Vijayakumaran Kuttampoil

Profession: Practitioner psychologist

Registration Number: PYL23901

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 07/04/2022 End: 17:00 07/04/2022

Location: Virtual Hearing via Video Conference

Panel: Conduct and Competence Committee
Outcome: Suspended

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation

Whilst registered as a Psychologist with the Health and Care Professions Council, (HCPC) you worked at Woodland View Hospital, and:

1. Between 25 September 2018 and 28 December 2018, you did not maintain adequate records, in that:

a) There were no clinical records on the electronic records system (CareNotes) for all the patients you had seen save for one record

b) Your handwritten notes did not have full entries relating to your patient contact;

2. Between 25 September 2018 and 23 January 2019, you did not maintain accurate records, in that:

a) The records on the CareNotes system did not match the information contained within your handwritten notes, specifically in relation to the following patients:

(i) Patient A;
(ii) Patient B;
(iii) Patient C;
(iv) Patient D;
(v) Patient E;
(vi) Patient F;
(vii) Patient G;
(viii) Patient H

b) There were no handwritten notes to correspond with the electronic records for the notes you later made on the “CareNotes” system, specifically in relation to the following patients:

i) Patient B
ii) Patient C
iii) Patient D
iv) Patient E
v) Patient F
vi) Patient G
vii) Patient H
viii) Patient I
ix) Patient A

c) [redacted – No Evidence Offered]

3. Between 25 September 2018 and 23 January 2019, you falsified patient records in that there were no handwritten notes for the electronic clinical entries you made on the ‘CareNotes’ system;

4. [redacted – No Evidence Offered]

5. On 15 April 2019, during a substantive review hearing into your fitness to practise with the HCPC’s Conduct and Competence Panel (the Panel), you misled the Panel when you stated you did not disclose to the Panel the reason for your departure from Woodlands View Hospital, when you stated in your witness statement that:

a) [redacted – No Evidence Offered]

b) [redacted – No Evidence Offered]

c) that you were offered a permanent job at Woodlands View Hospital and that you turned this down, when this was not correct

6. Your conduct in paragraphs 3 and 5 was dishonest and/ or misleading.

7. The matters set out in paragraphs 1 to 6 constitute misconduct and/ or lack of competence.

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

Finding

Preliminary Matters

Application to Amend the Allegation

1. At the outset of the hearing Mr Bridges, on behalf of the HCPC, made an application to amend the Allegation. Mr Bridges indicated that he applied to remove Particular 2 (c) because it was merely repetition of Particular 2 (b) and needed to be removed. In respect of Particular 4, it was accepted that the records had been securely locked away as indicated by the evidence of Colleague Z’s witness statement. With regards to sub-particulars 5 (a) and (b), which relate to representations made by the Registrant in his written statement to the substantive review hearing as opposed to sub-particular 5 (c), the HCPC wish to correct an inaccuracy which would be achieved by the removal of sub-particulars 5 (a) and (b). Mr Galvin submitted this would be fair. The Panel accepted legal advice from the Legal Assessor and considered both the public protection and the public interest in terms of whether this removal would amount to under-prosecution. However, given the evidence from HCPC witnesses, and the explanation from Mr Bridges, it was satisfied that it was fair to remove these particulars for the Registrant and that this would not prejudice the public.

Background

2. The Registrant began working as a Locum Psychologist at Woodland View, part of the Priory Group, on 24 September 2018.

3. On 28 December 2018 it came to light that the Registrant had not been recording notes of his patient sessions on the Priory’s electronic system CareNotes since he began working at Woodland View. The Registrant had instead been keeping his own handwritten session notes. Colleague Z reviewed the handwritten records and noted that many of these were inadequate.

4. The Registrant had also been keeping his handwritten notes in a locked cabinet that only he had access to, meaning they could not be easily accessed by other clinicians.

5. Colleague Z instructed the Registrant to type up his handwritten notes onto CareNotes as soon as possible. When Colleague Z checked the Registrant’s entries to CareNotes on 21 and 22 January 2019 he realised that, with the majority of the entries, the content was inconsistent with the corresponding handwritten note. Colleague Z also found that some CareNotes entries did not have a corresponding handwritten note, and vice versa. Colleague Z subsequently discussed this with the Registrant.

6. The Registrant finished working at Woodland View on 24 January 2019.

7. On 15 April 2019, in respect of prior and separate HCPC proceedings, the Registrant attended a substantive review hearing into his fitness to practise before the HCPC’s Conduct and Competence Panel (“the Previous Panel”). The Registrant is alleged to have misled the Previous Panel at this hearing in respect of his employment position.

Facts

Witnesses

8. Vanessa Florey, gave live evidence under oath in person, and adopted her written statement. She explained that she had showed the Registrant how to use CareNotes, which was not a complex system, and she had no recollection of any uncertainty or questions from the Registrant. She spent approximately half an hour with him to do this. In cross examination, she admitted that she is not a formal trainer and the Registrant had only been given a CareNotes password a month after he started and that his user name and password had to be changed because of lack of use. She said there were occasions where different passwords needed to be generated. She said that it was a busy job but in addition to herself, there would have been lots of colleagues, clinical and nursing staff who would use the system and been able to help the Registrant if he had asked.

9. Colleague Z, gave live evidence under oath via MS Teams. He adopted his written statement. He shared that when he had taken photocopies of the Registrant’s handwritten notes, the Registrant indicated that it would take some time to transfer his handwritten notes to CareNotes but that he would start on this task promptly. This was said on or around 28 December 2018. At a later stage, he indicated that he checked the CareNotes system in relation to a number of patients, but found no corresponding handwritten notes created by the Registrant. He confirmed that the Registrant was not offered a permanent post at Woodland View. He was clear that only one other person (Sunita Heeley, the Director) alongside himself, were the only two people who would have been in a position to make this offer.

10. In cross examination he acknowledged that as a Clinical Director he was the Registrant’s direct line-manager. He indicated that he had started after the Registrant. He said that while there is an online training academy, this would not have been available to the Registrant who was there in a locum post. He said that Vanessa Florey had introduced the Registrant to the CareNotes system. He said that while no specific CareNotes training had been formulated, if there is a training need that this could be raised by the Registrant with any staff. There would be an expectation that the Registrant would make staff aware if he could not use the system.

11. He said that it was not appropriate that the Registrant kept handwritten notes in a filing system that only he had access to. The notes should have been in a patient file. It would not be practical if the Registrant was on annual leave for other staff to contact him about previous interventions. It was necessary for patient notes to be kept up to date. A patient record policy was available on the intranet system at the facility which he had access to. When it was discovered that the notes were not on the CareNote system, he had said that the Registrant should prioritise the need to get the records updated so that they could be reviewed by others, rather than seeing patients. He agreed that note-writing styles could vary but that the relevant details and their accessibility to colleagues who may need to treat the patients was the priority. He said that he himself made brief notes as an aide memoir as ‘process notes’ during a patient session, but would do so with a view to ensuring that these were written up within 24 hours of the session while events were still fresh in his mind.

