Mr Simon P Goodwin

Profession: Chiropodist / podiatrist

Registration Number: CH08194

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 02/11/2020 End: 17:00 09/11/2020

Location: Virtual Hearing via video conference

Panel: Conduct and Competence Committee
Outcome: Not well founded

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Allegation

Amended Allegation

As a registered Chiropodist / Podiatrist (CH08194) your fitness to practise is impaired by reason of misconduct. In that:

1. Between March 2015 and December 2017, you did not maintain
adequate patient records in that:

a) Information was omitted from patient records, namely:

i) Wound description;
ii) Past Medical History of Individual;
iii) Decision Making rationale;
iv) Wound mapping;
v) Evidence of Consent to Treatment or care planning;
vi) Time of assessment;
vii) Printed name and/or full signature;
viii) Wound measurements

b) Your writing was not legible;

c) You did not record out of hours calls and texts with patients in their patient record.

2. You did not store documents containing patient identifiable information securely.

3. The matters described in paragraphs 1 to 2 constitute misconduct.

4. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Unrepresented Registrant and Reasonable Adjustments

1. The Registrant was not represented and has a diagnosis of dyslexia. Before commencing the hearing, the Panel was referred to the Practice Note on ‘Unrepresented Registrants’ by the Legal Assessor.

2. At the start of the hearing the Panel emphasised to the Registrant that he would be given every reasonable opportunity to make his case. The Panel indicated that, in view of his dyslexia, that he was not represented and that this was a virtual hearing that regular breaks would be taken. The Registrant would also be given extra time should he need it to consider and prepare for each stage of the process.

3. At all stages the Panel took time to explain the process to the Registrant, and assisted by the Legal Assessor and Mr Foxsmith, ensured that the Registrant’s case was properly and fully put before the Panel.

Application to Amend the Allegation

4. At the outset of the hearing the HCPC made an application to amend the allegations, as set out below.

5. The application sought the removal of the words ‘and/or lack of competence’ (amendment 1) and the addition of particular 1 (viii) (amendment 2).

‘As a registered Chiropodist / Podiatrist (CH08194) your fitness to practise is impaired by reason of misconduct and/or lack of competence. In that:
1. Between March 2015 and December 2017, you did not maintain adequate patient records in that:
a) Information was omitted from patient records, namely:
i) Wound description;
ii) Past Medical History of Individual;
iii) Decision Making rationale;
iv) Wound mapping;
v) Evidence of Consent to Treatment or care planning;
vi) Time of assessment;
vii) Printed name and/or full signature;
viii) Wound measurements
b) Your writing was not legible;
c) You did not record out of hours calls and texts with patients in their patient record.
2. You did not store documents containing patient identifiable information securely.
3. The matters described in paragraphs 1 to 2 constitute misconduct.
4. By reason of your misconduct your fitness to practise is impaired.’
6. The Registrant had been notified of amendment 2 on 3 April 2020 and amendment 1 on 27 August 2020 and. No objection had been raised by the Registrant prior to the hearing or at the hearing to determine the application. The application was fully explained to the Registrant by the Legal Assessor in the presence of the Hearings Officer and Mr Foxsmith and by the Panel Chair.

7. The Panel received and accepted the advice of the Legal Assessor. He advised the Panel they would need to consider whether the Registrant had sufficient notice of the application, whether the amendments were necessary and desirable and whether the Registrant was caused any prejudice by the application, both by its late nature or at all.

Panel Decision re Application to Amend

8. The Panel was satisfied that the Registrant had had sufficient notice of the application. The Panel noted that the Registrant did not object to any of the proposed amendments and was satisfied that the amendments were necessary and desirable as they provided greater clarity, did not substantively change the nature of the allegations, and did not cause the Registrant any prejudice.


Response to the Allegations

9. The amended allegations were then put to the Registrant.

10. The Registrant denied all of the matters set out in particular 1, save for particulars 1 (a) (v) and (viii) and 1c, denied particular 2, denied that the facts as pleaded amounted to misconduct and denied that he was currently impaired.

Background

11. At the time of these allegations the Registrant was employed as a Band 8a Podiatrist, a senior position, by the University Hospital South Manchester (‘UHSM’), part of the Manchester Foundation Trust (‘MFT’).

