Mr Inderjit Singh Sagar
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Allegation
In March 2011, whilst registered as a Chiropodist, you:
1. Did not complete an adequate assessment of Patient A prior to undertaking a nail ablation by not or not adequately:
(a) Assessing Patient A’s vascular supply;
(b) Obtaining Patient A’s medical history.
2. Did not complete adequate records in respect of Patient A.
3. Provided inappropriate treatment to Patient A’s right toe nail in that:
(a) You used phenol for the nail ablation when this was contra-indicated for Patient A;
(b) You did not refer Patient A to a GP or vascular consultant for assistance.
4. Did not obtain informed consent from Patient A prior to undertaking a nail ablation by not:
(a) Providing Patient A with a sufficient explanation of the treatment options;
(b) Providing Patient A with sufficient explanation of the risks and benefits of each of the treatment options.
5. Your actions described in paragraphs 1-4 amount to misconduct and/or lack of competence.
6. By reason of that misconduct and/or lack of competence, your fitness to practise is impaired.
Finding
Background
1. The Registrant is the owner of a Chiropody Practice. He has practised as a Registered Chiropodist/Podiatrist and a sole practitioner for over 20 years.
2. In March and April 2011, the Registrant provided treatment to Patient A that resulted in a complaint made three years later to the HCPC.
3. The Substantive Hearing took place in November 2017 and the first review was heard on the 18 January 2019.
4. On 23 January 2020 the Order was reviewed for the second time. The Registrant provided several documents setting out the courses he had attended, notes of discussions and learning, and one record keeping audit. The Registrant also provided a completed personal development plan (PDP) verified by his supervisor but with no notes of any meetings with the supervisor setting out the Registrant’s progress.
5. The second reviewing panel (2nd panel) considered that the Registrant had not fully complied with the conditions of practice order. As a result of being unable to find a supervisor the Registrant had not undertaken any partial or total nail avulsions. In these circumstances the 2nd panel concluded that the Registrant had not been able to demonstrate competence in this procedure or in any assessments prior to carrying out this procedure.
6. The 2nd panel noted the efforts made by the Registrant to produce his PDP and the reflective documents he had produced although it considered that these were insufficient to demonstrate complete insight or remediation and were lacking in several key areas.
7. The 2nd panel noted that there were no areas of concern highlighted by the Registrant’s supervisor. The 2nd panel was satisfied that on a general level the Registrant had remediated the concern in relation to his record keeping.
8. The 2nd panel concluded that there were no persistent or general failures and considered that the Registrant was genuinely willing to comply with conditions and had complied with the condition not to undertake partial or total nail avulsions without supervision. The 2nd panel considered that the Registrant was committed to improving his practice and had accessed training and support albeit that this process was not yet complete.
9. The 2nd panel concluded that, in all the circumstances, the appropriate and proportionate sanction to impose was a continuation of the Conditions of Practice order for a further period of 12 months with amendments to reflect the position at the time of the review.
10. Since then, there has been little contact from the Registrant. However, he emailed the HCPC on the 9 January 2021 and stated that he had had a “horrendous” year largely due to personal circumstances.
11. In that same email the Registrant stated that he had attended a cardiovascular shadowing session earlier in the year which “was very informative.” So much so that he booked onto a College of Podiatry “vascular court room” course which was cancelled due to Covid-19. He added that he had not managed to find a mentor but had not worked since April 2020. Furthermore, he expressed his desire to carry on working “when I get the opportunity, but it has been a very, very difficult year”.
Decision
12. The Panel heard the submission of Ms Sampson that the fitness to practise of the Registrant remained impaired and the appropriate course for the Panel to adopt today would be to extend the current Conditions of Practice Order for an additional 12 months.
13. Paying due regard to the HCPTS Practice Note “Fitness to Practise Impairment” the Panel’s view, after consideration of all the material in this case, is that the Registrant’s fitness to practise remains impaired on both public protection and public interest grounds.
14. The circumstances over the last 12 months have not altered in any material respect and the Panel’s view is that the Registrant has failed to discharge his persuasive burden to demonstrate that he has properly addressed the issues of concern that have been identified.
15. The Panel accepts the contention of Ms Sampson that the Registrant has failed to comply with conditions 1, 2, 3, 4 and 9 and that conditions 5, 6, 7 and 8 are not engaged. It seems to the Panel that a principal reason for this non-engagement has been the unfortunate personal circumstances suffered by the Registrant, not least the fact that the current pandemic has obliged him to self-isolate. Nevertheless, the Panel is fully aware that the Registrant’s practice has been subject to conditions for over 3 years and that very little progress been made. In this context the Panel wishes it to be known that its view is that, if no significant progress is made over the next 12 months, the future reviewing panel may wish to consider the option of imposing a Striking Off Order.
16. In all the circumstances, the Panel considers it appropriate to provide the Registrant with another opportunity to comply with the conditions. More lenient sanctions are plainly inappropriate in this case and the imposition of an order of suspension would, in the Panel’s view, achieve nothing.
17. Thus, the Panel has determined that it is appropriate and proportionate to extend the current Conditions of Practice Order for a further 12 months albeit with minor changes to Condition 2 and 3.
18. In making this order, the Panel suggests that any future reviewing panel would be assisted by the production from the Registrant of evidence to show that he has completed any relevant online learning available to him at the present time.
Order
ORDER: The Registrar is directed to annotate the Register to show that, for a period of one year from the date that this Order comes into effect, you, Inderjit Singh Sagar, must comply with the conditions of practice set out below:
1) You must not perform unsupervised partial or total nail avulsions under local anaesthetic until you have been assessed as competent, in both assessing a patient and carrying out the procedure, by a Chiropodist/Podiatrist registered with the HCPC with a minimum of five years post graduate qualification experience. You must send a copy of this completed assessment to the HCPC within 14 days of the assessment taking place.
2) You must work with a supervisor, who is a Chiropodist/Podiatrist registered with the HCPC with a minimum of five years post graduate qualification experience, who may or may not be the clinical supervisor referred to in Condition 1 above to formulate an updated Personal Development Plan (PDP) to address the following areas:
⦁ Completion of vascular assessments;
⦁ Outcomes of vascular assessments and their impact on treatment and referral.
3) You must send a copy of the updated PDP to the HCPC within 3 months of the date of this order.
4) You must meet with the supervisor referred to in condition 2 above, as required, to consider the aims as set out in your Personal Development Plan. At least 14 days before the next review of this Order, you must forward a copy of your Personal Development Plan with confirmation from your supervisor that all of the actions identified have been completed.
5) You must promptly inform the HCPC if you cease to be in self- employment or take up any other or further employment.
6) You must promptly inform the HCPC of any disciplinary proceedings taken against you by any employer.
7) 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).
8) You will be responsible for meeting any and all costs associated with complying with these conditions.
9) Any condition requiring you to provide any information to or obtain the approval of the HCPC is to be met by you. You must send the information required to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.
Notes
The Order will be reviewed before its expiry, i.e. on/around 27 February 2022.
Right of Appeal
The Registrant may appeal to the High Court against the Panel’s decision and the order it has made against him.
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 the notice is served on the Registrant.
Hearing History
History of Hearings for Mr Inderjit Singh Sagar
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 31/01/2022 | Conduct and Competence Committee | Review Hearing | Struck off |
| 21/01/2021 | Conduct and Competence Committee | Review Hearing | Conditions of Practice |
| 23/01/2020 | Conduct and Competence Committee | Review Hearing | Conditions of Practice |