12. He clarified that while the facility wanted to be paperless, it did matter that there were corresponding handwritten notes to the CareNotes entries, because the Registrant was relying on his handwritten notes from earlier sessions to create his CareNote entries. He said that it was fair to characterise the Registrant as struggling a little bit to update his notes and conversations regarding his wellbeing were had. He acknowledged that the Registrant had asked if he could start seeing patients again and had hoped to be able to update CareNotes by 3pm on 21st January 2019.

13. He was asked “Does it mean it was dishonest?” He replied, “Doesn’t mean that they were honest. There were entries which are contradictory.” When asked about the lack of a precise instruction for a new page to be used for each new patient notes, he agreed that this was not explicit but the need to have clear notes, and therefore separate patient notes from each other, for accurate filing and retrieval is a professional requirement clearly set out. He agreed that he had asked the Registrant to expand upon one “word” or very short entries such as “denied” or “anger management”. He assisted with this by providing him with a pro forma (sourced from a psychologist at another Priory Group Hospital) as to what was expected from him in creating a proper record that another colleague could rely upon.

14. He said that he gained the impression that the Registrant in creating retrospective entries on CareNotes was trying to either conceal that he had not made good notes, or to convey that he had done more work with patients than he had actually done. This impression was added to because of the multiple instances of text that appeared to be copied and pasted. He said that he didn’t believe that the Registrant’s CareNotes were accurate because of time that had passed, in some cases in excess of two months, between the patient consultations and the time when they had been written up.

15. Sunita Heeley, gave live evidence under affirmation in person, and adopted her written statement. She explained that locum staff were more expensive than permanent staff. It was suggested to her in cross examination that the Registrant recalls that someone said he should apply for a permanent post. She could only say that the organisation would always employ a locum if it could not fill a permanent post and there was a vacancy. She said she would never make an offer or promise a post to someone if they applied to fill a permanent post on the basis that it would need to go to open competition and the outcome of such a recruitment exercise could not be a forgone conclusion; nobody had the gift to suggest otherwise. She could not recall ever having any conversation with the Registrant regarding the offer of a permanent position.

16. The Registrant gave evidence under oath. He indicated that he was 63 years old and had been a psychologist in the UK since 2004. He said that some patients were not amenable to engagement with him. He said that he made electronic records on the CareNotes system but only after three months. He said he didn’t have a password at the outset and that Vanessa Florey indicated that this could be sorted out in due course when he told her this. He said that he did make notes when he saw patients, but these were handwritten. Some were simply “declined” or “didn’t take place” or “patient not in right frame of mind”.

17. He said when supervisory staff discovered that he was not using CareNotes, they arranged for a password and said that electronic records had to be updated. He said he worked long hours to do this and was in the office at 7.30PM. He said he was given Priory guidelines and policies to indicate how notes needed to be framed on CareNotes. He noticed that these were different from the British Psychological Society guidelines in some respects. He said that where there are not corresponding paper copies and electronic records, he suspects that is because some handwritten notes were misplaced or not copied, because they were simply loosely placed in a box file. He could not be sure about this because he was not allowed to keep the handwritten notes, which he thought he had the right to, because a psychologist is allowed to take ‘process’ notes.

18. He said that his Clinical Supervisor Colleague Z, wanted his notes expanded which he thought unfair because his clinical supervisor was not a psychologist. He said that his electronic notes were not untrue but was a compromise because Colleague Z wanted it expanded when he did not want to expand them. He said that the notes were accurate as best as he could say but went further to say that the notes were not in his possession at that point. He was asked to stop seeing patients until his CareNotes electronic records were up to date from the first week of January. His handwritten notes were taken as an aide memoir. He intended to shred his handwritten notes in time.

19. The Registrant has kept details in his diary and could indicate that he has worked at the Prior for 58 working days. He said that he had 33 uneventful days at the hospital prior to Colleague Z arriving. He said that he had a gut feeling something was going wrong when he worked there. He described the atmosphere as stressful but because he had worked in maximum security hospitals so that kind of pressure was nothing for him. Over 100 patient notes were electronically recorded, created retrospectively he said.

20. He acknowledged that he was not proficient with creating electronic clinical notes. He said that he had not worked between 2016 and 2018 due to professional regulatory matters and that he had not been familiar with the CareNotes system before he went to work at Woodland View. He said that he was planning to update his handwritten notes and thought he might do it over one weekend. He had paid Ms Florey for help with a PowerPoint presentation one weekend and had thought that he might also pay her to help him one weekend with CareNotes also.

21. He said that he had found the process of working with Colleague Z intimidating. He said that he “got shivers” and had a “gut feeling that this was someone who would potentially make my life difficult.” He said that by January 2019 he did share that he was very stressed with colleagues. He said the stress manifested itself as an acid reflux disorder for which he was prescribed Lansoprazole and that he noted that his blood pressure was slightly elevated from looking at the records he had kept in his diary, (he shared a reading of 133/73).

22. He said that he didn’t see many patients in January 2019 because Colleague Z was keen that he first cleared a backlog of electronic records that were not up to date. He indicated that there is an entry on the CareNotes system dated 21 January 2019, which references that he saw Patient A on 4 October 2018. This example illustrates that this is a backdated entry and others would have been aware of this.

23. While Introduction and Clinical Notes sections are separate, he indicated that what is written is accurate, but he was unsure whether the notes actually referenced Patient E, rather than Patient A. He agreed that there was a mismatch between the handwritten and electronic records. He suggested that somebody else has entered Patient E’s details onto Patient A’s record. He knew the identity of Patient E but not Patient A.

24. Insofar as whether the notes written accurately reflect what he said to that patient on the day that he saw them, he admitted that it would not be habit to add detail such as the type of therapy for psychosis. When asked if his handwritten notes were adequate, he said that they were not complete because some must be missing. Insofar as Psychology Notes and Session Notes being recorded together, he indicated that his handwritten notes were his aide memoire and not intended for hospital records, but for his own records. He said insofar as Patient G was concerned, Ward Rounds are not a clinical session but a regular handover when doctors and nurses are presented with a daily update. He said that he didn’t have to take notes, but did so for his own reference. There was no need to record a risk assessment at this time because that would already have been done in a clinical session and notes created for that.

25. He acknowledged that he kept his notes under lock and key but said that the spare key is available to colleagues. His view was that there is no need for patient notes to be kept under lock and key he said, albeit he acknowledged GDPR concerns. With the benefit of hindsight, he acknowledged that he should have sought assistance to use CareNotes at an earlier stage but considers that he would have been helped by a proper induction. He said that he never falsified patient records.