12. The Registrant managed and worked within the diabetic foot clinic at UHSM and supported ward rounds for patients with diabetic foot problems. He had previously been employed in community services, before transferring to UHSM in April 2011. This was a challenging environment with a high caseload of complex patients.

13. An investigation commenced into the Registrant’s conduct following an allegation that the Registrant was storing patient records in an unlocked storage room within the clinic where he treated patients. As a result, DW, Head of Nursing for Safeguarding, was appointed to investigate the matter by Graham Gledhill in January 2018. A human resources support officer, Ms C, provided ‘relevant support and advice.’ No statement from Ms C was provided for these proceedings.

14. The allegations were confirmed in writing to the Registrant on 19 December 2017. The Registrant was interviewed on 13 February and 30 April 2018. HT, the Registrant’s line manager and Head of Service, was interviewed on 22 February 2018. Dr NY, a Consultant from the same department as the Registrant, was interviewed on 6 March 2018. The notes of the interviews were produced to the Panel within the bundle.

15. The Registrant attended internal disciplinary hearings on 29 October and 8 November 2018. On 12 November 2020 the internal disciplinary panel found that the Registrant had failed to keep adequate patient records. The Registrant appealed that decision on 20 November 2018, citing bias, a failure to take into account his clean disciplinary record and further evidence (that he suffered from dyslexia). He acknowledged some poor record keeping but maintained this had not been previously questioned in any performance reviews. His appeal was successful, on the grounds that he had not been warned in relation to his record keeping or record storage. Having been reinstated, he subsequently resigned and now works in private practice.

16. The matter was self-referred to the HCPC by the Registrant. On 6 January 2020 a Panel of the Investigating Committee determined that there was a case to answer. The Registrant was informed of this on 13 January 2020. He was also notified the case would be set down for a final hearing.

The Evidence

17. On behalf of the HCPC, the Panel heard oral evidence from DW (‘DW’). The Registrant gave evidence on his own behalf and called two witnesses, Mr JM (‘JM’) and Dr NY (‘NY’).

18. The Panel also received a bundle of documentation (277 pages) from the HCPC, comprising notices, the case summary, 14 pages of witness statements and 235 pages of exhibits. A 36 page bundle was received from the Registrant, which included two references. In addition, during the course of the hearing, the Registrant provided photographs of foot wounds with measurements identified, one of which pertained to one of the written records relating to the allegation.

19. In reaching its decision the Panel took into account the oral evidence of the HCPC witness, the Registrant, the Registrant’s witnesses, the documentary evidence contained within the two bundles, as well as the oral submissions made by Mr Foxsmith and the Registrant.

Advice of the Legal Assessor
 
20. In approaching its task of making its findings of fact and consideration of whether those facts amounted to the statutory ground, the Panel accepted the advice of the Legal Assessor.

21. The Panel was reminded that the burden of proving the facts was on the HCPC alone and that the standard of proof is the ordinary civil standard, namely the balance of probabilities (‘more likely than not’).

22. The Panel was reminded about the sequential approach that must be adopted: -
a. Whether the facts set out in the allegation are proved;
b. Whether those facts amount to one or more of the ‘statutory grounds’ alleged (e.g. misconduct);
c. If so, hearing further argument on the issue of impairment and determining whether the registrant’s fitness to practise is impaired.
d. If a finding of impairment is made, Panels hear submissions on the question of sanction and determine what, if any, sanction to impose.

23. The Panel was reminded that it was important that these steps should be and be seen to be separate but that did not mean that, for example, Panels must retire to consider each individual step separately in every case. They were ‘steps’ rather than formal stages and their management would depend upon the nature and complexity of the case. However, the determination should reflect the Panel’s decision relating to each step.

24. In relation to stage (a), the HCPC has to provide sufficient evidence to persuade the Panel that the facts alleged are proved. Whether those facts amount to the statutory ground and whether fitness to practise is impaired is not automatic and are matters of judgement for the Panel. If any of the facts alleged are proved the Panel then has to decide whether they amount to one or more of the statutory grounds.

