Miss Sreenithi Sudhakar

Preliminary Matters
Service

1. 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 13 June 2023.

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

3. 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.

4. 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

5. Ms Khorassani, on behalf of the HCPC, made an application for the hearing to proceed in the absence of the Registrant.

6. 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”.

7. 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, or the review of the order held on 14 July 2022. The Registrant has confirmed in advance of each hearing that she would not be attending and had decided to change careers. In an email dated 22 June 2023 She stated:

“I do not wish to attend the hearing on 12th July as I no longer wish to continue my career in Physiotherapy.
I have recently changed careers and I am currently working as a coder. I wish to continue my career in coding and won’t be returning to practice Physiotherapy for the foreseeable future.”

The Panel also noted that other than these emails there has been no engagement from the Registrant since the substantive hearing.

Ms Khorassani informed the Panel that she wrote to the Registrant on the 26 June 2023 and set out the purpose of today’s review and requested copies of any documents. The Registrant did not respond. 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

8. 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.

9. A formal stage three capability meeting was held by the Trust on 16 September 2019 in relation to the Registrant’s performance at work and the 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.

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

11. At the substantive hearing in October 2021 the panel found the allegation, as outlined above, proved (save for Particular 1(b)) and imposed a suspension order for a period of 9 months. That panel considered that the failings of the Registrant were remediable, and should she wish to return to practice as a Physiotherapist she would have an opportunity to address her deficiencies within the period of suspension.

12. At the review hearing on 14 July 2022 the Registrant did not attend and again re-iterated her desire to change career and no longer practice as a Physiotherapist. The reviewing panel imposed a further suspension order for a period of 12 months and stated as follows:

“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.”

13. In June 2023 the Registrant made an application for voluntary removal which has been agreed but not yet formally concluded.

HCPC Submissions

14. Ms Khorassani, on behalf of the HCPC, confirmed that there has been no meaningful engagement from the Registrant in relation to addressing the shortcomings identified by the previous panels. Ms Khorassani confirmed that there had been no documentation provided from the Registrant or any other evidence to demonstrate she has taken any steps to remedy her practice.

15. Ms Khorassani submitted that the Panel should extend the current Suspension Order, for a period of at least 6 months to give the Registrant an opportunity for the voluntary removal application to be dealt with.

Panel’s Approach

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

17. 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

18. The Panel noted that the Registrant appears to have decided to leave the profession as she has repeatedly indicated in her emails, dated 28 September 2021, 14 July 2022 and 22 June 2023. Further, the Registrant has now decided to make an application for voluntary removal from the register.

19. Given this stated intention, it was not surprising that there has been no meaningful engagement from the Registrant which addressed her deficiencies as found by the previous panels. There is no evidence before this 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 a significant period of time.

20. 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 and had not taken any steps to address these deficiencies. 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 regulator given the nature and seriousness of the Registrant’s lack of competence.

21. Therefore, the Panel was led to the inevitable conclusion, in the absence of any evidence to the contrary, that the Registrant’s fitness to practise remains impaired on the basis of the personal and public component.

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

23. 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.

24. 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.

25. 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 panels 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, and wishes to return to practice Physiotherapy, the Panel concluded that there were no conditions it could devise which would be appropriate, workable, and measurable.

26. 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, should she wish to, and develop the insight which is essential if she is to return to practice.

27. The Panel noted that Registrant’s most recent communication with the HCPC suggests that she has made the conscious decision to relinquish her practice as a registered physiotherapist. As the Registrant’s practice 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 next review. In these circumstances, the Panel concluded that the only appropriate and proportionate option is an extension of the current suspension order.

28. The Panel was satisfied that a period of 6 months would be sufficient for the Registrant to demonstrate a commitment to return to practice and to take steps to return to the Register unrestricted should she wish to. Alternatively, if the Registrant remains committed to her stated intention to cease practice as a physiotherapist, this period will be sufficient to enable the voluntary removal process to conclude which will avoid the necessity of further review hearings.

29. The extended Suspension Order will be reviewed shortly before expiry. A future reviewing panel is likely to be assisted by the following, should the Registrant change her mind about voluntary removal:

⦁ The Registrant’s attendance;
⦁ A written reflection by the Registrant relating to the substantive 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 registration of Miss Sreenithi Sudhakar for a further period of 6 months on the expiry of the existing order.

The Order imposed today will apply from 11 August 2023.

This Order will be reviewed again before its expiry on 11 February 2024.

History of Hearings for Miss Sreenithi Sudhakar