26. He intimated that he suspected that because he did not always agree with others, that he had experienced a backlash. He said that he did not think patients should be considered in monetary terms or be detained for longer than was necessary. He indicated that a CQC report had been positive insofar as his engagement and paper records were concerned.

27. Insofar as him misleading a Previous Panel at HCPC hearings, he indicated that he had been offered a job on two occasions. He conceded that it was not a formal written job offer but it was an oral offer that ‘if you are interested, you are likely to get it, because there weren’t any/many competition’. He said that this was a semantic difference but he understood that it was a job offer in effect. He also said that he did not want the job. He said he was struggling with conditions of practice and would not have wanted to work under the supervision of Colleague Z permanently:

“Colleagues, Dr Ahmed and James, and managers in wards, and another psychiatrist called Wiktor…they were attempting to persuade me to apply. I thought I could have got it [the job], but I made a mistake in saying I had been offered it…The reality was I didn’t take it up. Honestly, strictly speaking, it was not an offer, but they did say they could convert a temporary position to a permanent one if I wanted. I interpreted it as meaning the job was mine if I wanted it. I did not say this to mislead, I was mistaken in saying that I was actually offered it…I never meant that I had been offered it. It would not help me in any way to say that. It was a mistake. I was offered the job in effect, but there was no actual job offer.”

28. In this hearing he has been adamant that Sunita Heeley had offered him the job on two separate occasions. However, he also conceded that once he had said he had been ‘offered’ the job, he did not feel that he could go back and correct the mistake he had made in using those words. He agreed that he had a good relationship with Sunita Heeley and that she had no motive to say anything untrue about him. He said that while she confirmed that he had not been offered a job, she might have said that she had encouraged him to apply, and that at least initially, she had been pleased with his work. He said that he had not felt comfortable sharing his sense about Colleagues Z being unfair to him because it could have made his position worse if that message had been conveyed to him. However, he conceded, he had felt sufficiently comfortable to complain that Colleague Z, “had no interpersonal skills, does not know how to talk to people, and challenged his competence as a psychologist.” He said he did not go further and indicate: “he’s hard on me or particularly punitive.”

29. In cross-examination, he acknowledged that although he could use electronic devices, he struggled with the system used by Woodland View. It was his first experience of creating digital consultation notes. Between 2004-2018 he had not personally been required to have digital consultation notes. He did accept that consultation notes could be used in courts, tribunals, inquests etc. and have the status of a legal document. He agreed that it was important that these were accurate and detailed so that others can read them, be this, medical colleagues or legal professionals. Other psychologists, nurses and doctors need to be able to look at patient records and look at history and treatment of a patient.

30. He agreed that the type of document that the CareNotes systems used was not unusual and it was unusual to find such policy on the intranet. He said that on 24 September 2018, he was of the view that he didn’t need to look at any policy documents but only needed to see patients. He accepted that as a professional he had a responsibility to make himself aware of the policy. He was taken to specific patient records and said that it wasn’t clear whether Patient C and Patient E notes had been combined with details of what Patient E has said has been recorded for Patient C. Insofar as his record of Patient K “session declined” with both Patient C and K appearing on the same page, he accepted that he knew these should have been on CareNotes and that individual notes should be kept for individual notes as Ms Florey had explained but said that these were his personal records.

31. He said that he recalled the work with Patient C who was struggling with time, and he saw from notes and he understood that there were some time management schemes that would be useful. He recalled that there are routines which could be helpful. When asked if another psychiatrist had to check Patient C a month later, would his notes be sufficient, he replied: “Honestly, this is actually…, it is insufficient. I agree. It was my intention to elaborate on these notes. So that another psychologist would have the relevant neurological information when they checked.”

32. Insofar as Patient K who he had recorded “session declined” was concerned, being sufficient for another clinician, he said: “If outright decline, there is nothing to say why,” but he simultaneously acknowledged that his entry did not say: “outright declined” and that the question of degree could be relevant. He said that some clinicians might simply indicate “DNA” (Did Not Attend) and that would have been sufficient.

33. Insofar as Patient G was concerned, he said that he reassured him because he was shaken by an incident with Patient A. Asked if that was adequate, he replied: “It is not adequate but it is the reason why he did not have a session because he was not in the right frame of mind. I agree that it was insufficient… While I recorded it electronically with more details, that would have been fine.”

34. The Registrant acknowledged that Ms Florey helped him get a password and that he had always known that at one point that he would have to create electronic records. He maintained that his handwritten notes, were only for him as an aide memoire, not to be hospital records. He said that he was aware of GDPR. He agreed that when he began working at Woodland View, Ms Florey had shown him how to log onto the system, and how to access patient records via CareNotes but didn’t give him a password straightaway. He accepted that this was not a difficult task to get onto CareNotes and that he had some responsibility to resolve the issue of a missing password. He said that he had tried his best but had had no access to emails.

35. When asked if his first and only opportunity to resolve matters was 28 December 2018, he acknowledged that this was not the case. He said that on 16 November 2018 he was helped by a nurse who accessed the system and showed him what to do. There were records made for 24/9/18 and 28/9/2018. Thereafter, he did not use the system and as a result his password was deactivated. He said that Ms Florey should not have expected him to be able to use the system without being properly inducted as he needed someone to sit with him.

36. As to Colleague Z’s conducted assessment of handwritten notes and electronic clinical records, cross-referencing the two, and the Registrant said that even he could not find exact matches, so thinks that something is missing. He acknowledged inconsistencies but did not agree with Colleague Z’s conclusion. Just because handwritten notes do not correspond with clinical notes does not mean that there needs to be a malicious explanation: i.e. that he made things up. He suggested that Colleague Z had an unfair motive for reaching those conclusions because he did not like him and wanted to get rid of him. He even suggested that Colleague Z wanted him “to die” and used the phrase “he was working at gunpoint”. He indicated that Colleague Z was confiscating his notes simply to make his life difficult. He said: “He was against me…He didn’t like me from our first meeting. My nerves were telling me that.” He said that Colleague Z was not sympathetic and had not adopted a neutral position. He described that his words may be “sugar-coated” but conveyed that he did not believe the Registrant was behaving honestly even if he did not use the word dishonest.

37. The Registrant said that several entries had no handwritten notes. He said that it is unlikely that this would be the case. This is the reason that he suspects some information is missing. Where there was no treatment, he said that there is no need for him to invent anything. He said that if his notes were in his possession, he could be clearer but that he did not have them. He said he had no evidence to support that Colleague Z is wrong about his conclusions or that Colleague Z had lost his handwritten notes. He denied that there were no relevant notes because he said that his practise was to have documented relevant findings and that he must have got this information from somewhere. He said that he would have no reason to falsify patient records and said that there was nothing wrong with a “cut and paste” of text approach if the risk is the same. He said that some meetings were repetitive because patients were inside for long term care.