25. In relation to misconduct, the Panel had specific regard to the helpful guidance provided in Roylance -v- GMC (No 2) [2000] 1 AC 311, Meadows v GMC [2007] QB 462 and Shaw v GOsC [2015] EWHC 2721.

26. In particular, 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.”

27. It noted that misconduct involves an act or omission which falls short of what would be proper in the circumstances and that in order to amount to misconduct, the act or omission needs to be serious and one which would attract a degree of strong public disapproval.

28. In relation to the standards to be considered, the HCPC had referred the Panel in its case summary to the following standards:  1, 5, 9 and 10 of the HCPC Standards of Conduct, Performance and Ethics (2016) and standards 1, 2 and 10 of the HCPC Standards of Conduct, Performance and Ethics (2012).

‘Keep records of your work
Keep accurate records
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;

Keep records secure
10.3  You must keep records secure by protecting them from loss, damage or inappropriate access.’

29. The Panel was also referred to the Trust’s record policy v5.2 and in particular section 5. Copies of the standards were produced to the Panel, including standards relating to Podiatrists/ Chiropodists.

30. In relation to evidential matters, the Panel was reminded that it was entitled to hear hearsay evidence but would need to consider the weight to be given to such evidence in each case, bearing in mind that such evidence had not been tested before the Panel. The Panel was also reminded that it was entitled to hear character evidence both at the fact finding and impairment stages. In relation to the fact finding stage it was potentially relevant as the credibility of the Registrant.

Decision on Facts

Assessment of Witnesses

DW

31. The Panel found DW to be an open and honest witness. The Panel considered DW had tried in her evidence to be helpful to the Panel. The Panel found that DW had not been biased in her conduct of the investigation and had not demonstrated any animus to the Registrant.

32. However, the Panel found that she was unfamiliar with some of the electronic patient records systems used in this case and had failed to interrogate them fully with respect to the Registrant. Consequently, the Panel considered that her investigation had been unduly narrow, superficial and passive. DW had not unfortunately consulted the NICE (National Institute for Clinical Excellence) guidelines with respect to diabetic footcare, which would have provided clinical context. 

33. As was conceded by the HCPC, witness statements had not been taken from other relevant individuals working in the department, including HT, the Registrant’s line manager. In the circumstances the HCPC properly did not seek to rely upon the contents of HT’s interview by DW. During the course of her evidence it became apparent that DW had failed to identify within the handwritten patient notes that some of the notes were not written by the Registrant but by another member of the Unit, namely his line manager HT.

34. In summary her investigation had been inadequate in the circumstances and of limited value to the Panel.

JM

35. The Panel found JM to be a highly credible, honest, passionate about his chosen profession and was an assured witness. His witness testimony had been well balanced, as he had experience both of private practice and practice in the NHS. He was able to give the Panel insight into the differences between NHS podiatry in the local community and within Hospitals and the operation of podiatry within a multi-disciplinary environment. Although he had not seen the allegations against the Registrant, or the patient records in question, he was able nevertheless to give the Panel a broad picture as to how patients notes were recorded, both manually and electronically, as he had used the Registrant’s patient records when undertaking his final year placement. 

36. JM gave to the Panel positive character evidence in favour of the Registrant, which the Panel found helpful and took into account when considering the Registrant’s credibility. As he had, subsequent to the events at issue, employed the Registrant he, was also able to give evidence as to the Registrant’s current working practice, including making and storage of patient notes and records.

NY

37. The Panel determined that NY was an honest, open, highly committed  professional and impartial witness. His evidence came across as balanced. He was not afraid to criticise poor practice when shown photographs of alleged inadequate records storage.

38. NY was able to give the Panel helpful evidence about the complex system of storage of patient records, including the overlapping patient record systems caused by the transition from paper to full electronic records. He also gave helpful evidence about how the multi-disciplinary teams at the Hospital came to decisions and how these were recorded.

39. He also gave supportive character evidence in favour of the Registrant, which the Panel were able to take into account when considering the Registrant’s credibility.

The Registrant

40. The Panel determined that the Registrant was an open and honest witness. The Panel found that the Registrant was an experienced professional who cared deeply about the patients he treated and worked well within the multi-disciplinary team.  

