Mrs Victoria V Asirvatham

Profession: Occupational therapist

Registration Number: OT41405

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 03/09/2021 End: 17:00 03/09/2021

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

The following Allegation was considered by a panel of the Conduct and Competence Committee at a substantive hearing on 26 February 2018 – 2 March 2018.

While registered as an Occupational Therapist and during the course of your employment as an Occupational Therapist for 2gether NHS Foundation Trust in a Band 5 post:

1. In relation to Service User 1, you: 

a. Between 11 March 2015 and 08 April 2015, conducted and/or recorded an assessment using the Model of Human Occupation Screening Tool [MOHOST], which did not contain;

(i) A comprehensive analysis of Service User 1’s occupational health needs,

(ii) Adequate clinical reasoning and/or demonstrate understanding of the use of the MOHST tool,

(iii) A summary, and/or

(iv) Recommendations for care intervention.

b. On 13 April 2015, conducted and/or recorded an assessment of Service User 1’s activities of daily living which did not contain;

(i) A summary,

(ii) An overall analysis of the Service User’s needs, and/or

(iii) An intervention plan and/or recommendations for care intervention.

c. On 30 June 2015, conducted and/or recorded an assessment/observation of Service User 1 and did not report and/or make a record of reporting Service User 1’s mental state to ward staff.

d. On 07 July 2015, conducted and/or recorded an assessment/observation of Service User 1 walking in hospital grounds which did not contain;

(i) A proper analysis of the observation,

(ii) An intervention plan, and/or

(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

e. On 29 July 2015, conducted and/or recorded an assessment/observation of Service User 1 cleaning their environment which did not contain;

(i) A proper analysis of the observation,

(ii) An intervention plan, and/or

(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

f. On 26 August 2015, conducted and/or recorded an assessment/observation of Service User 1 adapting their routine to attend lunch which did not contain;

(i) A proper analysis of the Service User’s process skills,

(ii) A plan for further intervention, and/or

(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

g. On 28 August 2015, conducted and/or recorded an assessment/observation of Service User 1 attending a chapel service, which did not contain;

(i) A proper analysis of the observation,

(ii) An intervention plan, and/or

(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

h. On 31 August 2015, conducted and/or recorded an assessment/observation with the purpose of increasing Service User’s 1’s attendance at music in mind group, which did not contain;

(i) A proper analysis of the observation,

(ii) An intervention plan, and/or

(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

i. On 03 September 2015, conducted and/or recorded an assessment/observation of Service User 1 using the bath, which did not contain a detailed analysis regarding;


(i) The Servicer User’s environment,

(ii) The limited use of transfers,

(iii) The Service User’s Mobility, and/or

(iv) The Service User’s use of equipment.

j. On 03 September 2015, conducted and/or recorded an assessment/observation of Service User 1’s shopping and banking, which did not contain;

(i) A detailed analysis of the activity and/or the environment in which the activity was conducted, and/or

(ii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

k. On 04 September 2015, conducted and/or recorded an assessment/observation of Service User 1 attending a chapel service, which did not contain;

(i) A detailed analysis of the activity and/or the environment in which the activity was conducted,

(ii) An intervention plan, and/or

(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

l. Between 11 March 2015 and 1 October 2015, you did not initiate a Care Plan in respect of Service User 1.

2. In relation to Service User 2, you:

a. On 09 July 2015, conducted and/or recorded a home visit assessment to assess bath transfer, which did not contain;

(i) A summary,

(ii) Adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs, and/or

(iii) Did not provide a recommendation about suitability of environment.

b. [not proved];

(i) [not proved];

(ii) [not proved];

(iii) [not proved].

c. On 17 August 2015, conducted and/or recorded an observation of Service User 2 engaging in an activity which could be adapted into their routine, which did not contain;

(i) [not proved];

(ii) [not proved];

(iii) Adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs.

d. Did not add any new information to the Care Plan to reflect developments in Service User 2’s treatment, such as the completion of an Interests Checklist on 26 January 2015, Service User 2’s discharge on 10 February 2015 and his re-admittance in June 2015.

e. On 24 March 2016, at a joint assessment of Service User 2, completed a record of the assessment which did not contain adequate analysis of the service user’s physical presentation during the assessment.

