Mr Inderjit Singh Sagar
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In March 2011, whilst registered as a Chiropodist, you:
1. Did not complete an adequate assessment of Patient A prior to undertaking a nail ablation by not or not adequately:
(a) Assessing Patient A’s vascular supply;
(b) Obtaining Patient A’s medical history.
2. Did not complete adequate records in respect of Patient A.
3. Provided inappropriate treatment to Patient A’s right toe nail in that:
(a) You used phenol for the nail ablation when this was contra-indicated for Patient A;
(b) You did not refer Patient A to a GP or vascular consultant for assistance.
4. Did not obtain informed consent from Patient A prior to undertaking a nail ablation by not:
(a) Providing Patient A with a sufficient explanation of the treatment options;
(b) Providing Patient A with sufficient explanation of the risks and benefits of each of the treatment options.
5. Your actions described in paragraphs 1-4 amount to misconduct and/or lack of competence.
6. By reason of that misconduct and/or lack of competence, your fitness to
practise is impaired
1. The Notice of Hearing was emailed to the Registrant’s email address on 16 December 2021. Since then, the Registrant has sent to the HCPC two emails, respectively dated 18 January 2022 and 29 January 2022, in which he makes it plain that he is aware of today’s hearing. As such the Panel found good service.
Proceeding in absence and application by the Registrant to adjourn
2. In the first above mentioned emails, dated 18 January 2022, the Registrant wrote “unfortunately I won’t be able to attend, as I have hardly worked in the 18 months as a result of covid…the clinic has been closed”. In his email on 29 January 2022, the Registrant updated matters and wrote that he would be unable to attend. He added that he didn’t feel well enough to attend and that he would appreciate it “if we could rearrange a meeting to next year”.
3. The Panel regarded this latter message to amount to an application by the Registrant to adjourn today’s proceedings.
4. This was an application which the HCPC opposed.
5. In deciding how to determine this matter, the Panel noted that the Registrant had been reminded by email from the HCPC on 16 December 2021 that he could join today’s hearing on the video link should he wish to do so. He had not responded to this invitation.
6. The Panel accepted the advice of the Legal Assessor and reminded itself of the Practice Note entitled Postponement and Adjournment of Proceedings, in particular the history of the case and whether there have been earlier requests for adjournments, at whose request and why and, above all, the general need for expedition in the conduct of proceedings. In this context, the Panel was aware that the original Conditions of Practice Order was imposed in November 2017 and that the current confirmed Order is due to expire 27 February 2022. The Panel also took into account, as mentioned above, the fact that the Registrant had not responded to the suggestion that he could join the hearing via video link, as had also been the case at the third review in January 2021.
7. In all the circumstances, the Panel took the view that relisting this case would serve no useful purpose and that it is in the public interest that this mandatory review should be heard today, albeit in the absence of the Registrant.
8. Thus, the application to adjourn was refused.
Proceeding in private
9. An application was made by Ms Welsh for those parts of the hearing which touched upon the private life and health of the Registrant to be heard in private, in accordance with the provisions of Rule 10 (1) of the Procedure Rules. The Panel assumed that the Registrant would not have opposed this application and felt it appropriate to grant it.
10. The Registrant is the owner of ‘The Chorley Chiropody Practice’. He has practised as a Registered Chiropodist/Podiatrist and a sole practitioner for over 20 years.
11. In March and April 2011, the Registrant provided treatment to Patient A that resulted in a complaint made three years later to the HCPC.
12. The Substantive Hearing took place in November 2017 and the first review was heard on the 18 January 2019.
13. On 23 January 2020 the Order was reviewed for the second time. The Registrant provided several documents setting out the courses he had attended, notes of discussions and learning, and one record keeping audit. The Registrant also provided a completed personal development plan (PDP) verified by his supervisor but with no notes of any meetings with the supervisor setting out the Registrant’s progress.
14. The second reviewing panel (2nd panel) considered that the Registrant had not fully complied with the conditions of practice order. As a result of being unable to find a supervisor the Registrant had not undertaken any partial or total nail avulsions. In these circumstances the 2nd panel concluded that the Registrant had not been able to demonstrate competence in this procedure or in any assessments prior to carrying out this procedure.
15. The 2nd panel noted the efforts made by the Registrant to produce his PDP and the reflective documents he had produced. It considered that these were insufficient to demonstrate complete insight or remediation and were lacking in several key areas.
16. The 2nd panel noted that there were no areas of concern highlighted by the Registrant’s supervisor. The 2nd panel was satisfied that on a general level the Registrant had remediated the concern in relation to his record keeping.
17. The 2nd panel concluded that there were no persistent or general failures and considered that the Registrant was genuinely willing to comply with conditions and had complied with the condition not to undertake partial or total nail avulsions without supervision. The 2nd panel considered that the Registrant was committed to improving his practice and had accessed training and support albeit that this process was not yet complete.
18. The 2nd panel concluded that, in all the circumstances, the appropriate and proportionate sanction to impose was a continuation of the Conditions of Practice order for a further period of 12 months with amendments to reflect the position at the time of the review.
