Mr Thomas Richard Sugarman

Profession: Dietitian

Registration Number: DT11872

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 24/05/2021 End: 17:00 24/05/2021

Location: Hearing taking place virtually

Panel: Conduct and Competence Committee
Outcome: Voluntary Removal agreed

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Allegation

Whilst registered as a Dietician and during the course of your employment at Guy’s and St Thomas’ NHS Foundation Trust, you:


1. On or around 23 January 2017:


a. inappropriately assessed and/ or recorded a recommendation of a ‘normal consistency diet’ in an assessment plan for Patient A;


b. did not advise Patient A that dry biscuits were inappropriate for her recommended ‘soft consistency diet’;


c. ordered snacks for Patient A which were inappropriate for a ‘soft consistency diet’.


2. Between 13 July 2017 and 10 May 2018:


a. failed to complete adequate dietetic assessments for patients in that you did not:


i. obtain and/ or record an adequate history for the patients identified in Schedule 1;


ii. provide adequate and/ or appropriatedietetic advice to the patients identified in Schedule 2;


iii. address and/ or respond appropriately to patients’ dietary knowledge, concerns or misconceptions for the patients identified in Schedule 3;


iv. give appropriate written information to the patients identified in Schedule 4;


v. advise appropriately in relation to phosphate binders for the patients identified in Schedule 5;


b. failed to refer the patients identified in Schedule 6 for onward assessment and/or treatment.


3. Between around January 2017 and May 2018, failed to provide and/ or arrange appropriate follow-up for the patients identified in Schedule 7.


4. The matters set out in paragraphs 1 – 3 constitute misconduct and/ or lack of competence.


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

Finding

Preliminary Matters


1. Ms Sampson made an application that any references to the Registrant’s health ought to be heard in private session. The application was not opposed by Ms Monaghan. Having taken the advice of the Legal Assessor the Panel allowed the application and determined that the hearing would go into private session in respect of any references to the Registrant’s health.

 


Background

2.The Registrant was employed at Guy’s and St Thomas’s NHS Foundation Trust (“The Trust”) as a Band 6 Specialist Renal Dietitian and was responsible for renal patients on haemodialysis and pre-dialysis renal patients who attended an outpatient clinic service.

3.Between January 2017 and May 2018, several concerns were raised about the Registrant, resulting in allegations relating to the Registrant’s assessment of patients, his provision of inadequate or inappropriate dietetic advice to patients and his failure to arrange appropriate follow up for patients.

4.In January 2017, an incident occurred in relation to an elderly patient, Patient A. Patient A had previously been assessed and recommended a soft consistency diet by her Speech and Language Therapist.

5.On 23 January 2017, the Registrant made a note of the earlier recommendation for a soft consistency diet, but also ordered a normal diet and made an order for Patient A of dry biscuits with cheese and sausages.

6.On 30 January 2017 Patient A sadly died following the consumption of normal food whilst on a soft diet. The Trust prepared a serious incident investigation report (QIPS) which identified multiple errors and system factors which may have contributed to this incident, including the Registrant’s actions. The Clinical Lead Dietitian was one of the authors of the QIPS report.

7.The Registrant was suspended on 13 February 2017. The Trust permitted him to return to work following finalisation of the QIPS report in May 2017. However, the Registrant was subject to a capability process involving a period of supervision and monitoring of his practice by a Band 8a Principal Renal Dietitian at the Trust.

8.Between 25 November – 02 December 2019 there was a substantive hearing of the Conduct and Competence Committee at which the following allegation was considered:

Whilst registered as a Dietician and during the course of your employment at Guy’s and St Thomas’s NHS Foundation Trust, you:

1.On or around the 23 January 2017:

(a)inappropriately assessed and/or/or recorded a recommendation of a “normal consistency diet” in an assessment plan for Patient A;
(b)did not advise Patient A that dry biscuits were inappropriate for her “recommended soft consistency diet”;
(c)ordered snacks for Patient A which were inappropriate for a “soft consistency diet”.