41. The Panel also found that the Registrant gave balanced evidence, and he was  honest about his own perceived shortcomings. The Registrant was open with the Panel about the impact of his dyslexia condition and conceded that his handwriting was not easy to read, although not in his view illegible.

42. The Panel found the Registrant’s evidence to be credible.

The Panel’s findings on the Particulars

‘Particular 1. Between March 2015 and December 2017, you did not maintain adequate patient records in that:
a) Information was omitted from patient records, namely:
i) Wound description;
ii) Past Medical History of Individual;
iii) Decision Making rationale;
iv) Wound mapping;
v) Evidence of Consent to Treatment or care planning;
vi) Time of assessment;
vii) Printed name and/or full signature;
viii) Wound measurements

43. In approaching this particular the Panel considered each of the allegations individually (1a, 1b and 1c) and then considered, based on its findings in relation to each individual allegation, whether the Particular had been proven, namely whether the Registrant had failed to maintain adequate patient records.

1a. Information was omitted from patient records: -

44. DW in her report confirmed that the Trust did not deliver record keeping training as either a mandatory requirement or a best practice requirement. She indicated that the record keeping policy should have been available on the intranet, but produced no evidence to that effect.

45. The Panel found that, due to the inadequate nature of the investigation,  many of the facts set out below in particular 1a were found to be not proven, as the HCPC had failed to discharge the evidential burden upon it.

46. In making the allegation that the Registrant did not maintain adequate patient records the HCPC relied upon five examples of handwritten patient notes. The Panel found that the HCPC had not carried out a comprehensive review of the other written records completed by the Registrant. Furthermore, the Panel were concerned about the reliance placed on the five samples. There was no evidence before the Panel to indicate how the five patient records had been chosen and/or that the five patient record samples were a truly representative sample of all the handwritten records. 

47. In addition, the HCPC had not reviewed properly or at all the other relevant electronic patient records available, namely the Electronic Patient Record (the ‘EPR’), the ‘Diamond’ patient record system from the diabetes service or the Patient Administration ‘Lorenzo’ system. The Panel found that clinicians had been asked to prioritise electronic patient notes. The Registrant had emphasised the use he made of electronic records in his first interview – ‘They (local podiatry care) don’t understand EPR. I’m sat looking at EPR’.

48. In summary the Panel were not supplied with the full patient record, including the handwritten notes and electronic records, or at the very least a statement confirming that the full patient records had been properly reviewed. 

49. It was apparent to the Panel, having heard the evidence from the Registrant, NY and JM, that the Diamond system was heavily used by clinicians in the unit, including the Registrant, to record patient information. The Panel found that the HCPC was on notice of the Diamond system from HT’s interview and following the Registrant’s internal appeal, where he made specific reference to it. NY in his interview commented that they had ‘looked at electronic formats so notes can be typed in to system.’

50. The Registrant also made explicit reference to the Diamond system in his bundle -  ‘The trust investigation continually ignored avenues which would have helped my case and/or disprove accusations. As the panel will be aware, modern computer systems record all visits on the system. This was the case for the Diamond system. During my brief re-instatement by the trust, I was presented with evidence that no member of the investigation team, including DW, had ever accessed these computer notes. Little wonder then, that she was unable to find evidence of medical illustrations etc. to support my claim, as these were stored on Diamond’. The Registrant confirmed that his notes would regularly be taken by the secretarial support to put onto Diamond, Lorenzo and EPR.

51. The Panel also placed some reliance on two documents from the Registrant’s bundle. First, a signed letter dated 25 September 2018 from three members of the secretarial staff, confirming they had inputted for the Registrant and confirmed ‘his handwriting is no different from that of other clinical staff.’ Second, an email from AW a Podiatrist who had covered a number of the Registrants’ clinics. He confirmed that he had found the Registrant’s ‘notes and history reasonably easy to follow.’

