steps to remedy the clinical deficiencies, or brought his knowledge and skills up to date, it concluded there was a serious and ongoing risk of repetition and a real risk of harm to patients. That panel was also satisfied that where a registrant was unable to work as an autonomous practitioner with vulnerable patients, a finding of impairment was in the public interest to uphold professional standards, and to safeguard public confidence in the profession and in its regulatory body. Having decided that the Registrant’s fitness to practise was impaired, the substantive hearing panel imposed a six-month Suspension Order.
8. The Suspension Order was reviewed by a review panel on 29 May 2018 and again on 28 May 2019. The Registrant did not attend either hearing or provide any information for the review panels. When the matter was last reviewed the panel considered that the next reviewing panel might be assisted by the same information as suggested by the panel at the substantive hearing, namely: Evidence of up to date physiotherapy specific skills and knowledge such as:
• Short course (online or otherwise)
• Reading journals
• Volunteering or work shadowing or substantive employment as a healthcare assistant
• Testimonials from individuals able to comment on the Registrant’s skills and knowledge relevant to a physiotherapy role
• A reflective statement on skills and knowledge that the Registrant has acquired
9. The Registrant did not provide any written submission or documents for this review hearing.
10. The Panel considered the written submissions set out in the HCPC Skeleton Argument dated 30 April 2020.
11. The Panel accepted the advice of the Legal Assessor. It had regard to the HCPTS Practice Note “Finding that Fitness to Practise is Impaired”.
12. The Panel considered that there had been no change in circumstances since the last review hearing. The Registrant has not engaged. There was no evidence that the Registrant had taken any remedial action or that his level of insight had changed. There was no evidence that he had considered or addressed any of the suggestions made.
13. In the circumstances, the Panel was unable to conclude that the Registrant has developed insight or that he has taken any steps to remedy his lack of competence. The Panel noted that the competency matters related to the fundamental skills of a physiotherapist such as treatment planning, clinical reasoning, and recording of information. The risk of repetition is unchanged and therefore there remains a real risk of harm to patients.
14. The Panel considered that members of the public would be concerned about the ongoing risk of repetition, the lack of evidence of remediation and insight and that Registrant’s fitness to practise remains impaired. Moreover, the Panel decided that a finding of impairment is justified to maintain confidence in the profession and the regulatory process and to uphold proper professional standards.
15. The Panel considered the available sanctions in ascending order of seriousness in order to determine the appropriate sanction.
16. The Panel decided that the option of either taking no action or imposing a Caution Order would not be sufficient to protect the public. These options would permit the Registrant to practise as a physiotherapist but without ongoing monitoring and, therefore, would not manage the risks in this case.
17. The Panel next considered the option of a Conditions of Practice Order. The Panel decided that conditions were not sufficient or appropriate. The Registrant has not engaged with the HCPC and has not demonstrated any insight. The Panel did not have confidence that the Registrant would comply with a Conditions of Practice Order and such an Order would not be workable or proportionate at the current time in light of his non-engagement.
18. The Panel next considered whether a further Suspension Order would be appropriate and proportionate. The Panel noted the submissions made in the HCPC Skeleton Argument. However, the Panel also noted that the Registrant has not engaged in any way with the matters that were previously identified in terms of his lack of competence or in response to the previous two review hearings. The Panel therefore concluded that a further Suspension Order for a period of twelve months would not be appropriate or proportionate.
19. In light of its decision that a Suspension Order would no longer be appropriate the Panel determined that the only proportionate and appropriate order would be an Order of Strike Off. Despite numerous opportunities to attend hearings in person and to present oral submissions, including at the substantive hearing and subsequent reviews, the Registrant has not done this. The Registrant has not engaged or participated in the HCPC process since May 2019. The Panel has seen no evidence of insight or remediation and in the circumstances the only outcome can be an Order of Strike Off.
The Registrar is directed to Strike Off the Registrant’s name.
The Order imposed today will apply from 28 June 2020.