3. In relation to Service User 3, you:

a. On 05 February 2016, conducted and/or recorded an assessment of Service User 3’s environment, which did not contain;

(i) A proper analysis of the observation and/or assessment findings,

(ii) An intervention plan, and/or

(iii) Adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs.

b. Completed a draft Occupational Therapy Report dated 10 February 2016 which was inadequate for the following reasons:

(i) You used incorrect paperwork showing the wrong NHS Trust,

(ii) The report did not contain sufficient information about Service User 3’s occupational needs,

(iii) [not proved].

4. In relation to Service User 4 you:

a. On or around 19 November 2015, you completed a Care Plan and included the requirement for weekly reviews to be conducted by the Occupational Therapist, which you then did not carry out.

b. [not proved];

c. On 07 December 2015, completed an Occupational Therapy report, which did not contain;

(i) A proper analysis of the observation,

(ii) Detailed clinical reasoning,

(iii) Detailed information about the Service User’s new environment and/or the relationship between the new environment and the service user’s occupational needs,

(iv) an intervention plan

5. In relation to Service User 5 you:

a. On 18 November 2015, completed and/or recorded an assessment to adapt Service User 5‘s routine which contained the wrong Service User 5’s name.

b. On 30 November 2015, conducted and/or recorded an observation/assessment in relation to Service User 5’s cooking skills, which did not contain;

(i) A proper analysis of the observation and/or potential risk, and/or

(ii) A strategy to support Service User 5.

c. On 09 December 2015, made a record of a conversation with a doctor which did not contain any explanation why the Service User was said to have a lack of capacity towards treatment.

d. On 11 December 2015, conducted and/or recorded observation of Service User 5 in the hospital grounds, and:

(i) Did not identify the Service User’s behaviour as a potential significant risk in the written record of the observation,

(ii) Did not identify the Service User’s behaviour may indicate the presence of mental health concerns in the written record of the observation, and/or

(iii) Did not feedback the potential risks regarding Service User 5’s presentation during the observation to the ward.

6. In relation to Service User 6 you:

a. On 20 November 2015, conducted and/or recorded an observation of the Service User engaging in tasks to adapt routine, which did not make reference to the impact of the environment.

b. On 23 November 2015, conducted and/or recorded an observation of the Service User during a walk in the hospital grounds which did not contain:

(i) a proper analysis of the observation; and/or

(ii) a detailed analysis of the Service User’s ability to plan for the future.

c. On 30 October 2015, conducted and/or recorded an observation/assessment of the Service User involving building rapport, which did not contain;

(i) A proper analysis of the Service User’s process skills, and/or

(ii) An intervention plan.

d. On 01 December 2015, completed an occupational therapy discharge summary, which did not contain a proper analysis of the Service User’s needs upon discharge.

e. On 01 December 2015, conducted and/or recorded an assessment using the Model of Human Occupation Screening Tool [MOHOST], which did not contain a comprehensive analysis of and/or adequate clinical reasoning regarding Service User 6’s occupational health needs at home.

7. In relation to Service User 7 you:

a. On 10 May 2016, conducted and/or recorded an observation during an initial contact ,which did not contain;

(i). A proper analysis of the observation,

(ii) An intervention plan, and/or

(iii) Indicate what further assessments were/will be required.

b. On 12 May 2016, completed a written record of an observation of the Service User, which;

(i) Described the activity incorrectly, and/or

(ii) Did not include detailed analysis and/or clinical reasoning for the recommendations made.

c. On 18 May 2016, conducted and/or recorded an observation of the Service User which incorrectly referred to one purpose of the assessment being re-motivation.

d. On 20 May 2016, conducted and/or recorded an observation of the Service User, which;

(i) incorrectly referred to the purpose of the observation as being re-motivation,

(ii) Did not contain a proper analysis of the observation and/or a summary, and/or

(iii) Did not contain an adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs.

e. On 25 May 2016, completed and/or recorded a record for an observation at a breakfast group which:

(i) incorrectly referred to the purpose of the observation as being re-motivation,

(ii) contained the wrong Service User’s name.

f. On 27 May 2016, conducted an ADL assessment in the community in relation to Service User 7, which was not required as this had already been completed on 17 May 2016.

g. On 01 June 2016, completed a written record of an observation involving a breakfast group activity, which incorrectly referred to one of the purposes of the intervention as being re-motivation.

8. In relation to Service User 8, on or around 16 April 2015 you completed a Care Plan which was inadequate, in that it:

a. did not reflect Service User 8’s Occupational Therapy needs, and/or

b. stated goals of exploring Service User 8’s routines and interests and engaging Service User 8 in meaningful activities which were insufficient to address Service User 8’s occupational needs.