52. Notwithstanding this, the HCPC did not produce to the Panel any investigations of the Registrant’s records on either the Lorenzo or Diamond systems. Reference was made to the Lorenzo system in DW’s terms of investigation reference, although there was no explicit reference to the Diamond system.

i. Wound Description. While DW had been unable to identify any evidence of wound descriptions within the handwritten notes produced to the Panel, the Panel itself had found within the written notes a number of example of wound descriptions. The Panel accepted the evidence of the Registrant, who stated that he had found within the written notes some 130 examples of wound descriptions.
ii. Past Medical History of the Individual. DW stated that the Registrant had told her that when he saw Hospital patients on wards the full Hospital record was before him and he did not need to further record the patient’s medical history. DW stated that as the diabetic clinic was a stand alone clinic that the only past medical history of a patient would have been that which he had recorded in his written records. The Registrant gave evidence that in fact the medical history would have been available from the electronic records, including the EPR and Diamond systems.
The Panel found that there was no past medical history recorded in the handwritten patient records produced to the Panel. However, the Panel found that the past medical history would have been recorded elsewhere on electronic record keeping systems and would not have been repeated in the handwritten patient records. Accordingly the Panel did not find that the failure to record the past medical history on the handwritten notes rendered his patient records inadequate.
iii. Decision Making Rationale (‘DMR’). DW was unable to find any evidence of the DMR within the handwritten records. The Registrant confirmed that a patient’s progress would be recorded electronically, particularly after the monthly Hospital diabetes team meetings, although there was some reference to the DMR within the handwritten notes.
The Panel found that there was no DMR in the handwritten patient records produced to the Panel. However, the Panel found that the HCPC had failed to establish that the DMR was not recorded elsewhere, specifically in the electronic notes, which included those made in the monthly review meetings by the Hospital Team. It would not have been repeated in the handwritten patient records if recorded electronically. Accordingly, the Panel did not find that the failure to record the DMR on the handwritten notes rendered the Registrant’s patient records inadequate.
iv. Wound Mapping. The Panel found that there was no wound mapping recorded in the handwritten patient records produced to the Panel. However, as per the evidence of the Registrant, NY and JM, the Panel found that wound mapping was recorded elsewhere in the electronic records and would not have been repeated in the handwritten patient records. Accordingly the Panel did not find that the failure to record the wound mapping on the handwritten notes rendered his patient records inadequate.
v. Evidence of Consent to Treatment or care planning (‘EOC’). The Panel found that there was no EOC to treatment or care planning in the five handwritten patient records produced to the Panel. The Registrant’s formal admission reflected this. However, the Registrant gave evidence to the Panel that he would have obtained formal consent for an invasive procedure and recorded it in the electronic record. The Panel accepted this explanation and found accordingly that it was recorded elsewhere, namely the EPR, and there was no need for that to be repeated in the handwritten patient records. The Panel did not find that the failure to record the EOC on the handwritten notes rendered his patient records inadequate.
vi. Time of Assessment (‘TOA’). The Panel found that there was no TOA in the handwritten patient records produced to the Panel. However, the Panel found that TOA was recorded elsewhere, namely in the Lorenzo electronic system, and would not have been repeated in the handwritten patient records. Accordingly, the Panel did not find that the failure to record the TOA on the handwritten notes rendered his patient records inadequate.
vii. Printed name and/or full signature. Having reviewed the handwritten records, the Panel found that each of the entries was endorsed with the Registrant’s signature or initials. It was not endorsed with his name. The Panel found that this was adequate for the purposes of identifying who made the entry – it rejected this assertion made by DW that this was insufficient, although his initials should have been recorded on the front sheet of the records. The Panel also found that the electronic record, namely the Diamond system, would have identified the author of the entries, as the handwritten notes had been transcribed onto that electronic record.
viii. Wound Measurements. DW noted in her interview with the Registrant that he had referred to medical records in the EPR. DW reviewed the EPR for the five patient samples, although did not extend her review of any other medical photography undertaken by the Registrant in the EPR. The Panel did not find that this would be effective in seeking to determine whether the Registrant carried out wound measurements.
In her evidence DW stated that she did not find any medical photographs supporting the five patient samples, although this assertion was undermined by photographs that were included in the Registrant’s bundle relating to one of the five Patients. In her report DW confirmed that in respect of the five patient records:
- None had any evidence of medical illustration that had been taken prior to the date Mr. Goodwin last provided care in the diabetic foot clinic.
 - Two had evidence of medical illustration that had been taken• after the date Mr. Goodwin had last provided care in the diabetic foot clinic.
 - Three had evidence of x-ray taken during the time Mr. Goodwin was providing care at the diabetic foot clinic.
However, neither the medical illustrations nor the x-rays had been provided to the Panel. Furthermore, the Registrant had been denied access to the EPR and thus had been unable to search for further photographs. He had only been able to recover the photographs in his bundle and a further set of photographs, which clearly showed wound measurements, as they had been retained as part of a research project. These had been supplied to the HCPC prior to the hearing but had not been included in their bundle or addressed in her statements by DW. In addition to the EPR the Registrant also stated that there were further photographs on Diamond. NY also stated that the use of wound photography had been standard practice for many years.
The Panel found that there were no wound measurements in the handwritten patient records produced to the Panel. The Registrant’s formal admission reflected this. However, the Panel found that there were wound measurements recorded elsewhere, namely the EPR and Diamond, and these would not have been repeated in the handwritten patient records. Accordingly the Panel did not find that the failure to record the wound measurements on the handwritten notes rendered his patient records inadequate.