38. He said that even though he was helped on 18th November 2018 with the CareNotes system, he didn’t have a clear understanding of this but that it was not his fault. He said that he was not able to follow up with Vanessa Florey who had some leave commitments and only worked until 3pm. He also said that colleagues were busy and said that “I should speak with Vanessa” and “I tried to help myself”. He said he did ask for help on six occasions but that he had taken annual leave from 16 October to 5 November 2022. He was tense in November because he was conscious that the number of patient notes that would have to be written up were accumulating. His leave meant that it was more than 28 days since he had accessed the system, but he didn’t have many opportunities in November because of other people being busy and the Christmas period and taking leave or cancelling appointments. He acknowledged that he had been reassured that he should come to Ms Florey at any time but that he felt sorry for her, because specialist doctors, directors, psychiatrists all called on her for administrative assistance.

39. He said that while other colleagues were available, it was a toxic and dysfunctional environment in which to work. He was not rationalising why he behaved as he did. He said that he was required to do risk assessments for sectioning an individual and that a disagreement with other colleagues meant that his work was checked, otherwise this would not have occurred. He said the CQC were positive about his work in November 2018 and that his employers did not want to pay him more following this positive report. Further, he said that there were differences in his views about patients compared to others. He felt that: “patients are chronically institutionalised. They know the routine and what they can get away with. It was a challenge, because this was meant to be a medium secure unit, but we had a high security. It is difficult to change patients. It was important for notes to be on the system. But I was doing nothing wrong in taking my notes that were relevant to recording clinical diagnosis which could be taken into account in future assessments by other clinicians.”

40. He wanted the Panel to take into account that this represented a very stressful time in his working career.

41. Professor Hacker-Hughes gave evidence remotely under oath. He has been the Registrant’s supervisor since 2018 but had got to know him well over the last eight years and said that he was proud to call him a friend. He said that he met with him monthly at the start of the supervision at the end of the working day for one hour, in person, or video link, and would also have frequent contact via email and instant messaging. Work and diary keeping, supervision and all sorts of problems were discussed.

42. He said that the Registrant had spoken about the unpleasant atmosphere at Woodland View in respect of management. He said that he was not assertive, but a mild-mannered, compassionate, good person. He said that the Registrant’s knowledge was encyclopaedic in terms of historical development of psychology on both sides of the Atlantic, both academic and practical. He said that the Registrant had spoken to him about record keeping. As a former president of the British Psychological Society, he had a strong belief that the Registrant’s record keeping was in line with the Society’s standards, although he had not himself seen the records in question. This was because the Registrant had assured them this was the case having read the standards, and he considered the Registrant to be a man of integrity. He said that he had encouraged the Registrant to do a Doctorate of the History of Psychology.

43. Submissions on behalf the HCPC were made by Mr Bridges. He submitted that the HCPC had presented credible witnesses whose testimony could be believed. He suggested that the Panel may find that the facts are made out to the relevant standard and that the Panel may consider that the Registrant’s behaviour was closer to the statutory ground of misconduct rather than a lack of competence. He submitted that insight was relevant to a finding of current impaired fitness to practise and that the Panel may come to the conclusion that this had not been demonstrated.

44. Mr Galvin on behalf of the Registrant submitted that the Registrant may have appeared defensive and been scared to admit any shortcomings but that this was unsurprising. In relation to the particular of the Allegation that dealt with a job offer, it was clear that the Registrant had had a hope of a job rather than a promise but had elevated this in his own mind to the latter. He further submitted that it didn’t make a material difference to the decision of the Panel in terms of the explanations it provided for its decision making. He submitted that the absence of handwritten notes is not evidence of falsification of the electronic notes, and repetition of the notes could reflect the repetition of events. He described the situation that the Registrant had been in as one that he had allowed to get out of hand but asked the Panel to be clear that the Registrant was adamant about his honesty, that this was supported by testimonial evidence, and a current employer who is content with his work and reports that there are no difficulties.

45. The Panel received and accepted legal advice from the Legal Assessor. It invited both advocates the opportunity to comment on the advice it has received. The Legal Assessor shared with the Panel that she had offered both advocates the opportunity to have sight of her advice before it was given to the Panel.

46. The Panel took into account the evidence before it, the submissions it had heard, the legal advice it had received and the HCPC Practise Note on Finding Fitness to Practise is Impaired in making its decision.

47. It considered the particulars of the Allegation in turn, bearing in mind the standard and burden of proof, and its need to resolve any doubt in favour of the Registrant.

Particular 1(a) – found proved

48. The Panel took into account the evidence of Colleague Z and the exhibits produced by him and by Ms Heeley. While the Registrant in the evidence he gave, indicates that he does not accept that he did not maintain adequate notes, he did accept that he had not placed clinical records on the CareNotes system between 25 September 2018 and 28 December 2018. The Registrant himself indicated that he knew from 4 October 2018 that his notes should be placed on the CareNotes system and that what he was doing in writing handwritten notes was “insufficient”. The Panel has taken into account Colleague Z’s explanation that an adequate record is one that colleagues could access promptly and place reliance upon. A written record that others did not have easy access to would not constitute the keeping of adequate records, irrespective of their content. The British Psychological Society guidance on notes, is clear that whether notes are ‘process’ notes or full notes, these do form part of the patient’s clinical notes and it should be possible to scan these onto a system. Scanning the Registrant’s handwritten notes was not possible, as Colleague Z explained in evidence, because there were multiple entries about different patients on a single page and cramped writing. He indicated that this would have been done otherwise.

Particular 1(b) – found proved

49. The Registrant’s case appears to be that different people have different styles when it comes to taking notes. This contention is accepted by Colleague Z who indicated the same in his witness statement. While Colleague Z accepted that where a patient would not engage there might be little to note down, he gave literal examples of the level of detail that it would be helpful to record as part of a patient’s notes. Accordingly, the Panel accepts that there is a difference between indicating a one word note “Denied” and detailing the circumstances in which a patient would not co-operate, (e.g., any reason given or their frame of mind), and what efforts were made to engage with them. Colleague Z explained that the more detail there is in the note, the more helpful this is to colleagues who may have need to refer to them and the Panel accepted this.

Particular 2 (a) – found proved

50. The Panel found the evidence of Colleague Z to be particularly relevant here given his assessment of the CareNotes system as against the handwritten notes. It was clear that on 28 December 2018 and 21-22 January 2019 he compared both and found that many of the entries did not match. He noted that many of the entries seemed to have been copied and pasted. On 24 January 2019 he indicated that the Registrant’s session notes were not adequate whereby the Registrant was annoyed and indicated that he did not feel he should be challenged by a non-psychologist.