9. You did not ensure that case notes entered on the RiO system were validated with a signed electronic signature in the cases of;

a. Service User 1, namely the entry dated 30 May 2016.

b. Service User 2, namely the entries dated:

(i). 08 July 2015,

(ii) 2 September 2015

(iii) 14 December 2015,

(iv) 14 March 2016 and/or

(v)14 April 2016.

c. Service User 3, namely the entries dated:

(i). 09 February 2016,

(ii). 11 February 2016, and/or

(iii) 23 February 2016 .

d. Service User 5, namely the entry dated 09 December 2015.

10. Your actions as described at paragraphs 1-9 amount to misconduct and/or lack of competence.

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

The panel at the substantive hearing found particulars 1(a)(i), 1(a)(ii), 1(a)(iii), 1(a)(iv), 1(b)(i), 1(b)(ii), 1(b)(iii), 1(c), 1(d)(i), 1(d)(ii), 1(d)(iii), 1(e)(i), 1(e)(ii), 1(e)(iii), 1(f)(i), 1(f)(ii), 1(f)(iii), 1(g)(i), 1(g)(ii), 1(g)(iii), 1(h)(i), 1(h)(ii), 1(h)(iii), 1(i)(i), 1(i)(ii), 1(i)(iii), 1(i)(iv), 1(j)(i), 1(j)(ii), 1(k)(i), 1(k)(ii), 1(k)(iii),1(l), 2(a)(i), 2(a)(ii), 2(a)(iii),, 2(c)(iii), 2(d), 3(a)(i), 3(a)(ii), 3(a)(iii), 3(b)(i), 3(b)(ii), 4(a), 4(c)(i), 4(c)(ii), 4(c)(iii), 4(c)(iv), 5(a), 5(b)(i), 5(b)(ii), 5(c), 5(d)(i), 5(d)(ii), 5(d)(iii), 6(a), 6(b)(i), 6(b)(ii), 6(c)(i), 6(c)(ii), 6(d), 6(e), 7(a)(i), 7(a)(ii), 7(a)(iii), 7(c), 7(d)(i), 7(d)(ii), 7(d)(iii), 7(e)(i), 7(e)(ii), 7(f), 7(g), 8(a), 8(b), 9(a), 9(b)(i), 9(b)(ii), 9(b)(iii), 9(b)(iv), 9(b)(v), 9(c)(i), 9(c)(ii), 9(c)(iii), and 9(d) proved, that the proven facts amounted to lack of competence, and that the Registrant’s fitness to practise was impaired.

Finding

Background

1. The Registrant is a registered Occupational Therapist (OT). On 8 December 2008, she was employed as a Band 5 Occupational Therapist by 2Gether NHS Foundation Trust (the Trust), which provides mental health and learning disability services. She was responsible for adult patients with severe and enduring mental illness.

2. From 3 November 2014 to 2016, she was employed in the Wotton Lawn Inpatient Unit, which provides inpatient treatment for adults with mental illness who require hospital treatment due to an acute episode prior to returning to the community.

3. On 26 February 2018 to 2 March 2018, a panel of the Conduct and Competence Committee considered an Allegation that the Registrant’s fitness to practise was impaired in relation to her responsibilities for eight separate service users over the period March 2015 to May 2016. The Registrant had failed in a wide range of areas of core occupational therapy skills, including the adequacy of her assessments and observations, the adequacy of her clinical reasoning, failures to initiate or implement Care Plans, and failures in respect of her case notes. The difficulties persisted despite the support provided by the Registrant’s managers of a reduced caseload, a less complex case load, and supervision.

4. The substantive hearing panel also considered that the Registrant had demonstrated an alarming lack of insight. There was no evidence that the Registrant recognised the effect that her shortcomings had on service users and colleagues.

5. The substantive hearing panel decided that the appropriate and proportionate Order was a Suspension Order for a period of 12 months.

6. At the first review hearing, that review panel found that the Registrant’s fitness to practise remained impaired and extended the period of suspension for a further 12 months.

7. In providing its reasons for this determination, the panel complimented the Registrant on her attendance at the hearing and took the view that she was enthusiastic and motivated in relation to her role as a support worker and her desire to return to practice as an OT. However, the panel also expressed its concern that the Registrant had not understood the seriousness of her lack of competence and said that, during the course of her evidence, she had failed to focus on the most serious findings made by the panel at the substantive hearing. Her level of insight, the review panel added, was limited and it found no evidence that the Registrant had remediated her deficiencies to the full.

