Miss Lois K Appleton
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Allegation
During the course of your employment as a registered Physiotherapist with Western Sussex Hospitals NHS Foundation Trust:
1. On or around 16 March 2016, while attending to Patient F, you:
a) did not check the amount of oxygen and flow rate being delivered via the Optiflow
b) did not take the respiratory rate during the assessment
c) relied on the doctor’s documentation of oxygen saturation, flow rate and respiratory rate
d) did not review the patient's bloods
e) were unable to identify indicators of renal failure/impairment
2. On or around 7 April 2016, while attending to Patient L, you did not know the normal/safe range for a troponin test result.
3. On or around 8 April 2016, while attending to Patient J, you did not know the normal/safe range for a troponin test result.
4. On or around 23 April 2016, while attending to Patient A, you:
a) did not check, and/or or take account of, Patient A's x-rays or blood test results
b) suggested an unsafe assessment
c) required intervention from a colleague to prevent an unsafe assessment being carried out
5. On or around 27 April 2016, while attending to Patient I, until prompted to do so, you did not:
a) prepare the area
b) source appropriate footwear
c) clear clutter from the chair
d) sit the patient out of bed
e) check the height of the chair
6. On or around 28 April 2016 assessed a new patient (Patient N) without a senior member of staff being present.
7. On or around 29 April 2016, you attended an unknown patient (Patient M) and did not:
a) calculate the patient’s respiratory rate
b) identify the patient's normal respiratory function
c) identify the patient's normal sputum production
d) identify that the patient had a Glyceryl Trinitrate [GTN] infusion/pump attached
8. On or around 29 April 2016, you attend Patient C and did not identify that intermittent positive-pressure breathing [IPPB] was contraindicated due to a very low blood pressure and pulmonary fibrosis.
9. On or around 6 May 2016, while attending to Patient H, you did not:
a) enquire about past falls
b) obtain a handover from the nursing team
c) check the patient's mobility aid, which they brought from home, for safety
d) assess a Timed Unsupported Steady Stand [TUSS] prior to mobilising
e) establish if the patient needed support whilst mobilising
f) initiate any action in response to the oxygen saturation probe alarm
10. On or around 8 April 2016, while attending to Patient E, you:
a) did not identify that Patient E's oxygen was not turned on at the wall
b) did not assess Patient E's:
i) respiratory rate
ii) oxygen saturation
iii) fraction of inspired oxygen
c) were unable to identify Patient E's target oxygen saturation
11. On or around 9 May 2017, while attending to Patient G, you
a) did not handover the assessment to the nursing team
b) did not document the safety recommendations which were discussed
12. On or around 13 May 2016, while attending to Patient B, did not:
a) identify that a stand aid or rota stand was needed to mobilise a patient
b) use the stand aid safely
13. On or around 27 May, while attending to Patient D, you did not calculate the:
a) respiratory rate
b) oxygen saturation
c) associated oxygen delivery
14. The matters set out in paragraphs 1 - 13 constitute lack of competence.
15. By reason of your lack of competence your fitness to practise is impaired.
Finding
Preliminary Matters:
Notice of Hearing
1. The Notice of Hearing was sent to the Registrant’s registered email address on 08 December 2020. In her emailed response of 08 January 2021, the Registrant wrote that she had “no intention of attending the aforementioned hearing”. The Panel determined that good Notice had been served in this case.
Proceeding in Absence
2. In the knowledge that good service had been found and that this is a mandatory review, the Panel, in considering this application, paid particular regard to the repeated statements from the Registrant that she had no desire to attend today’s Hearing. In addition to the contents of the 8 January 2021 email mentioned above at paragraph one, the Registrant confirmed this sentiment by expressing “ a desire not to engage with the upcoming Hearing” in an email she sent to the HCPC on the 17 January 2021. Thus, the Panel determined that it was appropriate for this case to proceed in the absence of the Registrant.
Background
3. The Registrant commenced employment as a Band 6 Physiotherapist within the Acute Admissions and Private Patients Team at St Richards Hospital NHS Foundation Trust (the Trust) in August 2015. In around October 2015 concerns were raised about the Registrant’s practice. The informal stage of the Trust’s capability process was implemented from 13 November 2015. As part of this process, the Registrant spent four weeks working full-time in the respiratory team to improve her skills in this area. A decision was taken to progress to the formal capability process and a Final Stage Capability hearing was held on 11 July 2016. As a result of patient safety concerns, toward the latter stage of the Trust’s capability process all the Registrant’s clinical work was supervised by a Senior Physiotherapist.
4. The HCPC Allegation, which related to the incidents which arose during the period of the Registrant’s supervised practice, was considered by a substantive hearing Panel on 23-25 July 2018. The Registrant had informed the HCPC that she would not attend the hearing and she did not do so. The panel found all the facts proved and that they constituted a lack of competence.