Particular 2(a)(i) – found proved

51. The evidence of Colleague Z was that full session notes need to be entered on CareNotes within 24 hours of the patient being seen. Sufficient detail is required as is outlined by the Policy for Healthcare Records, and which the ProForma indicates by way of a prompt. Colleague Z produced by way of an exhibit, the CareNote entry made by the Registrant in relation to Patient A. The entry is made on 21 January 2019 in relation to a session held on 12 November 2018. Insofar as the CareNote entry is concerned the information contained in the structure of the clinical care note breaks down details as regards aim, risk, consent, outcome and plan. Each of these sections is completed. However, the handwritten notes, which had been written more than two months earlier was limited to two sentences which contained the background biography of the Registrant, e.g. (2002 Came to England with sister), and contains no clinical information at all

52. The Panel was of the view that the notes’ accuracy in relation to the two documents being written with a gap of more than two months is not evidenced. Based on the burden and standard of proof the Panel finds this particular of the Allegation proved.

Particular 2(a)(ii) – found proved

53. Colleague Z produced the CareNote entry made by the Registrant in relation to Patient B. This was a session note made on 16 January 2019 in relation to a session on 4 January, with a gap of just under two weeks between the two. The CareNotes entry states that the Registrant had taught Patient B how to distract himself by going to his room or for a walk and that the session ended after 20 minutes because Patient B got up and excused himself. None of this information is in the corresponding handwritten note. The handwritten note states that Patient B discussed his desire to be closer to his mother’s house and says that Patient B has no psychotic symptoms but is frustrated because he has been denied a blister pack of medication. This is not mentioned in CareNotes, and whether the same session is being referenced is uncertain.

54. The discrepancies between the information in the two sets of notes suggests that at least one set of notes is inaccurate. Based on the burden and standard of proof, the Panel finds this particular of the Allegation proved.

Particular 2(a)(iii) – found proved

55. Colleague Z produced the CareNotes entry by the Registrant about Patient C. It showed that on 17 January 2019 the Registrant created a record for a session that had occurred on 16 November, more than two months earlier. In the outcome session on CareNotes the record indicated: “Very cooperative sessions, discussion emotional problems. Limited fact finding therapy.” However, in the handwritten notes, it reads: “Stressed-out about Patient A incident. Gardening. Dog walking. Anti-convulsant to be tapered. Plan B is a community place, Escorted to Meridan then to Coventry. Very excited about Xmas.” In his CareNotes, this covers: “a risk of violence, intimidation, property damage, and obstacle dominance. Risk to self and others.” This entry is added to every session with Patient C on CareNotes almost as a catch-all, although it does not feature in any handwritten notes.

56. The lack of detail means that a discussion of “emotional problems” and the “risks of violence” do not marry up. The two sets of notes bear scant reflection to each other. Given the burden and standard of proof, the Panel finds this particular of the Allegation proved.

Particular 2(a)(iv) – found proved

57. Colleague Z produced the CareNotes entry that the Registrant had created for Patient D in relation to a session held on 29 November 2018. It was uploaded on 21 January 2019 almost two months later. The CareNotes entry indicated that Patient D was “free from suspicious thoughts”; this contrasts with the corresponding handwritten notes. This indicated that Patient D “discussed his paranoid thought and hearing voices,” giving examples of derogatory remarks heard about the wife of the maintenance man.

58. The completely contradictory information between the two records casts doubt on their accuracy. Given the burden and standard of proof, the Panel finds this particular of the Allegation proved.

Particular 2(a)(v) – found proved

59. Colleague Z produced the CareNotes entry that the Registrant had created for Patient E in relation to a session held on 4 October 2018. The electronic record was made on 17 January 2019 more than three and a half months later. The electronic record notes that “there was good eye contact” and that “autistic features were noted” which appear contradictory, but there is no mention of either of these observations in the corresponding handwritten notes for this patient on this date.

Particular 2(a)(vi) – found proved

60. Colleague Z produced the CareNotes entry that the Registrant had created for Patient F in relation to a session held on 10 December 2018. The entry was made on 16 January some five weeks later. The CaseNotes session records that Patient F feebly said “I cannot bear this…I should be helped” and that Patient F agreed to anti-depressants. The corresponding handwritten note does not have this quote. It says that antidepressants were not administered.

61. While the Panel did not consider that the two records were necessarily contradictory, as it was not for the Registrant to prescribe anti-depressants, the electronic records do not accurately reflect the position as set out in the handwritten note. The CareNotes record: “Plan: To continue further exploring the underlying frustrations contributing to depression and to start CBT for depression ASAP Pt F amenable after the titration period of the antidepressant.” As the antidepressant was not administered a misleading impression is created. Given the burden and standard of proof the Panel finds this particular of the Allegation proved.

Particular 2(a)(vii) – found proved

62. Colleague Z produced the CareNotes entry that the Registrant had created for Patient G in relation to a session held on 21 November 2018. The entry was made on 21 January when two months had elapsed. CareNotes describes that Patient G has ongoing PTSD complex trauma in relation to his index offence of the manslaughter of his friend. It says that Patient G has described his flash-backs, drug abuse and that his offence was done in self-defence due to his friend threatening to kill his family. There is no handwritten session note for Patient G at all. However there is a handwritten note for 13 November and the content of this note appears to match the CareNotes entry.

63. Given the discrepancy between the records, it is unclear which the correct date for the session was. There is inaccuracy and given the standard and burden of proof, the Panel finds this particular of the Allegation proved.

Particular 2(a)(viii) – found proved

64. Colleague Z produced the CareNotes entry that the Registrant had created for Patient H in relation to a session held on 3 January 2019. The entry was made on 18 January when only two weeks had elapsed. CareNotes describes that relapse prevention work was required due to his move back into the community. The corresponding handwritten note does not mention relapse prevention note at all. It is not clear where the reference comes from.

65. The Panel had regard to the much shorter period of time between the session and the CareNotes entry being created. It considered whether it was feasible that the Registrant had remembered details that he had not recorded in his handwritten notes. However, the Panel took into account that the Registrant by his own admission was so stressed at having to create retrospective CareNotes entries, such that his physical health was impacted, that it does not consider that his short term memory can be relied upon in such circumstances. Further, it notes that this is not the case that the Registrant advances. The Panel considered that given the burden and standard of proof that this particular of the Allegation had been found proved.

Particular 2 (b) – found proved

66. The Panel took into account that at the time the Registrant accessed CareNotes that he had access to his handwritten notes. While photocopies were given to Colleague Z, the Registrant retained the originals. Colleague Z gave evidence that he was concerned that along with some handwritten notes not being transferred to the CareNotes system, there were also no handwritten notes to correspond to some of the entries that were placed onto CareNotes by the Registrant.