8. At the second review hearing, that panel found that the Registrant’s fitness to practice remained impaired, but considered that she had gained further insight into her deficiencies and decided to impose a Conditions of Practice Order for a period of 18 months.

Submissions and evidence

9. Mr D’Alton submitted that the Registrant remains impaired. While he commended the Registrant for the ongoing training she had undertaken in the field of Occupational Therapy, as well as other efforts to demonstrate her recent work, Mr D’Alton highlighted the fact that the Registrant had not yet found employment as an OT. Therefore she had not had an opportunity to practice as such and demonstrate remediation while subject to the conditions. Mr D’Alton submitted that in such circumstances, there remained a real risk of repetition of the lack of competence found proved.

10. Mr D’Alton submitted that a continuation of the current Conditions of Practice Order was the most appropriate and proportionate sanction, to allow the Registrant further time to remediate. He submitted that it may be appropriate to change the words “Operative Date” to make clear that some of the conditions only come into effect when the Registrant begins work as an OT.

11. The Registrant gave evidence. What follows is not intended to be an exhaustive rendition of the Registrant’s evidence, rather a summary.

12. The Registrant told the Panel that she continued to work part-time as a support worker at the Alders Clinic, a hospital providing rehabilitation for women with personality disorders, and the Panel read a reference from her manager, a Registered Mental Health Nurse, dated 24 August 2021. The Registrant also submitted reflective case studies, written after the last review hearing, relating to her work as a support worker, as well as appraisals and supervision records for that work.

13. The Registrant also explained that she has begun another role, currently part-time, as a relief rehabilitation officer at Great Western Court (GWC), a rehabilitation unit for the elderly. She explained that she was still in the Induction process of the new role, but stated that this role will involve risk assessments and clinical analysis, and she submitted some pro forma assessment forms which she will be using for that role. She continues to work as a volunteer for CRUSE bereavement care, which involves its own training, and is studying for a qualification in counselling.

14. She gave evidence that she had applied for Band 5 OT positions and provided documentary evidence of her applications, although she had not yet been successful.

15. She told the Panel about many different examples of training she has undertaken for her roles, as well as Continuing Professional Development (CPD) training undertaken at the Royal College of Occupational Therapy, and the Panel saw certificates attesting to that training, including training on risk assessments for OTs. She had also obtained support and guidance with a senior OT through online sessions, which had helped her reflect on the requirements of risk assessments from an OT perspective.

16. The Panel also saw a training certificate attesting to completion of an online course in medicine administration, which she said she had completed at her own cost in preparation for her role at GWC.

17. The Registrant told the Panel that, having carried out risk assessments in her role as a support worker, she now better understood her failings which were the subject of the original findings and accepted that she had put service users at risk and that this had an adverse impact on her colleagues. She confirmed that she hoped to rectify her mistakes.

18. She told the Panel that she was not as impaired as she was previously but accepted that she was still on a journey. The Registrant’s position was that the Conditions of Practice should continue but requested that the Panel consider lessening the degree of restriction in the conditions to reflect her work and the progress she has made.

19. The Panel read the HCPC bundle, and two bundles from the Registrant which contained a large amount of documentation.

Decision on Impairment

20. The Panel was aware that its purpose today was to conduct a comprehensive review of the Registrant’s fitness to return to unrestricted practice and considered the HCPTS Practice Note entitled “Review of Article 30 Sanction Orders”. The Panel accepted the advice of the Legal Assessor.

21. The Panel considered the evidence of the Registrant as well as the documentation which she put before the Panel. The Panel decided that she was continuing to develop insight into her previous lack of competence and the impact of it upon service users and colleagues, as well as upon public confidence in her and the profession. The Panel did remain concerned that the Registrant has not yet fully recognised how to remediate her failings and has therefore not yet achieved complete insight into her lack of competence.

22. With regard to the steps which the Registrant has taken, the Panel took the view that she has clearly been proactive in searching for training (including in the OT field) and roles which she views as relevant to demonstrating how she has addressed the concerns which were found proved, and the Panel commends her for her efforts. She has also undertaken a basic level of risk assessment in her role as a support worker. However, the Registrant has still not worked as an OT and therefore has not been able to demonstrate her remediation in line with the conditions which are specifically targeted at addressing the concerns found proved.

