Miss Sreenithi Sudhakar

Preliminary Matters

Service

1. The Panel was informed that Notice of the Hearing dated 12 August 2021 was sent to the Registrant at her registered email address informing her of the details of today’s hearing. Furthermore, email correspondence from the Registrant indicated that she was aware of the place and date of the hearing. The Panel was therefore satisfied that notice had been served in accordance with Rule 3 and Rule 6 of the Conduct and Competence Rules.

Proceeding In Absence

2. Mr Lloyd, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. He said that the Registrant had engaged with the HCPC and had been represented by a Solicitor at the Investigating Committee meeting in November 2020. However, in an email sent on 28 September 2021, the Registrant informed the Hearings Officer that she would not be attending the hearing. She further stated ‘Physiotherapy is no longer the career path I want to pursue…. and have started training for my new job as a Data Engineer’.

3. Mr Lloyd submitted that it was in the public interest that the hearing should proceed without delay. He said that two witnesses, both medical professionals, were in attendance today to give evidence by video link.

4. The Panel determined that the Registrant has voluntarily absented herself from the hearing and that in the light of her email, it was unlikely that if the hearing were adjourned, she would attend at a future date. Moreover, she has not requested an adjournment.

5. It is in the public interest that matters of this nature should be dealt with expeditiously. Furthermore, the HCPC is ready to proceed and two professional witnesses are ready to give evidence by video link.

6. The Panel has concluded that it is in the interests of justice that this matter should proceed despite the absence of the Registrant.
Hearing in Private

7. Mr Lloyd informed the Panel that there would be references to the Registrant’s health and other personal details. He submitted that those parts of the hearing where reference is made to these matters should be in private. The Panel accepted advice from the Legal Assessor and therefore determined, that such references should be heard in private.

Background

8. At the relevant time, the Registrant was employed as a Band 5 Physiotherapist at the Royal Cornwall Hospital Trust (‘the Trust’). These concerns, as set out above in the allegation, relates to a number of different complaints against the Registrant made by colleagues between January 2019 and September 2019. They generally relate to poor communication skills and a failure to demonstrate effective clinical reasoning and practice when dealing with patients and providing them with care.

9. A formal stage three capability meeting was held by the Trust on 16 September 2019 in relation to the Registrant’s performance at work and the little improvement made by the Registrant between the period January and September 2019, with a particular focus on the incident on 28 August 2019. The matter was referred to the HCPC on 25 September 2019.

Decision on Facts

10. There was before the Panel a bundle of documents prepared on behalf of the HCPC containing witness statements and exhibits. There was also a bundle of documents from the Registrant dated 6 November 2020, which had been before the Investigating Committee.

Assessment of Witnesses

11. Two witnesses were called on behalf of the HCPC.

MH

12. MH was the Clinical Lead Physiotherapist and Manager of the Respiratory Physiotherapy team at the Trust. As such, she was the Registrant’s Line Manager and Clinical Supervisor during the Registrant’s six week respiratory rotation between July and September 2019. MH worked in the team on a part-time basis, some three days per week. She was able to give evidence about the Registrant’s case load and her clinical skills during this period. She described the level of standards expected of a newly qualified Band 5 Physiotherapist in her first employment.

13. The Panel found her evidence to be credible, open and fair. She did not demonstrate any adverse motivation towards the Registrant and indeed described her concern about the Registrant’s circumstances the night before the stage 3 capability meeting on the 16 September 2019.

CK

14. CK was a Specialist Physiotherapist and Manager of the Neurological and Rehabilitation teams at the Trust. She was the Registrant’s Senior Therapist and Supervisor during her rotation in these teams. CK worked with the Registrant on the ward on a daily basis for the six months of her rotation between January and July 2019. She was able to give a full picture of the Registrant’s clinical abilities. She described the level of skills expected of a newly qualified Band 5 Physiotherapist in her first employment. The Panel found CK’s evidence to be detailed and wide ranging. She referred to her own observation of the Registrant and also to comments and reports from other staff members. She was fair and credible, indicating where her recollection was affected by the passage of time. She too did not demonstrate any adverse motivation toward the Registrant.

The Registrant’s Submissions to the Investigating Committee

15. In her reflective piece, the Registrant did not dispute many of the concerns raised. She referred to her declining level of confidence as being a contributory factor and accepted the need for supervision. She expressed remorse and an understanding of the potentially serious effects on patients of her failures.