Particular 2(b)(i) – found proved

67. Colleague Z indicated that on 7 January 2019, the Registrant entered a session note onto the CareNotes system for Patient B in relation to a session held on 10 October 2018. While the CareNotes system indicates that Patient B “Declined” the session, there is no handwritten plan for the session, or handwritten record of it being declined, or addressing the circumstances surrounding this. No satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.

Particular 2(b)(ii) – found proved

68. Colleague Z produced the CareNotes entry that the Registrant had created for Patient C in relation to a session held on 12 October 2018. The entry was made on 17 January when three months had elapsed. There is no handwritten note which references that the Registrant was due to meet, or met with Patient C on 12 October 2018 and no satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.

Particular 2(b)(iii) – found proved

69. Colleague Z produced the CareNotes entry that the Registrant had created for Patient D in relation to a session held on 8 October 2018. The entry was made on 18 January when more than three months had elapsed. There is no handwritten note which references that the Registrant was due to meet, or met with Patient D on 8 October 2018 and no satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.

Particular 2(b)(iv) – found proved

70. Colleague Z produced the CareNotes entry that the Registrant had created for Patient E in relation to a session held on 15 October 2018. The entry was made on 17 January when more than three months had elapsed. There is no handwritten note which references that the Registrant was due to meet, or met with Patient E on 15 October 2018 and no satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.

Particular 2(b)(v) – found proved

71. Colleague Z produced the CareNotes entry that the Registrant had created for Patient F in relation to a session held on 4 October 2018. The entry was made on 14 January when more than three months had elapsed. There is no handwritten note which references that the Registrant was due to meet, or met with Patient F on 4 October 2018 and no satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.

Particular 2(b)(vi) – found proved

72. Colleague Z produced the CareNotes entry that the Registrant had created for Patient G in relation to a session held on 4 October 2018. The entry was made on 17 January when three months had elapsed. There is no handwritten note which references that the Registrant was due to meet, or met with Patient G on 4 October 2018 and no satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.

Particular 2(b)(vii) – found proved

73. Colleague Z produced the CareNotes entry that the Registrant had created for Patient H in relation to a session held on 15 October 2018. The entry was made on 18 January when more than three months had elapsed. There is no handwritten note which references that the Registrant was due to meet, or met with Patient H on 15 October 2018 and no satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.

74. Another entry made by the Registrant on 17 January 2019 on the CareNotes system indicates that he met with Patient H on 12 September. The Registrant did not begin working at Woodland View until 24 September 2019. At a minimum, the date is incorrect.

Particular 2(b)(viii) – found proved

75. Colleague Z produced the CareNotes entries that the Registrant had created for Patient I in relation to four different sessions. There was no handwritten note which references that the Registrant was due to meet, or met with Patient I on those four occasions. The Panel did have regard to the Registrant’s position that there may sometimes be little to distinguish one visit from another, particularly when a patient will not engage, and took into account what Professor Hacker-Hughes had said in support of the Registrant’s note-taking. However, it noted that the Professor had never seen the notes in question, even when redacted, as they were being seen by the Panel, and was only taking the Registrant’s word as “a man of honour”. In the absence of any satisfactory explanation being offered for the absence of the handwritten document by the Registrant, the Panel finds this particular of the Allegation proved.

Particular 2(b)(ix) – found proved

76. Colleague Z produced the CareNotes entry that the Registrant had created for Patient A in relation to a session held on 4 October 2018. The entry was made on 21 January when more than three months had elapsed. There is no handwritten note which references that the Registrant was due to meet, or met with Patient A on 4 October 2018 and no satisfactory explanation has been offered for the absence of the handwritten document by the Registrant.
Particular 3 – found proved

77. There have been different instances highlighted by Colleague Z where the Registrant’s electronic clinical entries have no supporting handwritten entries. These include:

i) instances where detailed electronic notes are provided more than three months after sessions without paper records to copy these from;
ii) that multiple sessions, e.g. in the case of Patient I have no corresponding handwritten notes and that each session is a copy and paste of the previous session with a minor amendment;
iii) that there are records created for 12 September 2018, when the Registrant did not begin to work at Woodland View until 24 September 2018.

78. In the absence of any explanation for these contradictions, the Panel is of the view that the records are false. There has been no clear acknowledgement of error, but rather the suggestion that some of the Registrant’s process notes were deliberately confiscated from him in an attempt to dispense with his services when Woodland View no longer wanted to employ him.

79. The Panel has addressed the issue of whether the Registrant made up entries because he did not have sufficient handwritten notes. It has taken into account his admission that he was not enjoying good health and was stressed by the absence of electronic records that he knew that he had not created. He was conscious that as time went by it would be necessary to create additional records some spanning back more than three months. The Panel has heard that the Registrant was prevented from seeing patients until his electronic records were up to date, and that there was pressure to complete this speedily.

80. The Panel has asked itself whether in this context, whether it is feasible that the Registrant could simply keep all the information in his head and in fairness to the Registrant notes that this is not what he suggests. However, the Panel has concluded that rather than any sinister and calculated course to get rid of him, that the Registrant had succumbed to panic and made up entries. It has arrived at this view because even when presented with the photocopies of his own records, it notes that some dates appear to be incorrect and the detail is scant. His attention to detail is not good, and it is not considered feasible that he would have kept all the detail about different patients in his head over a period from October-December. In the absence of any evidence to support that handwritten notes ever existed, the Panel finds that the Registrant made up entries to cover the fact that he had not kept contemporaneous records of all the sessions he had attended since beginning at work at Woodland View.

Particular 5c – found proved

81. The Panel has taken into account the witness evidence of both Colleague Z and Sunita Heeley, along with the Registrant’s own evidence. The Panel notes that he maintained that Ms Heeley had offered him a job on two separate occasions, before conceding in his evidence at this hearing that he was never offered a job and that it was never his intention to mislead the previous panel. Given the burden and standard of proof, the Panel finds this particular of the Allegation proved.

Particular 6 – found proved

82. The Panel has considered whether the Registrant was dishonest and/or misleading in relation to 3 and 5 above.

i) In relation to 3 it finds that the records were falsified on the basis that the Registrant was stressed about how to create electronic records without the corresponding handwritten notes and so made them up. The Panel finds this conduct concerning given his experience and knowledge. It concluded that given the stress he was under he had chosen to make up records so as to try and keep his job. Accordingly, it finds that the Registrant both intended to mislead his employers into thinking that there were contemporaneous notes that he relied on and acted dishonestly, in acting outside the standards of what an ordinary decent person would have considered as dishonest, and was aware of this fact.

ii) In relation to 5 above, the Panel has considered what benefit and motive the Registrant could have to deliberately indicate that he had been offered a permanent post that he had turned down, when the reality was that he had left after having failed to complete patient note recording adequately. The Panel is mindful that at HCPC hearings, there is a limited opportunity to observe a Registrant and therefore the opinion of those who see the Registrant day in and day out at work may form a more nuanced and accurate impression. In indicating that he had been offered a permanent post, the Panel is of the view that the Registrant attempted to convey that he was highly thought of and that his colleagues wanted him as a permanent member of staff to such a degree that a firm offer was made. It does not accept that his optimism turned his hope into a promise and notes that he maintained that Ms Healy had offered him a job on two separate occasions, before conceding that it was not actually an offer at all. In saying that he knew he had used the wrong words but did not feel able to correct them, the Panel considers this to be an acknowledgement that he deliberately calculated the benefit he might have in creating this false impression.