2.Between 13 July 2017 and 10 May 2018:

a.failed to complete adequate dietetic assessments for patients in that you did not:
i.Obtain and/or record an adequate history for the patients identified in    Schedule 1;
ii.provide adequate and/or appropriate dietetic advice to the patients identified in Schedule 2;
iii.address and/or respond appropriately to patients dietary knowledge, concerns or misconceptions for the patients identified in Schedule 3;
iv.give appropriate written information to the patients identified in Schedule 4;
v.advise appropriately in relation to phosphate binders for the patients identified in Schedule 5;
b.Failed to refer the patients identified in Schedule 6 for onward assessment and/or treatment.

3.Between around January 2017 and May 2018, failed to provide and/or arrange appropriate follow-up for the patients identified in Schedule 7.

4.The matters set out in paragraph 1-3 constitute misconduct and/or lack of competence.

5.By reason of your misconduct and/or lack of competence your fitness to practice is impaired.

9.At the outset of the hearing, the Registrant made admissions to all the factual particulars, except for two patients. The Substantive Hearing Panel found all the particulars proved save for one patient. The Registrant’s fitness to practise was found to be impaired by reason of a lack of competence and he was suspended for a period of 12 months.

10.The Suspension Order was reviewed by a panel on 18 November 2020 and extended for a further 6 months.

Decision on Application

11.The Panel heard submissions from Ms Sampson who referred it to the skeleton argument dated 18 May 2021 in support of the application. Ms Sampson also referred the Panel to the contents of a statement from the Registrant which was sent to the HCPC in which the Registrant, in asking for a voluntary removal, informed the HCPC that he fully accepted the findings which had been made against him by the Conduct and Competence Committee and that his fitness to practise was currently impaired by reason of lack of competence. The Registrant also accepted in his email, that he was unable to remediate his lack of competence and had decided to pursue an alternative career as an IT specialist.

12.Ms Sampson submitted that the HCPC was satisfied that voluntary removal from the Register was an appropriate disposal of this case and would protect the public and was in the public interest. This was because its effect was the same as a strike-off from the Register following a finding of impairment of fitness to practise in that it would prevent the Registrant from practising or applying to re-join the Register for a period of five years. Further, any application for re-registration after 5 years would require a return to practise validation.

13.Miss Monaghan, on the Registrant’s behalf, supported the application. She confirmed to the Panel that the Registrant wished for the matter to be resolved by being removed from the Register and that he had no intention of ever practising as a dietitian in the future, that he wanted to leave this difficult period behind and intended to pursue an alternative career in IT.

14.The Panel received and accepted the advice of the Legal Assessor.

15.The Panel first reminded itself of the guidance offered in the HCPC Practice Note entitled “Disposal of Cases by Consent”. The Panel noted that it had the power to adopt one of two courses of action:

i.to deal with the case in an expedited manner by approving the proposal set out in the Voluntary Removal Agreement;

ii.to reject the proposal and allow the Registrant’s suspension to continue.

16.The Panel noted that the Registrant’s fitness to practise has been found to be impaired by reason of lack of competence. Since the conclusion of the substantive hearing on 2 December 2019, the Registrant has been suspended from the Register. The Panel noted that a Voluntary Removal Agreement will protect a future risk of harm to patients.
 
17.From the Registrant’s response, the Panel considered that he has demonstrated sincerity and fully understands the voluntary removal process and intends to abide by the agreement.

18.Accordingly, the Panel was satisfied that the public has been protected and the public interest satisfied by the finding of impairment and the sanction which was imposed. Whilst a striking off order could be considered at a further review hearing, the Panel was satisfied that the public would be protected, and the public interest served, by the Voluntary Removal Agreement which has the same effect as striking off.  Accordingly, the Panel was satisfied that the signed Voluntary Removal Agreement was a proportionate and appropriate response.

19.For all these reasons, the Panel considered it appropriate to approve the signed Voluntary Removal Agreement dated 24 May 2021.

Order

The Voluntary Removal Agreement is approved.

Notes

No notes available

Hearing History

History of Hearings for Mr Thomas Richard Sugarman

Date Panel Hearing type Outcomes / Status
24/05/2021 Conduct and Competence Committee Review Hearing Voluntary Removal agreed
18/11/2020 Conduct and Competence Committee Review Hearing Suspended
25/11/2019 Conduct and Competence Committee Final Hearing Suspended