16. In reaching its decisions on the facts, the Panel considered all the evidence before it, both oral and documentary, together with the submissions of Mr Lloyd and the material from the Registrant that was before the Investigating Committee. It accepted the advice of the Legal Assessor.

Particular 1(a)

17. The evidence of MH was that the Registrant was unable to formulate clear clinical reasoning. She gave as examples a number of relevant incidents, to which she referred in the supervision record sheets. Among them was an inability to explain and interpret the main clinical indications of issues that often arise for respiratory patients. Another was when the Registrant appeared to have no knowledge of pleural effusion and despite instruction and opportunity for reading, she was unable to explain the assessment findings. A further example was in regard to the Registrant’s understanding of types 1 and 2 respiratory failure.

18. In her evidence, CK referred to a number of incidents relevant to clinical reasoning. These included an occasion when the Registrant delivered to a patient treatment which the patient’s medical notes indicated should not be given. This indicated a failure to read or to understand the notes and amounted to inadequate clinical reasoning. Further incidents, described by CK as reported to her, included a lack of understanding of anatomical differences between paediatrics and adults.

19. The Panel was satisfied from the evidence and from the supervision records that the Registrant did not demonstrate adequate clinical reasoning when dealing with patients. Accordingly, this particular is found proved.

Particular 1(b)

20. Both MH and CK made some reference to the level of the Registrant’s communication skills with patients. MH described her as speaking in a monotone and being unable to adapt to patients with difficult modes of conversation. Examples were those with neurological, cognitive or hearing problems. CK referred to reports of concerns about the Registrant’s level of communication with colleagues. However in CK’s evidence, she stated that a Deputy Sister Nurse had emailed that the Registrant had a positive bedside manner and communication skills with patients. Furthermore, the supervision records entry for February 2019 indicated that the Registrant had adapted her conversation when treating hard of hearing patients. The Panel also had sight of other supervision records of acceptable levels of communication with patients. Further, in a letter from a Principal Lecturer and Course Leader in Physiotherapy at Brighton University dated 6 November 2020, it was stated that there had been positive comments from Practice Educators on the Registrant’s communication with patients.

21. In the light of the positive comments, the Panel cannot be satisfied that the Registrant’s communication skills when dealing with patients were inadequate. It therefore finds this Particular not proved.

Particular 2(a)

22. At the Trust’s final hearing on the 16 September 2019, the Registrant denied that she had incorrectly set up the modality. However, MH was present when the alarm was activating. Her evidence, which the Panel accepted, was that this was because the patient’s oxygen level was below that at which the alarm activates. The patient’s notes indicated that oxygen was required. The lack of oxygen could only have occurred because the Registrant had failed to set up the necessary modality in order to supply oxygen.

23. The Panel therefore finds this Particular proved.

Particular 2(b), (c), (d), (e)

24. The evidence of MH was that the Registrant did not react to the alarm and was unable to identify that the monitor alarm, rather than the ventilator alarm, was activating. As a consequence, she did not recognise that the patient was desaturating by reason of lack of oxygen and took no steps to remedy this. MH therefore had to intervene and provided oxygen to the patient.

25. The Panel accepted the evidence of MH and therefore Particular 2 is found proved in its entirety.

Decision on Grounds

26. The Panel has concluded that the matters found proved amount to lack of competence. In reaching its decision, the Panel has considered all the evidence before it, together with the submissions of Mr Lloyd and those made by the Registrant to the Investigating Committee. It had regard to the relevant HCPTS Practice Notes and to the various applicable HCPC Standards of conduct, performance and ethics and Standards of Proficiency for Physiotherapists. It accepted the advice of the Legal Assessor.

27. The Registrant’s failings were repeated and occurred over an extended period of time. The Panel found them to be a representative sample of the Registrant’s practice.

28. Although the Registrant was newly qualified and in her first employment as a Physiotherapist, the concerns related to competencies expected of a Band 5 Physiotherapist. Sound clinical reasoning when dealing with patients is essential and is a standard requirement for a Physiotherapist. Furthermore, the matters of concern continued despite the degree of support and supervision provided to the Registrant. Also, her caseload had been significantly reduced compared to that usually required of a Band 5 Physiotherapist at a similar stage in her career.