83. The Panel find proved that the Registrant was misleading and dishonest in relation to both 3 and 5.

Grounds

84. The Panel next went on to consider whether or not the facts found proved amounted to misconduct and/or a lack of competence. Once again, the Panel took into account the evidence, submissions and legal advice it had been given.

85. The Panel determined that the facts found proved did amount to misconduct on the Registrant’s part. They found that he had not created adequate and accurate contemporaneous notes when seeing patients and had then behaved dishonestly in deliberately falsifying patient electronic records, and misleading a previous panel. Had the facts related only to borderline inadequate note-taking and creating electronic/proper records belatedly, the Panel was of the view that this could be regarded as a lack of competence given his lack of previous training and experience of creating electronic patient records, which had not prepared him for this role. However, the Panel, having found that the Registrant was unable to account for some missing notes, had appeared to make up at least the date of one appointment and had deliberately falsified some records, and misled a previous panel, acting dishonestly in both instances, considered that this reached the threshold of the statutory ground of misconduct.

86. The Panel was of the view that the Registrant’s colleagues would consider his conduct to be deplorable. His actions and dishonesty had the possibility of placing patients and colleagues at risk, should follow up from other clinicians have been required promptly, when accurate and detailed records were not on the CareNotes system, with the situation continuing for some months. The Panel takes the view that the fact that no actual harm has come to a patient as a result is a matter of chance rather than design given the particularly vulnerable nature of some of the patients that the Registrant saw, who by his own admission may have been akin to needing a high-security environment rather than the medium-security environment that they were placed in.

87. The Panel concluded that the facts found proved in respect of the Registrant amounted to the statutory ground of misconduct.

Impairment

88. The Panel once again took into account the evidence, submissions, and legal advice it had been given.

89. The Panel considered that the Registrant had breached the following standards of the HCPC Standard of Proficiency and ethics.

6 Identify and minimise risk
• 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.
9 Be honest and trustworthy.

• 9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

10 Keep accurate records
• 10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.
• 10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.

90. The Panel heard from the Registrant and took into account the positive references submitted on behalf of the Registrant and what Professor Hacker-Hughes had been willing to indicate about his view of the Registrant and his confidence in his character and knowledge. However, it had to balance that the Registrant, while having remedied deficiencies in note-taking, was now working in a pain-management service without the same stressors that exist in a medium-high security unit. Further, that in looking back the Registrant had been willing to place blame at the door of multiple colleagues, and only grudgingly accepts even partial responsibility for his actions.

91. It concluded that the Registrant’s lack of insight means that the conduct shown by the Registrant in the past was likely to be repeated in the future, in respect of dishonesty (record-keeping having been addressed), in considering his own position before that of patients and colleagues, and accordingly to place patients at unwarranted risk of harm and breaching fundamental tenets of the profession and bringing the profession into disrepute.

92. The Panel determined that the Registrant’s fitness to practice is currently impaired on the personal component. The Panel had found misconduct based on comprehensive evidence.

93. The Panel also considers that the public interest demands a finding of current impairment in this case. The Registrant was operating as a psychologist in a role in which accurate electronic notes that could be accessed by other electronic users was required. He did not consider learning to access and use an electronic system of patient records a priority notwithstanding that he was working in a medium-high security unit with vulnerable individuals and did not appear to take personal responsibility for ensuring he was able to do his job as required. On any view that is a serious matter which would cause concern to the public.

94. The Panel took into account the need to protect members of the public, maintain public confidence in the profession, whilst also declaring and upholding proper standards of conduct in making its finding of current impairment. The public is entitled to expect registrants who are professionally competent and who act with decency, honesty and integrity. The public should also be able to rely on a regulatory process that is robust, fair and transparent.

Sanction

95. In considering what sanction, if any, to impose, the Panel has taken account the submissions made by Mr Bridges on behalf of the HCPC and those by Mr Galvin on behalf of the Registrant. It has also accepted the advice of the Legal Assessor.

96. Mr Bridges has said that the decision on what sanction, if any, to be imposed, is a matter for the Panel. Accordingly, the HCPC is neutral. However, he commended the HCPC Sanctions Policy March 2019 to the Panel. He suggested that the Panel may have particular regard to paragraphs 10, 25, mitigating and aggravating factors, along with paragraph 57 and 58 on page 61 concerning dishonesty because there are different degrees of dishonesty.

97. Mr Galvin submitted that the Registrant was ill at the time, and had not been experienced in using an electronic record system. The Registrant has shown insight for his failings he said and had perhaps exaggerated the position rather than deliberately setting out to be dishonest in giving evidence to the previous panel. He reminded the Panel that there had been mitigation advanced by the Registrant, and that steps via training have been taken to address any deficiencies in record-keeping.

98. He indicated that there have been fulsome testimonials shared on behalf of the Registrant who he said is a good and knowledgeable psychologist. He submitted that the Registrant had learnt a salutary lesson from these proceedings which he has found stressful. He said that the Registrant has suffered from depression and had the responsibility for care of his elderly mother. He said that the Registrant is willing to abide by any sanction but asked only that he be able to continue to work given his age, his commitments, and the skills he has to share which would benefit the public.

99. On resuming the hearing on 7 April, the Panel was presented with additional documentation which included a reflective piece in which the Registrant identified the steps that he has already begun to take to remediate his misconduct. Furthermore, the Registrant apologised for the impact that his actions may have had on the patients that he was treating, his colleagues and the reputation of the profession. He continued by acknowledging that his actions had fallen short of the proper standards of conduct expected of a registered professional. The Registrant recognises that developing his insight, training and stress management is an ongoing process which he has undertaken to progress. Whilst the Registrant’s record-keeping appears to have been remediated by training and working in his current post, the Panel acknowledges that the Registrant recognises this is the beginning of this process for him to begin to address the deficit and reflect upon his misleading and dishonest conduct.

100. The Panel has borne in mind that the purpose of sanctions is to protect the public and the public interest rather than to punish the Registrant for wrongdoing. It was conscious of the need to apply the principle of proportionality and balance the interests of the public with those of the practitioner.