53. Based on their findings upon, the Panel did not find particular 1a proven, in that the HCPC had not discharged the burden upon it to prove that information had been omitted in relation to patient records.

1b -  ‘Your writing was not legible’

54. During the course of his evidence the Registrant stated that while his handwriting could have been of a higher standard it was not illegible.

55. DW stated in her evidence before the Panel that she was not able to read the handwriting. She had required the Registrant to read a passage of the notes and he had been unable to read part of them.

56. DW had however made no allowance for his dyslexia condition, because she was not aware that he suffered from it. Following diagnosis the Registrant stated he had made significant improvement in his ability to decipher handwriting and his attention to detail.

57. NV and JM both confirmed that they had no difficulty in reading the Registrant’s handwriting.

58. During the hearing the Panel asked the Registrant to take his time and  read out a lengthy section of the handwritten patient records. The Registrant was able to do so. The Panel also determined that it was able to read the notes in question in its own right. 

59. The Panel was satisfied, after carefully reviewing the evidence presented to it, that while the handwriting could have been clearer it was legible.

60. The Registrant confirmed in his evidence that his handwritten notes would have been transcribed by the secretarial support staff, and entered into the patient record. They would have asked him for clarification were they not be able to read any part of his handwriting. The Panel was satisfied that even if the notes had been considered illegible, which it did not find, that it would not have rendered the notes inadequate, as a typed  version of his notes would have been available electronically.

61. Consequently the Panel found that the particular was not proved.

1c - ‘You did not record out of hours calls and texts with patients in their patient record.

62. The Panel noted that the Registrant had formally admitted this.  The Registrant stated to DW that he had taken multiple calls from staff and patients and had not recorded their contents, including any advice he may have given them. The Panel determined that, after carefully reviewing the evidence presented to it, that the Registrant did receive out of hours calls and texts from patients and did not record them either in his written records or in any other electronic records.

63. The Panel found that the calls may have ranged from the routine to the serious, bearing in mind the calls and texts would have been made out of hours. The calls and texts were not isolated. While his employers may have been aware that out of hours calls and texts were being referred to the Registrant, they were not aware he was failing to record information relating to those calls and texts on his patient records. The failure to record this information may have had serious consequences, although there was no evidence to suggest that it actually resulted in any harm to patients. The Panel accordingly found the allegation proven.

64. In summary, the Panel found none of the allegations proven save for allegation 1c, the failure to record out of hours texts and phone calls in patient records. The Panel found that the failure to do so in respect of allegation 1c meant the Registrant had failed to maintain adequate patient records.

Particular 2. You did not store documents containing patient identifiable information securely.

65. DW produced to the Panel five handwritten patient records recovered from 3 box files of patient records, found in an unlocked cupboard in an unlocked room in the diabetic foot clinic. DW referred to section 19 of the MFT Health Records and Clinical Record Keeping Policy that stated ‘health records must be stored in secure facilities at all times’ and Section 20 that stated that ‘the Data Protection Act 1998 and Caldicott principles must be adhered to at all times’. DW commented that in keeping the records in the cupboard the Registrant was not in keeping with Trust policy but was ‘not unique’ in keeping records in that way. She conceded that the room was likely to have been supervised – it was not an area immediately accessible to the Public.

