Miss Sreenithi Sudhakar

Service
6. The Panel was provided with a copy of the Notice of Hearing. It was sent by email to the Registrant’s registered email address on 14 June 2022.

7. The Panel accepted the advice of the Legal Assessor.

8. The Panel noted that the email to the Registrant confirmed that the hearing would be taking place remotely via video conference. The date and time of the review hearing was confirmed in the Notice of Hearing.

9. The Panel was satisfied that the Notice of Hearing had been properly served in accordance with the Health and Care Professions Council (Coronavirus) (Amendment) Rules Order of Council 2021 which came into force on 4 March 2021. These rules provide express provision for the HCPC to serve notices via electronic email and hold hearings via audio and video link where necessary.

Proceeding in Absence

10. Mr D’Alton, on behalf of the HCPC, made an application for the hearing to proceed in the absence of the Registrant.

11. The Panel was advised by the Legal Assessor and followed that advice. The Panel also took into account the guidance as set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.

12. The Panel determined that it was fair, reasonable and in the public interest to proceed in the Registrant’s absence for the following reasons:

a. The Panel noted that the Registrant did not attend the substantive hearing in October 2021. She confirmed in advance of that hearing, in an email dated 28 September 2021, that she would not be attending. She stated:

“I will NOT [emphasis in the original] be attending during the dates allocated [Monday 11th October – Friday 15th October].
I have decided to change careers as I feel that Physiotherapy is no longer the career path I want to pursue (partly due to the anxiety and stress which led to my dismissal), and I have started training for my new job as a data engineer.”

The Panel also noted that there has been no engagement from the Registrant since the substantive hearing save for her email, dated 14 July 2022 and timed at 09.46 in which she stated that she would not be attending this review hearing and reiterated that she no longer wishes to pursue a career in physiotherapy. She stated that she is now pursuing “a career in the Tech Industry”. Mr D’Alton informed the Panel that he telephoned the Registrant on 11 July 2022 but her phone rang continuously and he was unable to establish a connection. He was also unable to leave a voice message. In these circumstances, the Panel concluded that the Registrant’s absence was voluntary and represented a waiver of her right to participate in these proceedings.

b. There has been no application to adjourn and no indication that the Registrant would attend on an alternative date. Therefore, it is unlikely that re-listing this review hearing would serve any useful purpose.

c. The Panel recognised that there may be a disadvantage to the Registrant in not being able to make oral submissions with regard to her current fitness to practise or her current intentions. However, she was given the opportunity to participate in these proceedings and has not taken up that opportunity.

d. As this is a mandatory review any potential disadvantage to the Registrant is significantly outweighed by the strong public interest in ensuring that the hearing proceeds expeditiously.

Background
13. At the relevant time, the Registrant was employed as a Band 5 Physiotherapist at the Royal Cornwall Hospital Trust (‘the Trust’). A number of the Registrant’s colleagues raised complaints about the Registrant between January 2019 and September 2019. These complaints generally related to a failure to demonstrate effective clinical reasoning and practice when dealing with patients and providing them with care.

14. A formal stage three capability meeting was held by the Trust on 16 September 2019 in relation to the Registrant’s performance at work and the limited improvement made by the Registrant between the period January and September 2019. The primary focus of the capability meeting related to an incident which took place on 28 August 2019.

15. The Trust’s capability concerns were referred to the HCPC on 25 September 2019.

HCPC Submissions
16. Mr D’Alton, on behalf of the HCPC, confirmed that there has been no meaningful engagement from the Registrant.

17. Mr D’Alton submitted that the Panel should extend the current Suspension Order, for a period of 12 months to give the Registrant a further opportunity to engage with the regulatory process which may include a request for voluntary removal.

Panel’s Approach
18. In undertaking this review, the Panel took into account the documentary evidence and the submissions made on behalf of the HCPC.

19. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt. In particular that:
• The purpose of the review is to consider the issue of impairment based on the previous panel’s findings of fact, the extent to which the Registrant has engaged with the regulatory process, the scope and level of her insight and the risk of repetition.

• In terms of whether her lack of competence has been sufficiently, and appropriately remedied relevant factors include whether the Registrant:

(i) fully appreciates the gravity of the previous panel’s finding of impairment;

(ii) has maintained or updated her skills and knowledge;

• The Panel should have regard to the HCPTS Practice Note: ‘Finding that Fitness to Practise is impaired’ and must take account of a range of issues which, in essence, comprise two components:

(i) the ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and

(ii) the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

• It is only if the Panel determine that the Registrant’s fitness to practise remains impaired, that the Panel should go on to consider sanction by applying the guidance as set out in the HCPC Sanctions Policy (SP), and the principles of proportionality which require the Registrant’s interests to be balanced against the interests of the public. A striking off order may not be made in respect of a finding of lack of competence unless the registrant has been continuously suspended, or subject to a conditions of practice order, for a period of two years at the date of the decision to strike off. Interim orders do not count towards the period of two years.

Decision

Impairment
20. The Panel noted that the Registrant appears to have decided to leave the profession as she indicated in her email, dated 28 September 2021, that she was in the process of changing her career and at that time was about to undertake training in a new role as a data engineer. However, she did not respond to the letter from the HCPC, dated 22 June 2022, which provided her with information with regard to voluntary removal from the register. That letter also reminded the Registrant of the information that she may wish to provide in the event that she intends to return to practise as a physiotherapist.