101. The Panel identified the following aggravating and mitigating factors in this case:

Mitigating

• That the Registrant has now begun to take steps to remediate the deficiencies in record keeping by training;
• That there has been an acknowledgement and apology for his wrongdoing;
• That he had considered strategies to remedy his deficiency at the time which included paying for a 1:1 tutorial in his own time;
• That the Registrant has begun to develop some insight in acknowledging that he must accept responsibility for gaining the tools that allowed him to do his job;
• That he was under stress and unwell at the time of the incident, such that medical intervention and treatment were required;
• That it was unlikely that he had set out with the purpose to be deliberately dishonest when he went to work at Woodland View.

Aggravating

• That the Registrant has not taken steps to fully remediate or reflect meaningfully on his dishonesty and can show little insight.
• That vulnerable patients and health professionals were put at risk because their records were not accurate and up to date.
• That his dishonesty was motivated by protecting himself and not considering his colleagues responsibilities or patients.
• That he sought to blame others for his failings and to hide his dishonesty.

102. The Panel has referred to the HCPC Sanctions Policy in arriving at a decision.

103. In view of the seriousness of the case, to take no further action, would not be appropriate as it fails to address the risks of practicing without restriction, given the concerns raised in its findings at the Facts and Impairment stages of the hearing.

104. Imposition of a caution order was considered but discounted as this is not a case where a caution would be sufficient or appropriate to maintain confidence in the profession and the regulatory process. The wrongdoing was too great and had been repeated over a period of weeks.

105. The Panel went on to consider the imposition of a Conditions of Practice Order in terms of addressing the concerns identified in reaching its decision on Impairment. Given the concerns are threefold in terms of failing to meet standards, involving:

a. Identifying and minimising risk;
b. Being honest and trustworthy;
c. Keeping accurate records;

106. The Panel was conscious that it is difficult to formulate conditions to address dishonesty but was nonetheless mindful that there are different types and degrees of dishonesty. While the Panel does not consider that the Registrant set out to be dishonest at the outset of his time at Woodland View, it did not consider that there are appropriate conditions of practice to address these, nor would conditions accurately reflect the gravity of his wrongdoing.

107. The Panel next considered the sanction of suspension. It carefully considered the Sanctions Policy and was concerned at the lack of the Registrant’s insight into his dishonest conduct with its attendant risks of repetition. It took into account that the Registrant has been working without issue during the intervening period and that these matters dated back three years without any suggestion of repetition, that he has been working without restriction, and that his current employers have given him a positive reference.

108. The Panel considered whether the time which had elapsed without repetition of dishonesty or record-keeping issues was sufficient to indicate a lower likelihood of repetition than the absence of fully developed insight reflects. In seeking to apply the principle of proportionality, it balanced the Registrant’s good work, as evidenced by his employer, his friends, colleagues, his patients and supervisor against his wrongdoing back in 2018 and 2019. However, the Panel was of the view that it had found proved two distinct types of dishonesty: dishonesty in record-keeping and dishonesty to his regulator insofar as the previous panel was concerned, the first of which occurred over an extended period of time. It also noted that he had been less than frank about being offered a job, suggesting that Ms Heeley had offered him a job twice, albeit some allowances were made for communication difficulties given that the Registrant has not worked in the UK his whole life.

109. The Panel carefully considered whether a suspension order was sufficient to protect the public and the public interest, reflecting the wrongdoing of the Registrant. The Panel was mindful that the Registrant had not fully developed insight, albeit his reflection appeared to address all their concerns as highlighted through its determinations to date. It is clear that the Registrant has taken advantage of the further time that has elapsed before this stage of the hearing, to look back and consider what went wrong and could be done differently in the future. Similarly, he has been able to articulate his appreciation of the risks to vulnerable patients, colleagues and the reputation of the profession. The presence of insight as highlighted in the Sanctions Policy guidance at paragraph 121 has meant that the Panel is confident of imposing a sanction of a suspension order, as a way of addressing the wrongdoing.

110. The Panel did consider the ultimate sanction of a striking off order but was of the view that the Registrant’s current work without issue and the passage of time without repetition should factor in its arrival at a proportionate decision. Further, it notes that the clinical care provided by the Registrant has been described as “exceptional” and “inspiring”. Given the positive testimonials, the Panel is of the view that the principle set out in the case of Muscat v HCP, namely, that it is not in the public interest that a Registrant capable of providing good service to patients is struck off, applies in this case. Accordingly, not withstanding the serious breach of a fundamental tenet of the professional, the Panel considers that it would be sufficient to impose a Suspension Order and that a Striking-Off Order would be disproportionate.

111. In arriving at its decision, the Panel has taken account of the fact that the Registrant has undertaken relevant training which has had a positive impact on him. That he is clear that he has a desire to do things differently in the future and is committed to change. He has been candid that he recognises that his insight and reflection is not a moment in time but will be a continuing process. The Panel has decided that suspension will be a sanction which reflects the nature and gravity of the concerns that the Panel have in relation to dishonesty and protects the public and public confidence. It also allows the Registrant the period to reflect on the events with which this hearing is concerned.

112. Insofar as the period of the Suspension Order is concerned, the Panel determined that this should be 12 months. While it is of the view that this period of time will have an adverse impact on the Registrant, it considers that no lesser time would be sufficient for the Registrant to fully reflect on what has occurred and demonstrate the stress management strategies that he has in place.

113. There is to be a review before the end of the suspension period and a future panel will be assisted by:

• evidence of how his insight has meaningfully developed further via reflection about the standards he should operate under and why it is not acceptable to prioritise his own position over patients and colleagues;
• stress management strategies that he will employ so that such conduct is not repeated given his contention that this added to the environment in which his dishonest conduct occurred;
• evidence that he is keeping up to date with technological changes, such as electronically recording material.

Order

Order

The Registrar is directed to suspend the registration of Mr Vijayakumaran Kuttampoil for a period of 12 months from the date this Order comes into effect.

Notes

Right of Appeal
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.


Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.


Interim Order

Mr Bridges applied for an Interim Order to cover the 28 days before the substantive order took effect. Mr Galvin accepted that this would be required.

The Panel accepted the advice of the Legal Assessor that an interim order could be imposed if it was necessary for the protection of the public or otherwise in the public interest.

Given that the Panel has imposed a substantive order of suspension, it imposes an interim order of suspension to cover the period before the substantive order takes effect, or for any appeal period. It did so on both the grounds of public protection and public safety. The reasons for the interim order mirror the reasons for the substantive order.

The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. 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.

Hearing History

History of Hearings for Vijayakumaran Kuttampoil

Date Panel Hearing type Outcomes / Status
07/04/2022 Conduct and Competence Committee Final Hearing Suspended
21/02/2022 Conduct and Competence Committee Final Hearing Adjourned part heard