23. The Panel took the view that in the absence of working pursuant to the conditions, the Registrant has not demonstrated targeted and focused remediation. In particular, the Registrant was not able to provide substantive evidence of assessment observations, clinical reasoning, or treatment planning and observations to a standard commensurate with that expected of an OT.

24. While the manner in which the Registrant seeks to address the concerns is a matter for her, it seemed to the Panel that obtaining work as an OT assistant may assist the Registrant in re-entering the profession, as well as simultaneously allowing her to undertake the return to practice requirements.

25. Therefore, without being tested in the OT environment, which has its own particular demands and responsibilities which are substantively different to the roles which the Registrant currently undertakes, and in light of the length of time during which the Registrant has not practiced as an OT, the Panel concluded that there remains a real risk of repetition of the original concerns. Therefore, the Registrant’s fitness to practice remains impaired on the basis of the personal component.

26. The Panel was also of the view that in light of the wide-ranging lack of competence found proved and the lack of sufficient evidence of remediation, the need to uphold proper professional standards and to maintain public confidence in the profession would be undermined if a finding of impairment were not made.

27. Thus the Panel found that the Registrant remains impaired on both the personal and public components.

Decision on Sanction

28. The Panel next went on to consider sanction and took into account the HCPC Sanctions Policy (SP). The Panel bore in mind that sanction is a matter for its own independent judgement and that the purpose of a sanction is not to punish the Registrant. Any sanction must be proportionate, so that it is the least restrictive order necessary to protect the public interest.

29. The Panel first considered taking no action. The Panel concluded that, in view of the lack of sufficient remediation, it would be inappropriate to take no action. It would be insufficient to protect the public and maintain public confidence and uphold the reputation of the profession. The Panel concluded that a Caution Order would be inappropriate and insufficient for the same reasons.

30. The Panel next considered a Conditions of Practice Order. It carefully considered the current conditions in place and decided that they remain appropriate and proportionate, balancing the need to protect the public and the public interest, as well as allowing the Registrant to practice safely. The Panel made minor amendments to the wording to achieve further clarity, but the meaning of the conditions has not changed.

31. The Panel decided to impose the Conditions of Practice Order for a further 12 months, to begin when the current Order expires. The Panel decided that a further period of 12 months would be proportionate and appropriate, reflecting the Registrant’s developing insight and the efforts she has continued to make, as well as to allow her the opportunity to find work and practice pursuant to the conditions.

32. The Panel did consider Suspension but decided that this would be wholly disproportionate in light of the Registrant’s developing insight and engagement with the regulatory process, and her efforts to demonstrate to the Panel what she has been doing since the last review.

33. The Conditions are set out below.

Order

The Registrar is directed to annotate the HCPC Register to show that for 12 months from the date that this Order takes effect, you, Ms Victoria V Asirvatham, must comply with the following conditions of practice:

1. Before practising as an OT, you must satisfactorily complete the HCPC return to practice requirements and forward confirmation of so doing to the HCPC.

2. You must place yourself and remain under the supervision of your workplace supervisor, registered by the HCPC or other appropriate statutory regulator, and supply details of your supervisor to the HCPC within one month of beginning in a post as a Registered OT. You must attend upon that supervisor as required and follow their advice and recommendations.

3. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

4. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;

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

C. any prospective employer (at the time of your application).

5. You must meet with your supervisor on a monthly basis to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

I. Assessment observation;
II. Clinical reasoning;
III. Treatment planning and evaluation.

6. Within three months of beginning in a post as a Registered OT you must forward a copy of your Personal Development Plan to the HCPC.

7. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

8. You must maintain a reflective practice profile detailing every occasion when you conduct assessment and observations, clinical reasoning, and treatment planning, and must provide a copy of that profile to the HCPC on a monthly basis or confirm that there have been no such occasions in that period, the first profile or confirmation to be provided within one month of beginning in a post as a Registered OT.

Notes

The Order imposed today will apply from 30 September 2021.

This Order will be reviewed again before its expiry.

Hearing History

History of Hearings for Mrs Victoria V Asirvatham

Date Panel Hearing type Outcomes / Status
01/09/2022 Conduct and Competence Committee Review Hearing Conditions of Practice
03/09/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
27/02/2020 Conduct and Competence Committee Review Hearing Conditions of Practice
20/02/2019 Conduct and Competence Committee Review Hearing Suspended
26/02/2018 Conduct and Competence Committee Final Hearing Suspended
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