Miss Alexandra Claire Burns

Preliminary Matters

Service

1.There was before the Panel a copy email dated 15 March 2021, sent by the HCPC to the Registrant at her registered address, informing her of the details of today’s hearing. The Panel is satisfied from this documentation that the Registrant was properly served with notice of today’s hearing.

Proceeding in absence

2. Ms Sampson, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. She referred the Panel to an email from the Registrant sent to the Hearings Officer on 2 April 2021, in response to the Notice of Hearing, in which she said that she would be unable to participate due to work commitments and also that she would not be represented. The Registrant did not apply for an adjournment but said that she would be sending “a comprehensive personal statement/written submission”.

3. In reaching its decision the Panel had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”. It considered all the information before it together with the submissions of Ms Sampson and the Registrants email dated 2 April 2021. It accepted the advice of the Legal Assessor.

4. The Panel was satisfied that the Registrant is aware of today’s hearing. It has concluded that the Registrant has waived her right to participate. It has had in mind also that the Registrant has not attended previous hearings. The Panel in these circumstances is satisfied that it is in the public interest to deal with this mandatory review without delay. It is therefore determined to proceed in the Registrant's absence.

Background

5. The Registrant is registered with the HCPC as a Physiotherapist. At the relevant time, the Registrant was employed as a locum at three hospitals – Milton Keynes University Hospital, Peterborough City Hospital and Kettering General Hospital. On three separate occasions between December 2015 and October 2016 the Registrant was unable to undertake scheduled work as she was under the influence of alcohol.

6. Following a substantive hearing on 20 – 21 August 2018, which was not attended by the Registrant, allegations that she was unable to undertake her professional duties as she was under the influence of alcohol on three occasions with three different employers were found proved, and to amount to misconduct. The substantive panel considered that there was a lack of direct evidence from the Registrant as to insight or remediation. It noted that she had apologised to a number of witnesses, but there wasn’t any up-to-date evidence of the Registrant’s circumstances. The substantive panel found that the Registrant had little, if any, insight into her misconduct and there was no evidence of any remediation. The substantive panel determined that there was a high risk of repetition of the misconduct.

7. The substantive panel determined that the Registrant’s fitness to practise was impaired on both the personal and public components. The panel imposed a 12-month Suspension Order on the Registrant and made several recommendations about actions that the Registrant might take to assist a reviewing panel.

8. On 16 August 2019 the Suspension Order was reviewed for the first time. The first review panel noted that, at that time, the Registrant was engaging with the HCPC and seemed to be attempting to arrange for information to be provided in relation to her circumstances. The first review panel considered that the failings identified were capable of remediation. However, the panel did not consider that the limited information provided by the Registrant demonstrated that the risks identified by the substantive panel were reduced sufficiently to remove the need for an Order.

9. The first review panel was satisfied that the Registrant continued to pose a risk to the public, were she allowed to return to unrestricted practice at that point. Although the first review panel noted that the Registrant had informed the HCPC, during a telephone conversation on 14 June 2019, that she was “doing better” and that “the issues have been addressed”, it found little evidence of insight into the failings identified, or any evidence as to what remediation had been undertaken. The first review panel found that the Registrant remained impaired on both the personal and public components. It extended the Suspension Order for a further four months.

10. On 13 January 2020 the Suspension Order was reviewed a second time. The second review panel considered the findings of the previous panels to the effect that although the Registrant’s misconduct was capable of remediation, it had no evidence of any remediation. Further, the panel concluded that it had seen no information to demonstrate that the Registrant had reflected on her misconduct or that the Registrant had developed insight into the potentially serious consequences of her misconduct in relation to patient safety and the reputation of the profession. Further, the panel considered that there was no evidence of any meaningful engagement from the Registrant with the review process.

11. Therefore, the second review panel concluded that the risks identified by previous panels remained and that the Registrant’s fitness to practise remained impaired on both personal and public components. The panel decided to extend the Suspension Order for a further period of four months, to provide the Registrant with a further opportunity to demonstrate evidence of insight and remediation. The panel made several recommendations that, in its view, might assist the next reviewing panel.