19. On the 9 January 2021, in an email to the HCPC, the Registrant stated that he had had a “horrendous” year largely due to personal circumstances.
20. In that same email the Registrant stated that he had attended a cardiovascular shadowing session earlier in the year which “was very informative.” So much so that he booked onto a College of Podiatry “vascular court room” course which was cancelled due to Covid-19. He added that he had not managed to find a mentor but had not worked since April 2020. Furthermore, he expressed his desire to carry on working “when I get the opportunity, but it has been a very, very difficult year”.
21. The third review took place on 21 January 2021, in the absence of the Registrant. That panel (3rd panel) took the view that little progress had been made by the Registrant since November 2017 and added that, if that remains the position at the next hearing, “the future reviewing panel may wish to consider the option of imposing a striking off order”. Furthermore, it suggested that evidence of completion of online learning by the Registrant would be of assistance to such a panel.
22. The only communications since then from the Registrant have been in the above mentioned emails (paragraph 1 above) of 18th and 29th January 2022. In the first such email, he wrote that he hoped his clinic would be opening in the next few weeks and in the second he wrote as follows “In addition to covid nothing has changed since last year. Bar carrying out Cpds throughout the year.
23. The Panel heard the submissions of Ms Welsh that the fitness to practise of the Registrant remained impaired. She suggested that, although the imposition of a striking off order was a possibility, the Panel would also have the option of giving the Registrant a final chance and confirming the current Conditions of Practice Order for a further 12 months.
24. The Panel was aware that the process under Article 30 of the 2001 Order was one of review and not one of appeal, and that its function was to determine whether the Registrant’s fitness to practise was still impaired. And if impaired, what the appropriate and proportionate sanction, if any, should be, so as to protect the public and safeguard the public interest.
25. In considering the material in this case, it is plain to the Panel that the Conditions of Practice Order was imposed not as a punishment but to provide the Registrant with an opportunity to address the concerns about his practice that had been identified. His engagement since the last review has been, in the view of the Panel, at most, superficial. Although he continues to cite ill-health, he has not taken the advice of the 3rd panel in providing any evidence of completion of online learning.
26. Paying due regard to the HCPTS Practice Note “Fitness to Practise Impairment”, the Panel’s view, after consideration of all the material in this case, is that the Registrant’s fitness to practise remains impaired on both public protection and public interest grounds. His failings in 2011 put patients at unwarranted risk of harm and damaged the reputation of the profession.
27. The circumstances over the last twelve months have not altered in any material respect and, in the judgment of the Panel, the Registrant has failed to discharge his persuasive burden to demonstrate that he has properly addressed the issues of concern that have been identified. His lack of insight means that the Panel is not assured that, if permitted to return to unrestricted practice, the Registrant would not repeat his past failings.
28. In deciding what sanction, if any, to impose the Panel referred to the HCPTS Sanctions Policy.
29. The Panel has taken everything into account, in particular the Registrant’s lack of engagement in the process. This has been exemplified by non-attendance and a continuing lack of evidence over the years that he has taken steps to remediate his failings, or explanation of the same. The Panel’s judgment is that confirmation of the current Conditions of Practice Order would achieve nothing. The Registrant’s original failings were serious and, although the Panel accepts that he has been suffering from ill-health, he has, nevertheless, despite repeated invitations to do so, appeared quite unwilling to resolve the matters of concern. He has breached Conditions 3 and 4 and provided no evidence as to whether he has abided by the terms of Conditions 1 and 2.
30. In deciding whether or not it might be appropriate to impose an Order of Suspension, the Panel decided that such a sanction would serve no useful purpose. Paragraph 121 of the Sanctions Policy stipulates that such an Order is likely to be appropriate where the Registrant has insight, where the issues are unlikely to be repeated and where there is evidence to suggest the Registrant is likely to be able to resolve or remedy his failings. None of these factors are present in this case.
31. The Panel paid particular attention to the provisions of paragraph 131 of the Sanctions Policy and noted that a Striking Off Order is likely to be appropriate where the Registrant lacks insight, fails to address a lack of competence and is unwilling to resolve matters. All these factors are present and persuade the Panel that it has no option other than to impose a Striking Off Order.
32. The Panel is well aware that this sanction of last resort would have a significant impact upon the Registrant but is of the view that this is the only appropriate and proportionate Order to impose.
33. The Panel has determined that the current Conditions of Practice Order to be substituted by a Striking Off Order, with immediate effect.
The Registrar is directed to strike the name of Mr Inderjit Singh Sagar from the Register on the date that this order comes into effect.
No notes available
History of Hearings for Mr Inderjit Singh Sagar
|Date||Panel||Hearing type||Outcomes / Status|
|31/01/2022||Conduct and Competence Committee||Review Hearing||Struck off|
|21/01/2021||Conduct and Competence Committee||Review Hearing||Conditions of Practice|
|23/01/2020||Conduct and Competence Committee||Review Hearing||Conditions of Practice|
|18/01/2019||Conduct and Competence Committee||Review Hearing||Conditions of Practice|