Mr Daniel Cranganu

Profession: Physiotherapist

Registration Number: PH111306

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 22/02/2022 End: 17:00 08/03/2022

Location: Virtual Hearing via Video Conference

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Whilst registered with the Health and Care Professions Council as a Physiotherapist:

1) No evidence offered;

2) No evidence offered;

3) No evidence offered;

4) No evidence offered;

5) On or around 2 May 2019, you did not comply with your Interim Conditions of Practice Order when you assessed Patient 2 without a Chaperone.

6) No evidence offered;

7) You actions at paragraph 5 constitute misconduct.

8) By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Hearsay evidence

  1. Ms Reid, on behalf of the HCPC, raised a preliminary matter. In the absence of Patient 1 at the Hearing, Ms Reid made an application that the Panel should admit the hearsay evidence of Patient 1, the alleged victim of allegations of sexually motivated behaviour made against the Registrant.
  2. This evidence comprised three documents emanating from Patient 1 - an email dated 16 February 2018, sent by Patient 1, to her Referring Health Provider, a statement sent by her to HCPC dated 8 June 2018; and a witness statement dated 9 October 2021. In these documents Patient 1 described her experience at her appointments with the Registrant during January and February 2018.
  3. Ms Reid submitted that although Patient 1 was the sole witness to the allegations in Particulars 1 – 4 and 6, her first description of her experience was relatively close in time to the alleged events and her accounts in the subsequent statements were consistent and could therefore be regarded as reliable.
  4. Ms Reid said that initially Patient 1 had indicated that she was willing to attend to give evidence and wished to do so. However, she failed to attend when the hearing was first scheduled for September 2021. Subsequently, numerous attempts were made to contact Patient 1 but her responses were sporadic and inconclusive. A witness summons was therefore issued on 9 February 2022 but this had not secured her attendance. Further attempts to contact Patient 1 at the start of the Hearing had been unsuccessful. Ms Reid provided extensive documentation of the chronology of communication between Patient 1 and the HCPC.
  5. Ms Reid submitted that all reasonable steps had been taken to ensure Patient 1’s attendance. She said further that there was nothing to indicate animosity between Patient 1 and the Registrant nor any reason for fabrication of the allegations.
  6. Ms Reid further submitted that these serious allegations should be fully investigated and that it was in the public interest to do so.
  7. Ms Williamson opposed the application. She submitted that in the light of the serious nature of the allegation, which if proved, could well be career threatening, the Registrant would be severely prejudiced if the evidence of the sole and decisive witness could not be tested before the Panel. Further there are fundamental disputes in the respective accounts of Patient 1 and the Registrant. No reason has been advanced for Patient 1’s repeated failure to appear, even now that a witness summons has been issued. Ms Williamson submitted that the Panel could have no way of knowing whether Patient 1 continued to stand by the descriptions she had given in her various statements.
  8. Ms Williamson’s submission was that it would be unfair and unjust to admit this evidence.
  9. In reaching its decision the Panel considered all the documentary and other information before it, together with the submissions of Ms Reid and of Ms Williamson. It accepted the advice of the Legal Assessor.
  10. The Panel found that although the HCPC had made reasonable efforts to ensure the attendance of Patient 1, no reason for her failure to attend had been given. Furthermore the Panel noted that Patient 1 is the sole and decisive witness to serious allegations of sexually motivated conduct towards a patient.
  11. The Panel was aware that if this evidence were admitted it could attach such weight to it as would be appropriate, but the Panel concluded that the evidence of Patient 1 could not be tested before the Panel by means of cross examination or Panel questions.
  12. The Panel has had in mind its duty to make due enquiry into a serious allegation but it has concluded that in the circumstances of this case, it would be unfair and unjust to the Registrant to admit the hearsay evidence of Patient 1.
  13. The Panel therefore rejected this application.

    Offering no evidence and amending the Allegation

  14. As a consequence of this decision Ms Reid said that she would offer no evidence to Particulars 1 – 4 and 6. Ms Reid sought to amend Particular 7 accordingly. The Panel suggested amending the stem of the Allegation to remove the reference to Patient 1. These proposed amendments served to clarify and were not opposed by Ms Williamson.
  15. The Panel was satisfied in the light of its rejection of the hearsay application that there was no evidence to support Particulars 1 – 4 or 6 and the related matters in regard to Particular 7. The Allegation was amended accordingly. 
  16. Having been amended, the Allegation reads as follows;

    Whilst registered with the Health and Care Professions Council as a Physiotherapist:
    1) No evidence offered;
    2) No evidence offered;
    3) No evidence offered;
    4) No evidence offered;
    5) On or around 2 May 2019, you did not comply with your Interim Conditions of Practice Order when you assessed Patient 2 without a Chaperone.
    6) No evidence offered;
    7) Your actions at paragraph 5 constitute misconduct.
    8) By reason of your misconduct your fitness to practise is impaired.

