Vijayakumaran Kuttampoil

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

2. 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.

3. 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.

4. 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.

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

6. 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.

7. The Panel considered that the Registrant had breached the following standards of the HCPC Standards of Conduct, Performance 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

8. The original panel concluded that the Registrant’s lack of insight meant 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). He had considered his own position before that of patients and colleagues, placed patients at unwarranted risk of harm, breached fundamental tenets of the profession and brought the profession into disrepute.

9. The original panel determined that the Registrant’s fitness to practise was currently impaired on the personal component.

10. The original panel also considered that the public interest demanded a finding of current impairment. The Registrant was operating as a Psychologist in a role in which accurate notes were 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.

Submissions
11. Mr Galvin on behalf of the Registrant referred to the documents in the bundle and reminded the Panel of the fact that the Registrant had worked without incident, unsupervised for a considerable time prior to the matters proved against him. Mr Galvin referred the Panel to the various references and CPD training undertaken by the Registrant.
12. Mr Galvin submitted that the suspension was punitive for the Registrant and is intended to protect the public. It was further submitted that the Registrant’s fitness to practice is not currently impaired as he has addressed the problems identified and has had a period of reflection.

13. Ms O’Connor for the HCPC referred the Panel to the Practice Notes on Article 30 Reviews, Fitness to Practise Impairment and the Sanctions Policy.

Legal Assessor’s Advice
14. The Legal Assessor advised that this matter had been listed at the request of the Registrant, for a review of the Suspension Order imposed on 7 April 2022.

15. The Panel was reminded that Article 30(2) of the Health Professions Order 2001 provides panels with a discretionary power to review Suspension Orders at any time on the application of the person concerned or otherwise, at any time it is in force and that the reviewing panel may:
- confirm the order;
- extend, or further extend, the duration of the order;
- reduce the duration of the order
- replace the order with any other order which the Panel could have made (to run for the remaining term of the original order); or
- revoke the order.

16. Article 30(2) is a discretionary power and does not specify the circumstances in which it may be exercised. Consequently, reviews are not limited to cases in which new evidence has come to light but may encompass any case where a significant and material change in circumstances has occurred since the original order was made.

17. The Panel was reminded that the review process is not a mechanism for appealing against or ‘going behind’ the original finding that the Registrant’s fitness to practice is impaired. The purpose of the review is to consider:-
• Whether the Registrant’s fitness to practise remains impaired; and
• If so, whether the existing order or another order needs to be in place to protect the public.

18. The key issue which needs to be addressed is what, if anything, has changed since the current order was imposed. The factors to be taken into account include:
• the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decision;
• the degree of insight shown and whether this has changed;
• the steps which the Registrant has taken to maintain or improve his professional knowledge and skills; and
• whether any other fitness to practice issues have arisen.

19. The reviewing panel’s task “is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed”. Abrahaem v GMC [2008] EWHC 183 (Admin).

20. The decision reached must be proportionate, striking a fair balance between interfering with the Registrant’s ability to practise and the overarching objective of public protection.

Decision
21. In reaching its’ decision today the Panel considered all the information before it. The Panel first considered whether the Registrant’s fitness to practise remains impaired. The Panel was aware that the persuasive burden is upon the Registrant to demonstrate that his fitness to practise is no longer impaired. The Panel had regard to the decision of the substantive panel. However, it comprehensively reviewed the matter and exercised its own judgment in reaching its’ decision.

22. The Panel had regard to the HCPTS Practice Notes “Review of Article 30 Sanction Orders” and “Fitness to Practice Impairment” and accepted the advice of the Legal Assessor.

23. The original panel at the final hearing stated:
‘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’.

24. The Panel has considered carefully what has happened since the original decision was reached and was not of the view that the Registrant had satisfied the persuasive burden to demonstrate that he has fully acknowledged the deficiencies which led to the original finding or that he has addressed that impairment sufficiently through insight. In reaching this conclusion the Panel referred to the Registrant’s reflective statements in which he states ‘It would not be right of me to say to you that I accept that my actions were overtly dishonest, but I am coming to understand why my actions could have been viewed as dishonest, and I would like the opportunity to reflect on this further if the panel would allow me to retain my registration’ and ‘Turning to my dishonesty, I can only apologise and beg of the panel, to give me an opportunity to reflect further on this.’. The Registrant is in effect asking the Panel to allow him further time to reflect on and to address the issues raised. The Panel considers that further time is required in order for the Registrant to develop sufficient insight into his misconduct as found at the substantive hearing.

25. The Panel has noted the efforts that the Registrant has taken to develop and implement a stress management strategy and has taken into account his own reflection that his “…unfailing optimism is coming back”. The Panel wish to give the Registrant credit for this but considered that this was an ongoing process which was, as yet, incomplete.

26. The Panel took into consideration the action taken by the Registrant to address the record keeping concerns found by the original panel. This Panel noted that he has undertaken a one-hour online course in Digital Technology in Healthcare. The Panel considers that there is insufficient evidence that the Registrant has fully addressed his shortcomings in keeping up to date with technological changes, such as electronically recording material.

27. Having considered all of the information provided, the Panel finds that there has not been a significant and material change in circumstances since the original finding was made. The Panel determines that the Registrant’s fitness to practice remains impaired taking into account both the public component and the personal component. The concerns raised by the original panel have not been addressed sufficiently to allow this Panel to conclude that the Registrant’s fitness to practice is no longer impaired.

Review of Sanction
28. The Panel has had regard to all the evidence presented and its ability to review the Suspension Order. 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.

29. With regard to sanction, the Panel took into account the Practice Note on Review of Article 30 Sanction Orders and its ability to confirm, extend, reduce, replace or revoke the Suspension Order. The Panel also had regard to the HCPC’s Sanctions Policy. The Panel gave appropriate weight to the wider public interest, which includes the reputation of the profession and public confidence in the regulatory process.

30. The primary function of any sanction is to address public safety from the perspective of the risk which the Registrant may pose to those who use or need his services and to the wider public interest, namely the deterrent effect on other Registrants, the reputation of the profession and public confidence in the regulatory process.

31. The Panel took account of the careful analysis of the aggravating and mitigating factors that had been set out by the previous panel. The Panel had some additional information before it today but did not seek to go behind the findings of the previous panel. The Panel noted and accepted the reasons given by the original panel in deciding that a 12-month Suspension Order was the appropriate sanction.

32. Having determined that the Registrant’s fitness to practice remains impaired, the Panel have not heard or seen sufficient additional information today to go behind the decision of the original panel in concluding that a 12-month Suspension Order is appropriate.

33. Whilst the Panel accepts that the Registrant has made some progress to address the concerns in relation to his reflection and training, it considers that additional time is required to enable the Registrant to demonstrate a significant and material change in circumstances has occurred since the original order was made.

34. The Order of the original panel is confirmed and the 12-month Suspension Order will continue to apply. The Panel adopts the reasons given by the original panel in deciding a Suspension Order as the most proportionate sanction.

The current order remains in place for the original duration.

This Order will be reviewed again before its expiry on 5 May 2023.

History of Hearings for Vijayakumaran Kuttampoil