66. The Registrant stated that his handwritten notes were usually kept in a locked cabinet overnight for the ‘majority of times’. He had requested improvement with storage availability. The research team who worked with him also had issues with storage availability. The Registrant added that the diabetes centre had a number of security safeguards in place including an alarm, and during working hours receptionists were present.  He told the Panel that other notes from other clinicians were frequently left out on open shelving within the Hospital. 

67. The Panel found that at the time they were located the records in question were held in an unlocked cupboard in an unlocked room. To that extent the Panel found the allegation proved, in that the records contained patient information and were not stored securely.

68. However, the Panel also found that the records were not freely accessible to members of the public. The Panel found that in order to enter the room where the records were stored an individual would have had to pass a receptionist and enter the room, where a clinician was likely to be operating. The door to the room had the capacity to be locked, although was not locked by the Registrant. 

69. The Panel also determined that there was no evidence to suggest that the records were routinely stored in the cupboard in question. There was only one undated photo of the paper records in situ. The Registrant confirmed that the paper records were on occasion left with the receptionist for transcription to the electronic records or were passed to other Clinicians. Furthermore, while records could have been stored in other locked cupboards within the unit, space in those cupboards was not routinely available, with clinicians ‘fighting’ over storage space. There was, for example, no locked cupboard in the room in question made available in which the Registrant could have stored his written records.
Misconduct
70. Having found the Particular 1c and 2 proved, the Panel went on to consider whether the Registrant’s conduct amounted to misconduct.

71. The Panel reminded itself of the advice from the Legal Assessor. The Panel bore in mind that there is no standard of proof to be applied at this stage. Consideration as to whether the threshold for misconduct has been reached was a matter for its own judgment.

72. In considering whether misconduct was established, the Panel considered the individual particulars found proved and then the behaviour in the round.

Decision on Misconduct

73. The Panel also considered whether the proven facts amounted to breaches of the relevant HCPC Standards of Conduct, Performance and Ethics 2016 (“the HCPC Standards”), which applied at the time.

74. It bore in mind that breaches of any of these Standards did not, in themselves, necessarily constitute misconduct.

Particular 1c

The Panel considered that the facts found in relation to Particulars 1c involved a breach of the standards and amounted to misconduct. The Panel determined that the failure to record the details of text messages and/or calls in the patients notes over a significant period of time, amounting to more than 2 years, was serious and fell short of what was required in the circumstances. It would attract a degree of strong public disapproval, in that in failing to record the Registrant’s out of hours interaction with patients, there was a risk of patient harm.

Particular 2

75. The Panel considered that the facts found in relation to Particular 2 did not amount to misconduct.  While storage of the records was both serious and fell short of what would be required in the circumstances, it would not, taking into the facts set out above, attract a degree of strong public disapproval, in that the records were not freely accessible to members of the public, that there were issues in relation to storage generally and that there was no evidence that records were routinely stored there.

Decision on Impairment 

76. Having found misconduct, the Panel went on to consider whether, as a result of that misconduct, the Registrant's current fitness to practise is impaired. The Panel weighed up all of the evidence and the submissions made by both the HCPC and the Registrant.
77. The Panel took into account the HCPTS Practice Note: “Finding that Fitness to Practise is Impaired” (December 2019).  In particular, it noted that the test of impairment is expressed in the present tense – that fitness to practice is impaired.
78. A Registrant may have been impaired at the time of the failings identified in the allegation but the Panel’s function was to form a view about the Registrant’s current fitness to practice, by taking account of the way in which the Registrant has acted or failed to act in the past and looking forwards whether they consider that the Registrant’s ability to practice safely is compromised.

Legal Advice - Impairment

79. The Panel also accepted the advice of the Legal Assessor.
80. The Legal Assessor advised in relation to character evidence and the question of impairment. He advised that Panels may properly take account of evidence as to the Registrant’s general competence in relation to the subject matter of an allegation; the Registrant’s actions since the events giving rise to the allegation and/or the absence of similar events. 

81. In relation to character evidence Panels must exercise caution but should not adopt an over strict approach. It was thus important that all evidence which is relevant to the question of impairment should be considered, including evidence for example about a Registrant’s general professional conduct, as opposed to evidence about the Registrant’s general character.