    Interim Conditions of Practice Order

  17. During the Hearing, following the evidence of two witnesses and prior to the opening of the case for the Registrant, Ms Williamson applied for the existing Interim Conditions of Practice Order to be revoked. She submitted that the HCPC Practice Note ‘Interim Orders’ indicates that a Registrant may apply at any time for a review if new information becomes available. Further, she submitted that this Panel, albeit in the course of conducting the Substantive Hearing, has jurisdiction to hear such an application. Ms Williamson’s submission was that as no evidence is to be offered for Particulars 1 – 4 and 6, this is new and significant information. Moreover, the Interim Order was based on the nature of these allegations and the need for them has now fallen away. She referred also to the prejudice that would be suffered by the Registrant if the Interim Conditions of Practice remained in place until the conclusion of proceedings in March.
  18. Ms Reid did not dispute that the Panel had jurisdiction but submitted that the usual practice should be adopted that is to deal with Interim Orders when the allegation is determined. Ms Reid submitted that to review the Interim Order at this stage of the proceedings would give the impression that facts, seriousness and potentially, impairment, had been prejudged.
  19. In reaching its decision the Panel considered all the information before it together with Counsel’s submissions. It took into account the advice of the Legal Assessor.
  20. The Panel noted that it appeared that it had jurisdiction to hear an application to review the Interim Order at this stage. However, the Panel agreed with the submissions of the HCPC that to review an Interim Order at this stage of proceedings could give the impression of prejudging any factual, misconduct or impairment decisions that are yet to be made.
  21. The Panel rejected the application to review the Interim Order at this stage of proceedings.

    Background

  22. The Registrant is a registered Physiotherapist who was practising at the relevant time at the Wellbeing Centre (“the Centre”). He treated Patient 1 on a number of occasions between January 2018 and February 2018.

  23. It is alleged that during the course of physiotherapy the Registrant touched and massaged areas of Patient 1’s body without her consent and without clinical justification. It is further alleged that his actions were sexually motivated.

  24. This matter was referred to the HCPC in March 2018.

  25. It is also alleged that in May 2019, whilst practising under restrictions, the Registrant breached an Interim Conditions of Practice Order when he assessed Patient 2 without a chaperone.

    Admissions

  26. At the outset of the hearing Particular 5 of the Allegation was admitted. 

    Evidence

  27. There was before the Panel a bundle of documents prepared by the HCPC containing witness statements and exhibits. There were also documents from the Registrant, including his witness statement, Continuing Professional Development (CPD) and testimonials.

    Witnesses

  28. RS was Clinical Director at the Centre and the Registrant’s Clinical Supervisor. He worked with the Registrant approximately weekly and engaged with him and with others in clinical discussions.

  29. RS described the Registrant as a ‘keen learner’ who displayed empathy with his clients and appropriate clinical skills.

  30. He said that the Registrant had informed the Centre of the interim condition requiring him to be chaperoned when providing physiotherapy services to female patients, unless in life threatening or emergency situations.

  31. RS said that he was informed that on 2 May 2019 the Centre receptionist had booked in as an urgent appointment a female patient in place of the last patient of the day, a male, who had cancelled his appointment.

  32. The chaperone who would usually be in attendance at the Centre until the last appointment of the day had left early. The Registrant asked the receptionist to act as chaperone but she had been too busy to do so.

  33. In regard to Patient 2’s (the female appointment) condition, RS said that it was a question of judgment for the Registrant whether to treat her. RS said, that if he had been subject to such a condition, he, RS, would make a subjective assessment, but unless this indicated a life threatening or emergency situation, he would not make an objective assessment or treat the patient. His conclusion was that in the absence of a life threatening or emergency situation he would not treat the patient without a chaperone.

  34. AC attended the Centre one day every week and acted as a chaperone on 2 May 2019. Although untrained in that capacity the role had been explained to her by the Registrant. She said she had graduated as a physiotherapist in Romania but was not HCPC registered. She described the Registrant as displaying a very caring attitude towards his patients.

  35. AS-C was called as expert Clinical Physiotherapist and spoke to his reports. He had examined the Registrant’s clinical notes relating to Patient 2. His opinion was that although Patient 2 was described as referring to severe pain and was describing her urgent need to see a physiotherapist, no ‘red flags’ were recorded. There was therefore nothing to indicate a life threatening or emergency situation. In these circumstances in the light of the Interim Conditions of Practice Order, the Registrant should not have provided physiotherapy services in the absence of a chaperone, notwithstanding any pressure that might have been exerted on him by Patient 2.