12. On 20 April 2020, the Suspension Order was reviewed for the third time. The panel noted that the Registrant had made no progress, since the previous review, towards supplying any of the information that, it had been repeatedly suggested by previous panels, would be helpful. The panel concluded that “the Registrant’s fitness to practice remains as impaired as it was at the time of the Final Hearing in August 2018. The absence of evidence of insight and remediation has the consequence that the risk of repetition remains …”

13. Having decided that the Registrant’s fitness to practise remained impaired the panel considered the issue of sanction. The panel concluded that the only realistic choice was between yet another period of suspension or a striking off order. Given the lack of any demonstrable progress made by the Registrant during the period since August 2018, when she was clearly prompted as to the measures that she could take, the panel seriously considered making a striking off order. However, considering the COVID-19 pandemic, the panel “stepped back from making a striking off order” lest the exceptional circumstances “had impeded the Registrant in demonstrating that she has in fact made some progress”. Consequently, the panel extended the Suspension Order for a period of 12 months.

14. However, in its decision the panel noted that “the Registrant would be well advised to consider that if her lack of real engagement and the absence of demonstrable remediation continues, a striking off order might well be the order made on the next review. As to the steps that the Registrant might consider taking to satisfy a future reviewing panel that she should be permitted to return to practise, they have already been suggested by the previous panels. They are as follows:

A future reviewing panel would be assisted by:
⦁ engagement on her part;
⦁ a reflective piece from her regarding the impact of her misconduct on patients and colleagues;
⦁ any relevant information about the registrant’s health and well-being;
⦁ any relevant information as to professional development;
⦁ any relevant testimonials in relation to paid or unpaid work.”

Submissions

15. Ms Sampson referred to the decision on 20 April 2021 of the most recent reviewing panel, and to the matters which it indicated would assist a panel at any future review. She said that apart from the statement dated 11 April 2021 the Registrant has not responded to any of these suggestions. Further, that in her statement the Registrant continues to demonstrate little by way of insight, remorse or remedial steps taken.

16. Ms Sampson commented that little has changed since the Final hearing in August 2018. Her submission was that there remains a significant risk of repetition and as a consequence, of harm to service users. Furthermore, the public interest concerns have not been addressed and that confidence in the profession would be undermined if there were not a finding of impairment. In summary Ms Sampson’s submission was that the Registrant’s fitness to practise remains impaired on both public and personal grounds.

17. In regard to sanction, Ms Sampson observed that despite a total period of Suspension of some two years eight months, the Registrant has failed to address the recommendations of three previous panels. Her submission therefore was that now the only appropriate and proportionate sanction was that of a Striking Off Order.

18. The Registrant in her statement, says that she no longer intended to return to practice but wished to seek voluntary removal from the register rather than being struck off.

Decision

19. In reaching its decision the Panel considered all the information before it together with the submissions of Ms Sampson and what has been said by the Registrant in her recent statement. It has had regard to the HCPTS Practice Note “Review of Article 30 Orders” and the Council’s Sanctions Policy. The Panel accepted the advice of the Legal Assessor. It has exercised the principle of proportionality at all times.

20. The Panel had regard to the decisions of previous panels but it has comprehensively reviewed the case and has exercised its own judgement in reaching its decision.

21. The Panel first considered whether the Registrant's fitness to practise is currently impaired by reason of the misconduct found proved at the subsequent hearing.

22. The Registrant has since the last review given little indication of any further insight into her misconduct or of remedial steps taken, as is apparent from her recent statement. This statement did not address the recommendations made by previous panels and despite the opportunities which have been afforded her since the original hearing, there has been little significant change in circumstances since that hearing in 2018. However, in her statement the Registrant has indicated that she no longer wishes to return to practice.

23. The Panel has concluded that in the absence of significant insight it cannot be satisfied that misconduct of this nature is unlikely to be repeated nor that it is likely that the Registrant will remedy her failings. In all the current circumstances the Panel has determined that the Registrant's fitness to practise remains impaired.

24. In regard to sanction the Panel did consider whether the current Suspension Order should be allowed to lapse, but to allow the Registrant to practise unrestricted would not address public protection and public interest concerns. Misconduct of this nature demands sanction. The Panel discounted a Caution Order for the same reasons. Furthermore, a Conditions of Practice Order would not be appropriate in the light of the serious nature of the misconduct and the Registrant’s indication that she no longer wishes to practice as a Physiotherapist.

25. The Panel next considered whether to extend the Suspension Order but despite the several opportunities given to her since the original order was imposed, the Registrant has failed to address the recommendations made by previous panels. In the circumstances the Panel has concluded that a further period of Suspension would serve no useful purpose.

26. The Panel has therefore concluded that the only appropriate, proportionate and sufficient sanction is that of a Striking Off Order. Only would this adequately protect the public and address the wider public interest.

ORDER: The Registrar is directed to strike the name of Miss Alexandra Claire Burns from the Register on the date this order comes into effect.

The order imposed will apply from 18 May 2021.

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 Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

History of Hearings for Miss Alexandra Claire Burns