82. The Legal Assessor advised that in determining current impairment the Panel should have regard to the following aspects of the public interest:
i) The ‘personal’ component: the current behaviour of the individual Registrant; and
ii) The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

83. In relation to the Personal component, the key questions that needed to be asked were: -
a. Are the acts or omissions which led to the allegation remediable?
b. Had the Registrant taken remedial action?
c. Are those acts or omissions likely to be repeated?

84. An important factor will be the Registrant’s insight into those acts or omissions, the extent to which the Registrant: -
d. Accepts that their behaviour fell below professional standards, understand how and why it occurred and its consequences for those affected; and
e. Can demonstrate they have taken action to address that failure which remedies any past harm where that is possible and avoids any future repetition.

85. In relation to the public component, Panels must consider the three elements of the public component. The first element of the public component - the need to protect service users - overlaps with the personal component. A registrant who has insight and is unlikely to repeat past acts or omissions is unlikely to present an ongoing/ future risk to service users.

86. The other two elements of the public component are maintaining professional standards and public confidence in the profession concerned. The professional standards expected of registrants are what the public expects of them. Panels should consider the need for the public to have confidence in the registrants they are treated by. The public is entitled to expect registrants who are professionally competent and act with decency, honesty and integrity. The public should also be able to rely on the regulatory process to be robust, fair and transparent.

87. The key question was, given the nature of the allegation and the facts found proved, would public confidence in the profession be undermined if there were to be no finding of impairment?

88. In assessing the likelihood of a Registrant causing similar harm in the future, Panels should take account of:
f.  The degree of harm caused by the registrant; and
g.  The registrant’s culpability for that harm.

 

 

The Panel’s Decision on Impairment
Risk of Harm

89. The Panel considered in relation to Particulars 1 (c) the Registrant had potentially increased the risk of harm to Patients. The Panel also considered that the Registrant was culpable in relation to his actions.
The Personal Component

90. In relation to the personal component and remediation, following these events the Registrant had acknowledged his shortcomings and has undertaken and paid for a registered course offered by the College of Podiatry of his own volition relating to record keeping.

91. The Registrant had not been the subject of any further complaints since the events in question. There had been no issues or complaints raised in relation to his clinical ability.

92. The Panel also considered that the Registrant’s efforts to remediate his mistakes had also been reflected in his character references and other documentation.

93. The Panel noted that the Registrant had formally admitted the matter and made a number of admissions during the course of his evidence to the Panel. The Panel found that the Registrant had shown considerable insight into his conduct, stating he was acutely aware of what he had done and was embarrassed by his shortcomings, and the effect that it could have had on service users. He was remorseful about what had occurred.

94. The Registrant was now in private practice and indicated he would decline any out of hours calls. However, in the event that he was required to do so, he was clear that he was fully aware of the necessity of ensuring that patient records were properly updated.

95. The Panel found the acts or omissions were remediable and that the Registrant had taken remedial action in relation to his conduct, namely he had undertaken a relevant course and shown genuine insight into his conduct and the effect it might have had. The Panel concluded that the risk of repetition in this regard was therefore low.


The Public Component

96. The Panel went on to consider whether this was a case that required a finding of impairment on public interest grounds in order to protect service users, to uphold proper standards of behaviour and to maintain public confidence in the profession and the Regulator.

97. The Panel was satisfied that a fully informed member of the public, who was aware of all of the background to this case, would not have their confidence in the profession and the Regulator undermined if a finding of no impairment was made in view of the Registrant’s admissions, his insight, the remediation and full engagement with the HCPC.

98. The Panel acknowledged that there was a need to protect service users and uphold proper standards of conduct and behaviour in the Podiatry profession but that an informed member of the public would not expect there to be a finding of impairment in respect of the misconduct found in this case.

99. Accordingly, the Panel found the Registrant’s current fitness to practise is not impaired in respect of both the personal and public component and therefore concluded that the Registrant’s fitness to practise is not currently impaired.

 

 

 

Order

No information currently available

Notes

No notes available

Hearing History

History of Hearings for Mr Simon P Goodwin

Date Panel Hearing type Outcomes / Status
02/11/2020 Conduct and Competence Committee Final Hearing Not well founded