  36. The Registrant gave evidence. He said that an urgent appointment had been made for late in the afternoon. He also said that he learnt that Patient 2 was female only when he met her and that, unexpectedly the chaperone had left early and no other was available. He asked the receptionist to take her place but she was unavailable.

  37. He agreed that although Patient 2 was complaining of severe pain there were no ‘Red Flags’ which could indicate a life threatening or emergency situation. Despite this, and in the knowledge that he should be chaperoned, he stated that examined Patient 2, asking her to identify the area of pain in her shoulder but touching her shoulder only with his finger. He then advised exercises. The Registrant agreed that he should not have conducted this objective assessment. He said that he could have told Patient 2 of the condition on his practice, and asked her whether she wished to proceed or advised her to return the following day. In his witness statement the Registrant stated that ‘to comply with the conditions of practice I should have advised Patient 2 to attend Accident and Emergency rather than provide an initial assessment’.

  38. The Panel heard that the Registrant had been advised by RS to self-report this breach of the condition to the HCPC and that he then did so.

  39. In his evidence the Registrant expressed remorse for his breach of a condition which had been imposed on him as a professional, by his regulator. He said that the realisation of the serious nature of this had affected his health. He said he appreciated the effect that doing so would have on the profession as a whole. He understood also that Patient 2 had lost confidence in the Centre and in the profession when she became aware that he had not complied with a condition imposed by the regulator to protect the safety of patients.

  40. The Registrant said that he had registered with the HCPC in 2016 and worked as a physiotherapist since 2017. He stated that he was proud to be a member of his profession and that he had not been the subject of any references to the HCPC before or since this allegation was raised. Since the imposition of the condition he said he had provided physiotherapy services to some 200 female patients, each time in the presence of a chaperone.

    Decision on Facts

  41. In reaching its decision, the Panel considered all the evidence before it, both oral and documentary together with the submissions by Ms Reid and by Ms Williamson. The Panel accepted the advice of the Legal Assessor. It had well in mind that although the Registrant has admitted the facts alleged in Particular 5, the burden of proof in regard to that and to the other factual particulars, which are not admitted, is on the HCPC. Further, that the facts must be proved on the balance of probabilities.

    Particulars 1 – 4

    The HCPC offered no evidence. The Panel therefore found these Particulars not proved.

    Particular 5

    This Particular has been found proved in the light of the Registrant’s admission and the evidence of RS, AC and AS-C.

    Particular 6

    The HCPC offered no evidence. The Panel therefore found this Particular not proved.

    Decision on Grounds

  42. In reaching its decision the Panel again considered all the evidence and the information before it, together with the submissions by Ms Reid and Ms Williamson. It accepted the advice of the Legal Assessor.

  43. The Registrant is an experienced professional having first qualified in Romania in 2011 and practising in the UK as a physiotherapist since 2017.

  44. Although this was a single breach of the Interim Conditions of Practice Order, the Order was imposed by his Regulator. By this breach the Registrant was also in breach of:

    The HCPC Standards of Conduct, Performance and Ethics
    Standard 9.1: You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
    The HCPC Standards of Proficiency for Physiotherapists
    Standard 2.2: Understand what is required of them by the Health and Care Professions Council.

  45. In the Panel’s view, the Registrant’s breach of the Interim Conditions of Practice Order demonstrated a disregard for his regulator and the standards set by the regulator, and fell seriously short of the standards expected of a Physiotherapist. The Panel has concluded that it amounts to misconduct.

    Decision on Impairment

  46. In reaching its decision, the Panel considered the submissions by Ms Reid and Ms Williamson and the HCPTS Practice Note ‘Fitness to Practise Impairment (December 2019)’. The Panel accepted the advice of the Legal Assessor.

  47. The Registrant has admitted that he breached a condition of his Conditions of Practice Order. He has, in his Witness Statement and in his evidence, demonstrated that he has reflected on what he did, and demonstrated understanding of how he should have managed the situation in the circumstances. The Registrant has apologised to the HCPC, the profession, and the public. He has developed insight into his misconduct and the effect that it could have had upon Patient 2, and the reputation of the profession, although his insight into the impact on his colleagues at the Centre was less well articulated. The Panel considered the Registrant’s expressed understanding of his misconduct in his Witness Statement; ‘A Registrant should comply with any restrictions placed on their profession by a Health and Care Professions Tribunal (‘HCPTS’) because this is a professional and legal obligation and a registrant must be trustworthy. Any restrictions will be based on the HCPTS’s Panel’s assessment of the risk presented by the registrant and not following them could lead patients to be put at the risk that the Panel was trying to avoid’.