29. The Panel noted that a lack of competency arises where a Registrant has repeatedly or persistently failed to reach the expected standard of competence. The failure by the Registrant to provide a necessary level of care, found proved under Particular 2, was part of a pattern of the Registrant’s lack of competence and could have resulted in significant harm to that patient.

30. The Panel considered the relevant Codes and Standards.

HCPC Standards of conduct, performance and ethics

3.3 You must keep your knowledge and skills up to date and relevant to your scope of practice through continuing professional development.

6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.

Standards of Proficiency for Physiotherapists

4 Be able to practise as an autonomous professional, exercising their own professional judgement

14 Be able to draw on appropriate knowledge and skills to inform practice

31. The Panel found that although the Registrant was newly qualified and in her first employment as a Physiotherapist, she was unable to perform at the level expected in the important area of clinical reasoning. Furthermore, this was demonstrated when she did not provide adequate care to a patient, as found proved under Particular 2.

32. The Panel found that the matters found proved amount to a lack of competence. It did not however, find that they amounted to misconduct.

Decision on Impairment

33. The Panel first considered the personal component. The Registrant has shown a degree of remorse and insight in her submissions to the Investigating Committee. She referred also to her declining level of confidence during her time on the rotations at the Trust. She has however, stated that she no longer wishes to pursue a career as a physiotherapist and has begun training in a different profession. There is nothing to indicate that she has taken any steps to remedy her failings. In these circumstances, the Panel cannot be satisfied that the matters found proved would not be repeated.

34. The Panel next considered the public component. In the light of these findings, the Panel has concluded that the Registrant continues to present a risk to patients. Furthermore, public confidence in the profession and in the HCPC as the Regulator, would be undermined if there were not a finding of impairment.

35. The Panel has determined that the Registrant’s lack of competence is serious and therefore that her fitness to practise is currently impaired on both the public and personal components.

Order: The Registrar is directed to suspend the registration of Sreenithi Sudhakar for a period of 9 months from the date this order comes into effect.

Interim Order

1.Mr Lloyd applied for an Interim Order on the grounds that it is necessary for the protection of the public and is otherwise in the public interest. He submitted that the order should be for a maximum period of 18 months to cover the 28 day appeal period and the time that might be required to cover any appeal.

2. The Registrant is not in attendance at the hearing but she was informed in the Notice of Hearing that in the event of a finding of impairment an Interim Order of Conditions of Practice or Suspension to cover the appeal period might be imposed. The Panel is therefore satisfied that the Registrant is aware of this possibility but despite that has made no representations to the Panel nor has she asked for the matter to be adjourned to enable her to attend.

3. For the reasons given at the outset of this hearing the Panel is satisfied that it is in the interests of justice that this application should be dealt with despite the absence of the Registrant.

4. In reaching its decision, the Panel considered all the information before it, together with its findings on impairment, and the submissions by Mr Lloyd. It took into account the HCPTS Practice Note ‘Interim Orders’ and the relevant paragraphs of the HCPC Sanctions Policy. It accepted the advice of the Legal Assessor.

5. The Panel was satisfied that as it has found the Registrant’s fitness to practise to be impaired and that there is a risk of repetition of her lack of competence, an Interim Order is necessary for the protection of the public. Furthermore, an order is also in the public interest as members of the public would be concerned if the Registrant were allowed to practice unrestricted until the substantive order comes into effect. It is therefore determined that an Interim Order is necessary for the protection of the public and is otherwise in the public interest.

6. The Panel was satisfied that during the appeal period, there were no workable or appropriate conditions which would be sufficient to protect the public. It therefore concluded that an Interim Suspension Order was necessary to protect the public and is otherwise in the public interest to maintain public confidence in the profession and in the Regulatory process. Although the Registrant will be unable to practise during the currency of this Interim Order, her interests are outweighed by those of the public. The Interim Suspension Order will be for a period of 18 months to cover any appeal period.

7. The Panel makes an Interim Suspension Order under Article 31 (2) of the Health and Social Work Professions Order 201, the same being necessary to protect members of the public and being otherwise in the public interest.

8. This Order will expire (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order, the final determination of that appeal, subject to a maximum period of 18 months).

History of Hearings for Miss Sreenithi Sudhakar