21. Despite being encouraged by the substantive hearing panel and the HCPC to re-engage there has been no communication from the Registrant since September 2021 other than the email she sent today (14 July 2022). As there has been no meaningful engagement from the Registrant during the last 9 months, there was no evidence before the Panel that the Registrant fully appreciates the gravity of her lack of competence, or the impact on patients. Nor has she taken the opportunity to demonstrate that she has taken steps to remediate her lack of competence. In the absence of any insight and remediation, the Panel concluded that there has been no material change in circumstances, since the finding of impairment in October 2021. The Panel concluded that if anything the deficiencies in the Registrant’s practise are likely to have increased due to the passing of time.

22. The Panel noted that a significant aspect of the public component is upholding proper standards of behaviour. Members of the public would be extremely concerned to learn that a physiotherapist that had failed to meet the standards expected of them had not taken any steps to address the deficiencies and had not taken the opportunity to persuade this Panel that she is committed to upholding the high standards expected of a registered practitioner. The Panel concluded that, in these circumstances, a finding of no impairment would fail to declare and uphold proper standards, would undermine public confidence in the profession and in the HCPC as a professional regulator given the nature and seriousness of the Registrant’s lack of competence.

23. Therefore, the Panel was led to the inevitable conclusion that, the Registrant’s fitness to practise remains impaired on the basis of the personal and public component.

24. Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what sanction, if any, to impose.

Sanction
25. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s lack of competence which has not been remediated to take no action on her registration would be inappropriate. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

26. The Panel considered a Caution Order. As the Registrant has demonstrated only limited insight into her lack of competence and has provided no evidence of remediation, the Panel concluded that a Caution Order would be inappropriate and insufficient to protect the public and meet the wider public interest.

27. The Panel went on to consider a Conditions of Practice Order. The Panel took the view that the Registrant is currently either unwilling or unable to provide the information that was suggested by the substantive hearing panel in order to demonstrate that she is committed to making a return to practice. Although the Panel acknowledged that the Registrant’s failings are potentially capable of being remedied, in the absence of engagement from the Registrant, there was no indication that she is committed to addressing the issues which led to the original finding of impairment. In these circumstances, this Panel had no confidence that she would comply with a Conditions of Practice Order, even if suitable conditions could be formulated. The Panel was aware that the suggestions made by the previous panel are only indicative and do not have any binding authority, unlike conditions which require compliance. However, both involve willingness on the part of the Registrant to make a determined effort to demonstrate competence. In the absence of any evidence that the Registrant is willing and able to remediate her lack of competence the Panel concluded that there were no conditions it could devise which would be appropriate, workable, and measurable.

28. The Panel next considered extending the current Suspension Order for a further period of time. A Suspension Order would re-affirm to the Registrant, the profession and the wider public standards expected of a registered physiotherapist. The Panel noted that a Suspension Order would prevent the Registrant from practising during the extended suspension period, which would therefore protect the public and the wider public interest. A Suspension Order would also provide the Registrant with the opportunity to address her clinical deficiencies and develop the insight which is essential if she is to return to practice.

29. The Panel noted that paragraph 131 of the SP states that a Striking Off order may be appropriate where a registrant is unwilling to resolve matters. The Panel took the view that the Registrant appears to be unwilling to resolve matters as she has embarked on a new career path. In any event, there is no information available to indicate that the Registrant is willing to address her lack of competence. The Registrant has not taken advantage of the opportunity to demonstrate her commitment to the practise of physiotherapy and execute a plan towards a return to practice and there is no indication that she would do so in the future. On the contrary, the Registrant’s most recent communication with the HCPC strongly suggests that she has made the conscious decision to relinquish her practise as a registered physiotherapist. As the Registrant’s practise has not been restricted for a period of two years a Striking Off order is not available to this Panel and will not be available until the third review. In these circumstances, the Panel concluded that the only appropriate and proportionate option is an extension of the current suspension order.

30. The Panel was satisfied that a period of 12 months would be sufficient for the Registrant to demonstrate an appropriate level of insight into her failings and to take the steps required to return to the Register unrestricted. The Panel recognised that alternatively if the Registrant remains committed to her stated intention to cease practice as a physiotherapist, she may use the intervening period to enter into discussions with the HCPC with regards to voluntary removal from the register which will avoid the necessity of further review hearings.

31. The extended Suspension Order will be reviewed shortly before expiry. A future reviewing panel is likely to be assisted by the following:
• The Registrant’s attendance;
• A written reflection by the Registrant relating to this Panel’s findings
• Evidence of remedial steps taken by the Registrant to address the nature of the concerns found proved, including CPD courses undertaken and appropriate reading;
• Testimonials in regard to any work undertaken, paid or voluntary, in a healthcare setting.

ORDER: The Registrar is directed to suspend the Registrant for a period of 12 months

The Order imposed today will apply from 11 August 2022.

This Order will be reviewed again before its expiry on 10 August 2023.

History of Hearings for Miss Sreenithi Sudhakar