  48. Since this breach in 2019, the Registrant has undertaken several relevant and clinical CPD courses including ‘Chaperone for Health and Social Care’ in August 2021, consent training and privacy and dignity training.

  49. The Panel accepted the Registrant’s emphatic evidence that this was the ‘first and last time’ that such an event would occur.

  50. Whilst Patient 2’s confidence in the Centre was impacted as a consequence of the lack of transparency of the Registrant and the Centre in respect of not having been informed of the Registrant’s conditions, there are no concerns regarding the Registrant’s clinical competence. In fact, both Patient 2 and the Registrant’s colleagues at the Centre were complimentary as to his clinical ability.

  51. Taking all the above into account, the Panel has concluded that there is little likelihood of repetition.

  52. The Panel is satisfied that in regard to the ‘personal component’, the Registrant’s Fitness to Practise is not impaired.

  53. However, considering the public component of impairment, the Panel has concluded that the breach of an Interim Conditions of Practice Order was a serious disregard of a direction by the regulator. This undermines the authority of the regulator and is wholly contrary to what would be expected by the profession. Such a breach would doubtless be of grave concern to members of the physiotherapy profession. Furthermore, the wider public, which would necessarily rely upon the regulator to protect the safety of patients, would also be concerned by the Registrant’s misconduct.

  54. In the Panel’s view, members of the profession and the wider public would be concerned and troubled if a finding of impairment were not made.

  55. A finding of current impairment is therefore in the public interest in order to declare and to uphold proper standards and to maintain confidence in the profession and in the regulatory process.

    Decision on Sanction 

  56. In reaching its decision on sanction, the Panel considered all the information before it, together with the submissions from Ms Reid and those from Ms Williamson. It had regard to the HCPC’s Sanctions Policy. It accepted the advice of the Legal Assessor.

  57. The Panel found these to be aggravating factors:

    • The Registrant’s disregard of the directions of his professional Regulator was in breach of the trust invested in him by the Interim Orders Panel when imposing the original Interim Conditions of Practice Order and at every subsequent review. The Registrant was trusted to abide by the conditions imposed.
    • The Registrant’s breach of condition amounted also to a breach of the trust invested in him by Patient 2, who was entitled to expect him to abide by conditions imposed by his Regulator for the protection of patients.
    • The Registrant’s disregard of the integrity of the profession.

  58. The Panel found these to be mitigating factors:

    • The allegation was admitted at an early stage.
    • This was an isolated incident in a previously unblemished career.
    • From the outset, the Registrant has demonstrated significant insight and remorse, with apologies made to Patient 2, to the profession, and to the public.
    • The Registrant has undertaken relevant CPD training and has demonstrated an understanding of the standards required by the HCPC.
    • The Registrant now recognises the importance of maintaining the integrity of the profession.
    • The Registrant understands what he should have done in the circumstances.
    • There is little likelihood of repetition of the Registrant’s misconduct.

  59. The Panel first considered whether to take no action, but the findings of misconduct and of impairment on public interest grounds do not justify such a course.

  60. The Panel considered mediation. However, there are no issues to be resolved between the Registrant and any other party. Mediation is therefore not appropriate.

  61. In these circumstances, and in the light of the nature of the misconduct, a sanction is required.

  62. The Panel next considered a Caution Order. In the light of the mitigating factors identified above, it has concluded that a Caution Order would be appropriate and proportionate. Such an order would send a message to the Registrant and to the profession that breach of an interim condition imposed by the regulator is a serious matter. Furthermore, it would demonstrate to the public the regulator’s concern for the general public interest. It would emphasise also the regulator’s determination to declare and to maintain proper standards of conduct and of behaviour.

  63. The Panel did consider a Conditions of Practice Order but conditions would be inappropriate to address the misconduct found proved.

  64. The Panel considered a Suspension Order as a sanction. However, it concluded that in the circumstances of the case, and in the light of the significant mitigating factors, it would be disproportionate to prohibit the Registrant from practising his profession.

  65. The Panel determined that the minimum period of one year for the duration of the Caution Order is appropriate, proportionate and sufficient to protect the public and to maintain public confidence in the profession.

  66. The Panel therefore determined to impose a Caution Order for a period of one year.

     

     

Order

ORDER: That the Registrar is directed to annotate the register entry of Mr Daniel Cranganu with a caution which is to remain on the register for a period of 1 year from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Mr Daniel Cranganu

Date Panel Hearing type Outcomes / Status
22/02/2022 Conduct and Competence Committee Final Hearing Caution