5. In its decision on impairment the substantive hearing panel explained that although the Registrant engaged fully with the capability process, she did not appear to have any insight into her failings or to understand the seriousness of them with regard to patient safety. There was also no evidence of remediation. The substantive hearing panel was of the view that the Registrant had repeatedly demonstrated wide-ranging failings in basic physiotherapy skills relevant to her role. In the absence of remediation there was a real risk of repetition. That panel found impairment also on the public interest limb in that they concluded that there was a serious risk of an adverse impact on public confidence in the profession and in the regulatory process if a finding of impairment was not made in the circumstances.
6. The sanction imposed on that occasion was a Suspension Order for 12 months and a suggestion was made that any reviewing panel might be assisted by evidence from the Registrant of relevant continuing education and professional development, relevant work experience and references from any employers, together with evidence that the Registrant wished to continue to work as a Physiotherapist.
7. At the review hearing held on 22 July 2019, the panel determined that there had been no change in circumstances of relevance and that the appropriate sanction to impose was to extend the order of suspension for a further 12 months, having found that the Registrant’s fitness to practice was still impaired on public protection and public interest grounds.
8. The reviewing panel considered that it may assist a future panel if the Registrant were to demonstrate engagement with the HCPC and attend a future hearing. In addition, a future panel would also be assisted with the following evidence:
• Of relevant continuing education and professional development;
• of relevant work experience and references from any employers; and,
• that the Registrant now wished to continue to work as a physiotherapist.
9. The next review took place on 13 June 2020. On this occasion the panel noted that the Registrant had been continuously suspended for a period of 23 months and there was nothing before it to show that she had achieved any insight into her identified failings. Again, there had been no relevant change in circumstances and the Registrant had failed to abide by any of the suggestions made by the previous panel in July 2019. The panel found a failure by the Registrant to engage in the HCPC process and extended the order of suspension for an additional six months. A warning was given that any future panel would have the option of imposing a Striking off Order. This was accompanied by a recommendation that the Registrant should undertake a number of steps in order to demonstrate engagement with the process. These steps were similar to the ones suggested six months earlier and included an additional recommendation that the Registrant should provide a reflective piece of writing.
Decision:
10. The Panel heard the submission of Ms Bwoma that the fitness to practise of the Registrant remained impaired and that the appropriate course for the Panel to adopt today would be to impose a Striking off Order. Ms Bwoma stressed that it was plain from recent correspondence that the Registrant had determined for some time that she had no desire to return to the profession of physiotherapy. Her decision not to engage, continued Ms Bwoma, was a deliberate one and she emphasised that the Registrant, who has not practised within the NHS since 2017, was anxious to cut her ties with her regulatory body.
11. In confirmation of this, in her email of 08 January 2021 to the HCPC, the Registrant stated that she had no intention “of working within the NHS or under the HCPC again”. She added in this same email that she therefore considered there was no point in her providing information about professional development or employment references. In a later email to the HCPC on 17 January 2021, the Registrant made mention of a 2017 request of hers for voluntary removal from the Register.
12. The Panel took account of all the material in this case and accepted the advice of the Legal Assessor. It also reminded itself of the contents of the HCPTS Practice Note ‘Finding Fitness to Practise Impaired’ and noted the relevant contents of the HCPC’s Sanction Policy.
13. Although in the past, voluntary removal may have been a theoretically appropriate disposal of this case and had been explored by the HCPC with the Registrant in 2017, the Panel noted that, because the Registrant did not accept that her fitness to practise was impaired, this was an avenue which could not be pursued.
14. For all the reasons given by the previous panels in this case, it is plain that the fitness to practise of this Registrant remains impaired, on both public protection and public interest grounds. No material has been submitted by her to rebut the persuasive burden that she has to demonstrate that she has properly addressed the issues of concern in this case.
15. Aware that a Striking off Order is a sanction of last resort, the Panel nevertheless takes a view that this would be the only appropriate and proportionate sanction to impose. Paragraph 101 of the Sanctions Policy states that such a disposal “may be particularly appropriate where the Registrant is unwilling to resolve matters”. The Registrant has made it entirely plain that any other sanction less onerous than this would be pointless, because she has firmly decided that she has no desire to return to physiotherapy.
Order
ORDER: That the Registrar is directed to strike the name of Lois K Appleton from the Register on the date this Order comes into effect.
Notes
No notes available
Hearing History
History of Hearings for Miss Lois K Appleton
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 19/01/2021 | Conduct and Competence Committee | Review Hearing | Struck off |
| 13/07/2020 | Conduct and Competence Committee | Review Hearing | Suspended |